AUSTIN, Texas (Legal Newsline) - Parents who won a $1.4 million verdict against a pediatrician and physician assistant they blamed for their daughter’s suicide failed to prove poor medical care was the cause of the girl’s death, the Texas Supreme Court ruled, reversing the verdict and affirming a stringent test for liability in suicide cases.
Rejecting plaintiff arguments, the state’s high court had loosened its rules for cases involving multiple defendants, the Texas Supreme Court said plaintiffs still must prove so-called “but-for” causation – that without the defendants’ negligence, the injury wouldn’t have occurred.
Ginger Thompson and Brad Washington sued Dr. Jose Salguero, the owner of Pediatrics Cool Care, and others after their 14-year-old daughter A.W. took an overdose of Benadryl in August 2012. A.W. had been a patient at the pediatric clinic since 2010 and visited earlier that year, when Physician Assistant Jenelle Robinson diagnosed her with depression and prescribed Celexa, a drug that can cause suicidal thoughts.
Robinson later testified she “strongly recommended” A.W. see a therapist but her mother said her daughter refused. About six weeks later, A.W. returned to the clinic and Allyn Kawalek, a nurse practitioner, examined her and reported an improvement in her mood in the medical record. Almost two years after the visit, and after A.W.’s parents filed this suit, an unknown person altered the record of this visit to add the phrase “patient is to come back in 30 days for follow-up.”
In July, Thompson called the practice to ask for a prescription refill. Bernadette Aguillon, a medical assistant, took the call and authorized a refill. She later testified that she regularly wrote prescription refills on Dr. Salguero’s behalf without consulting him. After learning of A.W.’s suicide, Aguillon attempted to alter A.W.’s medical records to conceal her error.
About two weeks later, A.W. committed suicide. Thompson and Washington, said they had no indication she was considering suicide. They sued Pediatrics Cool Care for negligence, claiming the practice had failed to properly diagnose A.W. or prescribe medications for her.
At trial, the parents’ psychiatric expert, Dr. Fred Moss, said had Robinson performed a proper examination out of the presence of A.W.’s mother, the girl might have obtained “pathways of treatment” that prevented her suicide. He refused to rule out the possibility she would have killed herself anyway, however, and said Celexa wasn’t to blame.
Dr. Armando Correa of Baylor College of Medicine told the jury “suicide in teenagers is usually impulsive. It’s unforeseeable…and sadly, most of the time it cannot be prevented.”
The jury found Dr. Salguero and Robinson liable for A.W.’s death and ordered a multimillion-dollar verdict, reduced to $1.3 million plus interest. The jury didn’t find Kawalek liable. An appeals court upheld the verdict.
The Texas Supreme Court, in a May 13 decision, reversed. Plaintiffs in medical malpractice suits must prove both that the provider was negligent and that but for the negligence, the injury wouldn’t have occurred. There was no dispute that the defendants were negligent, the court ruled, but the plaintiff’s medical expert failed to establish but-for causation.
The plaintiffs pointed to other Texas Supreme Court decisions where experts declined to say whether an individual defendant caused the injury, suggesting the high court had abandoned but-for causation. The court said those were cases where the evidence was clear that the combined effect of negligent actions was the but-for cause, however.