In a case decided on August 25, 2016, the Supreme Court of Florida (“Florida Supreme Court”) held that the trial court had improperly granted summary judgment to the Florida medical malpractice defendants because the trial court’s decision was based on an improper determination of the duty owed by a primary care physician to his patient who committed suicide.
The Underlying Facts
The decedent suffered from depression for which the defendant primary care physician switched her from the antidepressant Prozac to another antidepressant, Effexor. Just over three years later, the decedent telephoned the defendant primary care physician’s office and told his medical assistant that she had stopped taking the Effexor because she thought it was causing her to experience some side effects (not sleeping well, having to take more sleeping pills, being under mental strain and crying easily, having gastrointestinal problems, and not feeling right for over three months).
In response, the defendant primary care physician changed the decedent’s antidepressant to Lexapro and referred her to a gastroenterologist. The day after the decedent picked up samples and a prescription for Lexapro from the defendants’ office (she was not seen or evaluated by her physician that day), the decedent was found hanging in her garage (no suicide note was found).
The decedent’s husband filed a Florida medical malpractice lawsuit against the defendant primary care physician and his medical practice, after which the defendants filed a motion for summary judgment, arguing that the primary care physician owed no duty to prevent the decedent from committing an unforeseeable suicide while she was not in his control. The trial court granted the defendants’ motion for summary judgment, and the plaintiff appealed.
Duty, Proximate Cause, and Foreseeability
The Florida Supreme Court stated that foreseeability is relevant to the elements of both duty and proximate cause: under duty, the question is whether the defendant’s conduct foreseeably created a broader ‘zone of risk’ that poses a general threat of harm to others. Proximate cause asks whether and to what extent the defendant’s conduct foreseeably and substantially caused the specific injury that actually occurred.
Duty is determined as a matter of law and is the tool used by the jury to assess the defendant’s behavior, whereas proximate cause is a fact-specific assessment by the jury to determine whether the exact injury is likely to recur if the defendant’s same conduct is repeated in a similar context. Although a duty analysis considers some general facts of the case, it does so only to determine whether a general, foreseeable zone of risk was created, without delving into the specific injury that occurred or whether such injury was foreseeable.
Inpatient Duty Vs. Outpatient Duty
The Florida Supreme Court stated that Florida law that establishes an inpatient duty to prevent suicide has not extended the duty to prevent suicide to an outpatient scenario; however, the nonexistence of one specific type of duty (i.e., there was no duty to prevent an outpatient suicide) does not mean that the decedent’s primary care physician did not have a duty owed to the decedent: there still existed a statutory duty under section 766.102 to treat the decedent in accordance with the standard of care (section 766.102 provides, in part, that the claimant in a medical negligence claim has the burden of proving by the greater weight of evidence that the alleged actions of the health care provider represented a breach of the prevailing professional standard of care for that health care provider).
The Florida Supreme Court held that it was error for the trial court to enter summary judgment in favor of the medical malpractice defendants (i.e., the error of classifying the duty in this case as a duty to prevent suicide), based on the statutory duty owed to the decedent, and that foreseeability of the decedent’s suicide was a matter of fact for the jury to decide in determining proximate cause (summary judgment would be appropriate only if the evidence was undisputed that the suicide was not foreseeable): the foreseeability of the decedent’s suicide is relevant to the proximate cause analysis, not the determination of duty. Summary judgment is proper only where the evidence supports no more than a single reasonable inference as to proximate cause or where there are no genuine issues of material fact as to proximate cause. If reasonable persons can disagree as to whether the facts establish proximate cause, summary judgment is not proper and the issue is for the jury to decide.
The Florida Supreme Court held that because the defendant primary care physician (1) knew that patients who stopped taking Effexor abruptly had an increased risk of suicide and (2) ultimately opined that stopping Effexor was a contributing factor in the decedent’s suicide, there is a genuine issue of material fact remaining as to proximate cause and therefore, summary judgment should not have been granted.
Source Chirillo v. Granicz, No. SC14-898.
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