Stickley v. Chisholm
765 A.2d 662, 2001 Md. App. LEXIS 6, 136 Md. App. 305 (2001)
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Rule of Law:
In a negligence action, the plaintiff must prove that the defendant's breach of duty was 'a' proximate cause of the injury, not that it was 'the' sole cause of the injury.
Facts:
- On January 17, 1995, Charles L. Stickley, III sought treatment from Dr. Roy D. Chisholm, III for a large mass under his arm.
- Dr. Chisholm performed a biopsy, identifying the mass as a desmoid tumor, and then performed surgery on January 27, 1995, to remove it.
- Pathology results from the surgery indicated that some abnormal cells might have been left behind.
- Dr. Chisholm decided to monitor Stickley for reoccurrence rather than recommend further surgery or radiation therapy.
- In June 1995, Stickley began complaining of pain in the incision area.
- On August 9, 1995, a CT scan ordered by Dr. Chisholm was reported as 'suspicious for a neoplastic process' and a biopsy was recommended.
- Dr. Chisholm did not perform a follow-up biopsy after receiving the CT scan results.
Procedural Posture:
- Charles L. Stickley, III sued Dr. Roy D. Chisholm, III for medical malpractice in the Circuit Court for Allegany County, a state trial court.
- At trial, the court instructed the jury that for Stickley to recover, Dr. Chisholm's negligence must be 'the cause' of the injury.
- Stickley's counsel objected and requested the Maryland Civil Pattern Jury Instruction stating negligence must be 'a cause', but the court refused.
- The jury returned a special verdict finding Dr. Chisholm was negligent but that his negligence was not the proximate cause of Stickley's injury.
- The trial court entered a judgment in favor of Dr. Chisholm.
- Stickley, as the appellant, appealed the judgment to the Court of Special Appeals of Maryland, an intermediate appellate court.
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Issue:
Did the trial court commit reversible error by instructing the jury that the defendant's negligence must be 'the cause' of the plaintiff's injury, rather than 'a cause'?
Opinions:
Majority - Chief Judge Murphy
Yes, the trial court's instruction misstated Maryland law on proximate cause, which constituted prejudicial, reversible error. In a negligence case, a plaintiff is only required to prove that the defendant's negligence was 'a' cause of the injury, not 'the' sole cause. By instructing the jury that negligence must be 'the cause' and omitting the standard instruction that there can be more than one cause of an injury, the court imposed an incorrect and higher burden of proof on the plaintiff. This error was particularly prejudicial in a medical malpractice case where the patient's pre-existing condition is also a cause of the ultimate harm. Because the issues of negligence and proximate cause are so intricately intertwined, the error requires a new trial on all issues, not just on causation and damages.
Analysis:
This decision reinforces a fundamental tenet of tort law: a defendant's negligence need only be a substantial factor in causing harm, not the sole factor. The court's ruling emphasizes the critical importance of precise jury instructions, as the difference between the articles 'a' and 'the' can fundamentally alter the legal standard for causation. This case is particularly significant in medical malpractice litigation, where a patient's underlying condition is almost always a contributing cause of their ultimate injury. By clarifying that a doctor's negligence can be a concurrent cause, the opinion prevents defendants from escaping liability simply because other factors also contributed to the negative outcome.
