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Bowman v. Gronstedt3/13/2002
f's injuries. Daboll v. Hoden, 222 N.W.2d 727, 734 (Iowa 1974). After prima facie evidence of negligence has been established, the remaining question of proximate cause is ordinarily a jury question. Causation, like the standard of care and its breach, requires proof by expert testimony. McCleeary v. Wirtz, 222 N.W.2d 409, 414-15 (Iowa 1974); Cronin v. Hagan, 221 N.W.2d 748, 755 (Iowa 1974); Barnes v. Bovenmyer, 255 Iowa 220, 229, 122 N.W.2d 312, 317 (1963); Bradshaw v. Iowa Methodist Hosp., 251 Iowa 375, 383, 101 N.W.2d 167, 171 (1960); Wilson v. Corbin, 241 Iowa 593, 604, 41 N.W.2d 702, 708 (1950).
The conduct of a party is a proximate cause of an injury when it is a substantial factor in producing the injury and the injury would not have happened except for the conduct. Huber v. Watson, 568 N.W.2d 787, 790 (Iowa 1997). A proximate cause need not be the sole proximate cause in order for a negligent party to be liable to an injured person. Gunnison v. Torrey, 216 N.W.2d 361, 364 (Iowa 1974). Because there may be more than one substantial factor in bringing about a harm, there can be more than one proximate cause of an injury. Johnson v. Interstate Power Co., 461 N.W.2d 310, 323 (Iowa 1992) (citations omitted).
Under Bowman's causation theory, Wendy's mental and physical condition would not have deteriorated to the extent it did, nor would she have disappeared on October 11, had Drs. Lee and Gronstedt promptly intervened by hospitalizing her or otherwise treating her. This theory finds abundant support in the opinion by Dr. Luchins that Wendy's fatty liver changes, the most likely immediate cause of death, resulted from starvation or water intoxication.
Moreover, an expert's opinion on the possibility of a causal connection between negligent conduct and injury can be sufficient to generate a jury issue if there is other testimony connecting the injuries to the negligent act. See Gerst v. Marshall, 549 N.W.2d 810, 818 (Iowa 1996). Here, Bennett's autopsy report listed four possible causes for a fatty liver: starvation, pregnancy, diabetes, and alcohol withdrawal. Bennett's autopsy report noted Wendy was not pregnant and did not have a history of diabetes or alcohol use. Bennett's report therefore supports the conclusion by Dr. Luchins that starvation was a likely factor contributing to Wendy's death.
Contrary to the district court's conclusion, we find sufficient evidence supporting the submission of Bowman's malpractice and causation theories to the jury. By concluding otherwise, the trial court failed to consider the substance of the causation opinion given by Dr. Luchins as well as the fact that Wendy's death could have resulted from more than one proximate cause. Where evidence of a defendant's negligence is not wholly excluded as a contributing cause of a plaintiff's injuries as a matter of law, the issue of proximate cause is a factual question for the jury to determine. Molchon v. Tyler, 546 S.E.2d 691, 696 (Va. 2001) (holding there was a jury question on whether psychiatrist's discharge of patient was proximate cause of patient's suicide shortly thereafter). Because the evidence does not wholly exclude the doctors' malpractice as a substantial factor causing Wendy's death, the resulting fact questions should have been submitted to the jury.
We accordingly reverse the judgment of the district court and remand for a new trial.
REVERSED AND REMANDED.
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