BOURNE v. VALDES, M.D.
141 Nev. Adv. Op. No. 30 (2025)
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Rule of Law:
A patient's suicide does not, as a matter of law, preclude a medical provider from being held liable for medical malpractice; instead, ordinary medical malpractice principles apply, and liability hinges on whether the suicide was a reasonably foreseeable consequence of the provider's negligence.
Facts:
- In 2015, Dr. Zidrieck Valdes diagnosed his patient, David Bourne, with chronic anxiety, major depressive disorder, and chronic low back pain, and prescribed him Klonopin and an opioid.
- In May 2019, Dr. Valdes informed Bourne about new Centers for Disease Control guidelines recommending against concurrent benzodiazepine and opioid use, then took Bourne off Klonopin and prescribed Buspar.
- At some point, Bourne's wife overheard Bourne telling Dr. Valdes that he was experiencing withdrawal symptoms after being taken off Klonopin, after which Valdes referred Bourne to an in-patient drug treatment facility, which Bourne refused.
- In August 2019, Bourne reported 'unbearable' work-related stress, and Dr. Valdes provided him with a half-dose emergency prescription of Klonopin.
- In subsequent medical visits in September and October 2019, medical notes indicated Bourne reported Buspar was effective for his anxiety, displayed no symptoms of Klonopin withdrawal, and denied suicidal ideations.
- In November 2019, shortly after one of his medical visits with Dr. Valdes, Bourne died by suicide, leaving a note attributing his mental state to being taken off a prescribed drug without tapering.
- At the time of his death, Bourne had therapeutic levels of Xanax and an opioid in his system, neither of which Dr. Valdes had prescribed and was unaware Bourne was taking.
Procedural Posture:
- Katy Bourne and David Bourne, Jr. (appellants) filed a medical malpractice lawsuit against Dr. Zidrieck Valdes and Zidrieck P. Valdes, MD LTD. (respondents) in the Eighth Judicial District Court, Clark County (trial court).
- Respondents filed a motion for summary judgment, which the district court denied.
- Respondents filed a second motion for summary judgment, arguing that a patient's suicide constitutes a superseding intervening cause that severs liability.
- The district court granted respondents' second motion for summary judgment, finding that the 'suicide rule' precluded liability because Bourne was not under Valdes' custody or control.
- Appellants appealed the district court's order granting summary judgment to the Nevada Supreme Court.
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Issue:
Does a patient's suicide automatically preclude a medical provider from being held liable for medical malpractice where the patient was not under the provider's custody or control at the time of death?
Opinions:
Majority - Lee, J.
No, a patient's suicide does not preclude liability for medical malpractice as a matter of law. The Nevada Supreme Court declines to adopt the 'suicide rule' as a complete defense, noting that Nevada's professional negligence statutes (NRS Chapter 41A) do not implicitly or explicitly preclude liability for a patient's death by suicide, nor does existing Nevada caselaw. The court holds that ordinary principles of medical malpractice apply, meaning a medical provider owes a duty of care regardless of custody or control over the patient. The critical inquiry is whether the medical provider's negligent conduct made the patient's suicide reasonably foreseeable. If the suicide is a foreseeable consequence of the negligence, the provider may be held liable; if unforeseeable, it acts as a superseding intervening cause, severing the causal chain. The district court erred in granting summary judgment based on the incorrect rationale that liability was precluded because the patient was not in the provider's custody or control, especially since appellants presented a prima facie case through expert testimony regarding breach of the standard of care and causation leading to suicide.
Dissenting - Stiglich, J.
Yes, suicide should generally preclude a medical provider from liability, as it is a voluntary and intentional act that traditionally breaks the causal chain. Justice Stiglich argues that at common law, suicide was viewed as 'a new and independent agency which breaks the causal connection between the wrongful act and the death,' thus an unforeseeable intervening cause precluding recovery. While narrow exceptions exist (e.g., defendant intended distress, caused uncontrollable impulse, or maintained custody/control), they are not present here. Nevada statutes are to be construed in harmony with common law, not in opposition. In this case, Dr. Valdes's alleged negligent action occurred six months prior to Bourne's death, with multiple superseding events in between, rendering the connection remote and tenuous. Furthermore, Bourne had Xanax in his system, a medication Valdes did not prescribe and was unaware of, which is associated with increased suicidal ideation. Therefore, the district court's grant of summary judgment should have been affirmed, and Nevada should adopt the common law suicide rule with its well-reasoned exceptions.
Analysis:
This case represents a significant development in Nevada medical malpractice law, establishing a new precedent that explicitly rejects the 'suicide rule' as an automatic defense for medical providers. By affirming that patient suicides must be analyzed under standard foreseeability and causation principles, the Nevada Supreme Court broadens the scope of potential liability for healthcare professionals, particularly those involved in mental health treatment and medication management. This ruling emphasizes that negligent care contributing to a foreseeable suicide can lead to accountability, encouraging providers to consider the full spectrum of potential patient harms, including those leading to self-inflicted death. This decision aligns Nevada with a growing number of jurisdictions that recognize the complex interplay between medical negligence and patient suicide, shifting the focus from a categorical bar to a fact-specific inquiry regarding the standard of care and proximate causation.
