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Woodward v. Research Medical Center8/23/2005
for Ms. Woodward's death. According to Research, (i) a heart arrhythmia alone caused the fall, (ii) the heart arrhythmia that occurred three months after the fall was a superseding cause of death, and (iii) underlying, pre-existing medical conditions do not constitute independent, intervening causes. Mr. Woodward did not plead multiple causes and, in opening, told the jury that it would have to decide whether cardiac arrhythmia caused the fall or the fall caused the cardiac arrhythmia. Nevertheless, his expert witness testified that Ms. Woodward's pre-existing medical conditions (i) put her at risk of falling in the first place, (ii) caused her body to react to the negligently caused fall and broken hip by going into cardiac arrest, or (iii) so interfered with her ability to recover from the fall that she had a series of complications which ultimately led to her death.
Instructional Error -- Cases Applying MAI 19.01
The multiple causes modification is applied where more than one party's actions may be responsible for the plaintiff's injuries. Callahan v. Cardinal Glennon Hosp. , 863 S.W.2d 852 (Mo. banc 1993) (parents of child, who contracted paralytic polio when improperly treated abscess weakened his immune system several weeks after live polio vaccine was administered, filed medical malpractice claim against four defendants, two of whom remained in the case at the time of trial; MAI 19.01 modification given); Honey , 708 S.W.2d at 692 (parents of psychiatric patient who committed suicide brought wrongful-death action against hospital, general contractor, architect, and window manufacturer; no error found in application of MAI 19.01 modification to wrongful-death verdict director).
The instruction has also been applied where previous and/or subsequent injuries are similar to the injury at issue, so that the jury can sort out to what extent the incident giving rise to the cause of action is responsible for the damages alleged. Carlson v. K-Mart Corp. , 979 S.W.2d 145 (Mo. banc 1998) (primary dispute at trial is what part incident at K-Mart and subsequent auto accident played in creating painful neck and back condition; there was also pre-existing degenerative disk disease in evidence); Higby v. Wein , 996 S.W.2d 95 (Mo. App. E.D. 1999) (plaintiff had pre-existing shoulder injury; MAI 19.01 modification required so jury could determine to what extent auto accident was responsible for aggravation of shoulder injury); Snelling v. Gress, 996 S.W.2d 538 (Mo. App. W.D. 1999) (evidence was presented that plaintiff experienced multiple possible causes of neck, shoulder and back injuries, including work-related events occurring before and after accident at issue; court determines verdict-directing and damages instructions should both have been modified by MAI 19.01).
The MAI 19.01 modification has been approved for use as well in a "two fires" case. Wright, 62 S.W.3d at 530. Ms. Wright, who alleged that medical malpractice caused her stroke, was already at high risk of a stroke due to pre-existing medical conditions, and the doctor's alleged deviation from the standard of care in performing a cardioversion placed her at a much higher risk of stroke. The Wright court referred to this situation as the classic "two fires" case. Id. Prosser describes this aspect of multiple causation as a situation where two causes concur in bringing about an event, and either one of them operating alone would have been sufficient to cause the identical result. W. PAGE K EETON ET AL., P ROSSER AND K EETON ON THE LAW OF TORTS Section 41, at 266-67 (5th ed. 1984). This case is not a "two fires" case, because the evidence showed that (i) the purported negligence which resulted in a fall would not alone
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