In its opinion filed on June 30, 2016, the New York Court of Appeals (“Appellate Court”) reversed a New York medical malpractice jury’s verdict in favor of the plaintiff, finding that the trial judge had erroneously admitted evidence concerning the defendant’s negligent treatment of twelve other patients, which evidence tainted the jury’s deliberative process. The Appellate Court determined that the trial court abused its discretion by admitting evidence that was irrelevant to the defendant’s liability and that unduly prejudiced the jury.
The plaintiff was the wife of a man who committed suicide, allegedly as a result of the medical negligence of two of his treating physicians. While one of the defendant physician’s admitted at trial that he had deviated from accepted medical practice by prescribing the husband the antidepressant drug Paxil for over a decade while failing to adequately monitor his condition, he contended that he was not liable for medical malpractice because superceding acts severed the causal connection between his conduct and the husband’s suicide, including the medical care provided by the other defendant physician. The New York medical malpractice jury rejected that defense and decided that the first physician (“the defendant”) was solely liable for the man’s death, leading to the defendant’s appeal to the Appellate Court.
The Alleged Underlying Facts
The defendant began treating the plaintiff’s husband in October 1993, at which time he diagnosed him with major depression, obsessive-compulsive disorder, and generalized anxiety disorder. The defendant prescribed 20 mg. of Paxil and eventually discontinued the husband’s antianxiety medication, Klonopin, which had been previously prescribed by the husband’s family physician.
In April 1994, the defendant tapered off the man’s Paxil dosage and instructed him to discontinue it the following month, and to call the defendant if there were any problems.
The man next contacted the defendant on April 7, 1998, following an episode of depression. The defendant, in consultation with the man’s primary care physician, placed the man on the anti-anxiety drug, Ativan, and 40 mg. of Paxil. Within a few weeks, the man showed improvement and the defendant reduced the Ativan dosage, eventually discontinuing it within the month, and he reduced the Paxil dosage to 20 mg.
For more than ten years, the defendant refilled the prescriptions for Paxil by telephone or fascimile, without seeing or examining the man.
On August 9, 2009, the man called the defendant complaining about anxiety, an increase in obsessive thoughts, and difficulty sleeping. The defendant instructed the man to double the Paxil dosage to 40 mg. and also prescribed the anti-psychotic medication Zyprexa, for the man’s anxiety and sleep problems. The following day, the man and his wife called the defendant and told him that the man was pale, nauseous, lightheaded, and did not feel well. The defendant instructed the man to double the Zyprexa dosage and that he would call him the next day in the late afternoon.
On August 11th, the plaintiff observed that her husband’s condition had worsen and she took him to the emergency room. After the man was cleared medically, he was transferred to the hospital’s Community Psychiatric Emergency Program (CPEP) for overnight observation. According to the hospital records admitted into evidence, the man complained of suicidal ideations, difficulty sleeping and controlling his thoughts, and feeling as if his body was on fire inside. That night he was taken off Zyprexa and given Ativan. Upon his discharge the following day, the man was told to discontinue Zyprexa, take Klonopin, and reduce his Paxil dosage to 30 mg. For the next five days, the man appeared stable.
On August 17th, the plaintiff and her husband visited the defendant, for the last time before the man’s suicide. Early on September 12, 2009, the man went to his garage and committed suicide by stabbing himself with a knife. Shortly after, his wife found him there, face down in a pool of blood.
The Plaintiff’s Medical Malpractice Claims Against The Defendant
The wife’s New York medical malpractice and wrongful death lawsuit alleged that the defendant’s treatment of her husband was negligent, as demonstrated, in part, by his failure to properly prescribe and monitor his medication, and by his failure to adequately diagnose her husband’s worsening condition during the August 17, 2009 office visit. The plaintiff alleged that the defendant’s medical negligence was a direct and proximate cause of her husband’s suicide.
Defendant’s Consent Order With The Office Of Professional Medical Conduct (“OPMC”)
In January 2012, OPMC brought misconduct charges against the defendant, alleging that he “deviated from accepted standards of medical care” by prescribing medications to 13 patients over several years without adequately monitoring and evaluating them, and often without any face-to-face visits. The plaintiff’s husband was one of the listed patients. By Consent Agreement and Order dated and finalized in February 2012 (“Consent Order”), the defendant agreed not to contest charges of negligence based on allegations involving his treatment for 12 of the 13 patients, specifically excluding the plaintiff’s husband.
The Consent Order was admitted into evidence during the New York medical malpractice trial, over objection by the defendant, during the defendant’s testimony. When the plaintiff called the defendant as a witness, he testified that he failed to appropriately monitor her husband from 2000 to 2009 while he was on Paxil, but denied that this constituted medical malpractice. Over defense counsel’s objection, the court admitted the Consent Order and allowed the plaintiff to question the defendant about its contents. During that questioning, the defendant was repeatedly confronted with the fact that OPMC had charged him with “gross negligence” with regard to 13 patients, including the plaintiff’s husband, and that the defendant signed the Consent Order in satisfaction of the charges, receiving a reprimand and censure as punishment for his misconduct.
The plaintiff’s medical expert testified during the New York medical malpractice trial that the defendant’s actions on August 17th, after years of failing to monitor the man’s prescription medication and doubling the Paxil dosage over the telephone without an in-person assessment of the man, was a significant contributing factor to his suicide.
The New York medical malpractice jury found both defendants were negligent but only the defendant’s negligence proximately caused the man’s suicide. The jury awarded $1,200,000 in damages and apportioned $800,000 to the plaintiff and $400,000 to be divided among the decedent’s three surviving daughters. The intermediate appellate court affirmed the verdict.
Admission Of The Consent Order Was Error
The Appellate Court stated that, in general, it is improper to prove that a person did an act on a particular occasion by showing that he did a similar act on a different, unrelated occasion. There are exceptions to the general rule: if the evidence is being offered to show motive, intent, the absence of mistake or accident, a common scheme or plan, or identity, none of which applied in the present case.
The Appellate Court held that the Consent Order was neither probative of the defendant’s negligence or the question of proximate cause. As part of the Consent Order, the defendant agreed not to contest negligent treatment of certain anonymous patients, none of whom was the decedent. As such, the defendant preserved his objections to factual allegations related to the decedent and any charges of misconduct based on those allegations. Since the Consent Order did not establish facts concerning the defendant’s treatment of decedent, it was not probative as to that issue. In any event, given the defendant’s pre-trial concession that he deviated from accepted medical practice, the issue of negligent treatment did not require resolution by the jury.
Furthermore, any possible relevance of the Consent Order’s contents was outweighed by the obvious undue prejudice of his repeated violations of accepted medical standards – the Consent Order was nothing more than evidence of unrelated bad acts, the type of propensity evidence that lacks probative value concerning any material factual issue, and has the potential to induce the jury to decide the case based on evidence of the defendant’s character. The Appellate Court held that given the defendant’s concession at trial that he deviated from accepted medical practices, the Consent Order was unquestionably collateral, without probative value, and, regardless, improperly prejudicial. The Appellate Court therefore order a new trial.
Source Mazella v. Beals, No. 119.
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