DeMoss v. Hamilton

Iowa Supreme Court · Torts

TortsMedical malpracticeComparative faultmedical malpracticecomparative faultpatient faultproximate causemisdiagnosis

Facts

Brian DeMoss went to a hospital emergency room with chest pain, where Dr. Hamilton examined him, ordered testing that reportedly showed no acute changes, diagnosed recurrent bronchitis, and discharged him with antibiotics and instructions to return if not improved. Early the next morning, Brian suffered a heart attack at home and died, and his wife sued Hamilton and his medical group for malpractice. During discovery, evidence showed Brian had a family history of early coronary disease, had suffered a prior heart attack in 1994, and had been advised to stop smoking, lose weight, exercise, and obtain follow-up care but had not effectively done so. Over the plaintiff's objections, the district court admitted that evidence and instructed the jury that it could assign fault to Brian for failing to follow prior physicians' recommendations if that fault proximately caused the plaintiff's damages.

Issue

In a medical malpractice case, may the jury hear evidence and assess comparative fault against the patient when the patient's earlier conduct merely created or contributed to the illness or condition for which the patient later sought allegedly negligent treatment? If giving such an instruction was error, did it require reversal where the jury first found the doctor free from fault?

Rule

A patient's negligence may be considered in a medical malpractice case only in limited circumstances. To constitute comparative or contributory fault in such an action, the patient's negligence must be an active and efficient contributing cause of the injury, must cooperate with the medical provider's negligence, must enter into proximate causation of the injury, and must be an element in the transaction on which the malpractice is based; conduct that merely provides the occasion for treatment or contributes to the underlying condition for which treatment is sought is not comparative fault on the malpractice claim.

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One of 10 multiple-choice questions for this case. Pick an answer to see why.

In Des Moines, Caleb Turner had ignored years of advice from prior doctors to control his blood pressure, stop smoking, and return for cardiac follow-up. He later went to River Bend Clinic with crushing chest pain, where Dr. Nora Pike allegedly misread his test results and sent him home; Caleb suffered a fatal heart attack that night.

In the wrongful-death malpractice action, when is Caleb's earlier failure to follow prior medical advice properly treated as comparative fault on the malpractice claim against Dr. Pike?

Explanation. The majority adopted a limited rule: patient negligence is comparable in a malpractice action only when it actively and efficiently contributes to the injury, cooperates with the provider's negligence, enters into proximate causation, and is an element of the transaction on which the malpractice claim is based. Conduct that merely created or contributed to the condition for which treatment was sought is not comparative fault on the malpractice claim.