Jackson v. Axelrad
221 S.W.3d 650, 2007 Tex. LEXIS 323, 50 Tex. Sup. Ct. J. 628 (2007)
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Rule of Law:
When determining a plaintiff's contributory negligence, the standard of ordinary care requires consideration of the plaintiff's superior knowledge, skills, and training as part of the "same or similar circumstances." A patient with medical expertise is therefore held to a standard of conduct consistent with that expertise when cooperating in their own diagnosis.
Facts:
- Dr. David Axelrad, a psychiatrist, experienced intermittent abdominal cramps and diarrhea for several months, which was followed by an abrupt onset of acute pain.
- Axelrad sought treatment from Dr. Richard Jackson, an internist.
- The key factual dispute was whether Axelrad informed Dr. Jackson that his pain originated in his left lower quadrant, a classic symptom of diverticulitis.
- Dr. Jackson, testifying that he was not told about the pain's origin, diagnosed Axelrad with fecal impaction and prescribed a laxative and an enema.
- It is medically undisputed that an enema should not be prescribed for diverticulitis due to the risk of a perforated colon.
- After administering the enema at home, Axelrad experienced severe pain and was hospitalized, where he was diagnosed with diverticulitis and a perforated colon.
- Axelrad required surgery to remove part of his colon and a temporary colostomy.
- Axelrad had extensive medical experience, including as an emergency room physician, and frequently served as a medical expert in negligence cases.
Procedural Posture:
- Dr. David Axelrad filed a medical malpractice lawsuit against Dr. Richard Jackson in a Texas trial court.
- A jury found both parties negligent, apportioning 51% of the fault to Axelrad and 49% to Dr. Jackson.
- Pursuant to Texas's comparative fault statute, the trial court entered a take-nothing judgment against Axelrad.
- Axelrad, as appellant, appealed to the Texas Court of Appeals.
- The Court of Appeals reversed the trial court's judgment, holding there was no evidence to support the finding of Axelrad's negligence, and remanded for a new trial.
- Dr. Jackson, as petitioner, appealed that decision to the Supreme Court of Texas.
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Issue:
Does a patient's own specialized medical knowledge and training constitute part of the "same or similar circumstances" that a jury must consider when determining if the patient was contributorily negligent for failing to provide a complete and accurate medical history?
Opinions:
Majority - Justice Brister
Yes. A patient's specialized knowledge is part of the circumstances a jury must consider in a contributory negligence analysis. The standard for negligence is what a person of ordinary prudence would do under the 'same or similar circumstances,' and those circumstances include any superior knowledge, skill, or intelligence the person possesses. This principle applies equally to defendants and plaintiffs. Because the rules for determining a plaintiff's contributory negligence are the same as those for a defendant's negligence, a physician-plaintiff's expertise must be considered. In this case, Axelrad presented himself to the jury as a medical expert. The jury could reasonably infer that a patient with his medical background either knew or should have known the significance of his pain's origin and was negligent for failing to report it. Therefore, there was sufficient evidence to support the jury's finding that Axelrad was contributorily negligent.
Analysis:
This decision solidifies that the standard of care for contributory negligence is not a one-size-fits-all 'ordinary person' standard but is tailored to the individual plaintiff's actual knowledge and expertise. It establishes that a patient's duty to cooperate in their own medical care includes a responsibility to communicate information that their specialized knowledge would indicate is significant. This ruling provides a significant defense in medical malpractice cases where the patient is a healthcare professional or possesses other relevant expertise, as they can be held partially responsible for a negative outcome if they fail to leverage that expertise in communicating with their physician.
