Van Vacter v. Hierholzer
865 S.W.2d 355, 1993 WL 214158 (1993)
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Rule of Law:
A patient's prior, remote negligence that creates the underlying medical condition is not a proximate cause of injury or death if there is an intervening, distinct act of medical negligence. For a patient's negligence to be considered a legal cause that apportions fault, it must be simultaneous and cooperative with the physician's negligent act, not merely the conduct that created the occasion for treatment.
Facts:
- In 1982, Jerry Van Vacter suffered a major heart attack and was diagnosed with severe arterial disease, for which doctors prescribed lifestyle changes and medication.
- On October 12, 1983, Van Vacter was hospitalized for chest pains, where he rejected a proposed balloon angioplasty and subsequently failed to take his prescribed medication.
- Between 1983 and 1986, Van Vacter largely ignored medical advice until August 1, 1986, when he sought treatment for chest pains but again quit taking prescribed drugs and missed follow-up appointments.
- On the night of March 10, 1987, Van Vacter experienced severe chest pains, prompting his wife to call Prime Health, who directed them to go to a hospital.
- At 1:40 A.M. on March 11, Dr. Rebecca Hierholzer examined Van Vacter at the hospital, ran tests, and consulted with Dr. Mary Coltharp, the on-duty physician at Prime Health.
- Believing his condition had stabilized, Hierholzer, with Coltharp's approval, discharged Van Vacter with instructions to seek immediate attention if his pain recurred and to see a cardiologist later that morning.
- While returning home, Van Vacter continued to feel pain but did not go back to the hospital.
- A few hours later at home, Van Vacter was found gasping for breath and was later pronounced dead at another hospital at 6:40 A.M.
Procedural Posture:
- Jerry Van Vacter's survivors sued Dr. Rebecca Hierholzer and Dr. Mary Coltharp for wrongful death in a Missouri trial court.
- At trial, the jury found the doctors negligent but apportioned 93% of the fault to Jerry Van Vacter.
- The jury returned a verdict of zero damages.
- The Van Vacters (appellants) filed a motion for a new trial, which the trial court denied.
- The Van Vacters appealed the jury's verdict to the Missouri Court of Appeals, with Dr. Hierholzer as the respondent.
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Issue:
Does a patient's long-term failure to follow medical advice regarding lifestyle and treatment, which created the underlying condition, constitute a proximate cause of death that can be used to apportion fault in a medical malpractice action where the doctor's subsequent treatment is an alleged intervening cause?
Opinions:
Majority - Spinden, Judge
No. A patient’s prior, remote negligence that gives rise to the condition requiring medical treatment is not a proximate cause of death for the purpose of apportioning fault where a physician’s subsequent negligence acts as an intervening cause. The court reasoned that for a patient's negligence to be a proximate cause, it must be 'simultaneous and cooperative' with the physician's negligence. Van Vacter's long-term failure to manage his health since 1982 merely furnished the 'condition' or 'occasion' for the doctors' alleged negligence on March 11, 1987. The doctors' actions were a distinct, intervening cause. Therefore, the jury instruction that allowed the jury to consider Van Vacter's entire history of non-compliance was an incorrect statement of the law, as that conduct was too remote to be a legal cause of his death.
Analysis:
This decision reinforces the distinction between a condition and a cause in tort law, specifically within medical malpractice. It establishes that a patient does not become a joint tortfeasor simply by negligently creating the illness for which they seek treatment. By defining the doctor's malpractice as a potential intervening cause, the ruling limits the scope of a patient's contributory negligence to actions that are closely and concurrently connected to the specific instance of alleged malpractice. This precedent protects patients from having their recovery unfairly diminished by a lifetime of conduct that, while unhealthy, is not the direct, legal cause of the harm resulting from a doctor's error.
