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Woodward v. Research Medical Center8/23/2005
esearch's alleged negligence directly caused Ms. Woodward's death. Without the intervention of her pre-existing medical conditions, the alleged negligence would only have directly caused a broken hip. We do not believe that the application of MAI 19.01 is limited to a "two fires" case or to cases where (i) the independent, intervening cause is chargeable to another actor or event, or (ii) an existing or subsequent injury is so similar to that allegedly caused by the tortfeasor that the jury would otherwise be confused about the extent to which the incident giving rise to the cause of action is responsible for the damages alleged. As noted above, the committee comment to MAI 19.01 speaks in terms of a general rule that defendants can be negligent and liable for injury even though their negligence is not the sole negligence or the sole proximate cause of the injury. MAI 19.01 Committee Comment (1995 New). There is no reason in the law to make a distinction between other proximate causes that are chargeable to an actor, an event, or a condition , where the issue is to what extent a tortfeasor's negligence has contributed to a plaintiff's damage or death, and that negligence is not shown to be the sole proximate cause of the injury.
We think that a plaintiff, who has shown that a defendant's alleged negligence, acting in combination with a pre-existing condition, has caused injury , is entitled to the MAI 19.01 modification. We also believe that any evidence in the case that supports a multiple causes theory as opposed to alternative causation, whether introduced by plaintiff or defendant, can be considered in determining if plaintiff's instruction modification is supported by substantial evidence. Bank of Am., N.A., 83 S.W.3d at 54. As long as the instructions are within the pleadings and evidence and are correct in form and substance, a party is entitled to have his theory of the case submitted to the jury by those instructions. Wright, 62 S.W.3d at 530.
Nevertheless, Research's concerns about a potential expansion of liability for health-care professionals are well taken. Obviously, the majority of hospital patients bring pre-existing conditions with them when they are admitted. It is clear to this court, however, that the multiple causes instruction will only be justified where there is a demonstrated relationship between the pre-existing condition and the resulting injury . For example, if the pre-existing condition in this case had been Alzheimer's disease and the decedent had been admitted to treat a broken bone, it would have been difficult, if not impossible, for plaintiffs to show that the fall and subsequent heart attacks were caused by the disease in combination with defendant Nevertheless, Research's concerns about a potential expansion of liability for health-care professionals are well taken. Obviously, the majority of hospital patients bring pre-existing conditions with them when they are admitted. It is clear to this court, however, that the multiple causes instruction will only be justified where there is a demonstrated relationship between the pre-existing condition and the resulting injury. For example, if the pre-existing condition in this case had been Alzheimer's disease and the decedent had been admitted to treat a broken bone, it would have been difficult, if not impossible, for plaintiffs to show that the fall and subsequent heart attacks were caused by the disease in combination with defendant's negligence.
Because Mr. Woodward was entitled to the MAI 19.01 modification of his wrongful-death verdict director, we must next determine whether the merits of the case have been materially affected by the circuit court's refusal to submit the instruction to the jury. Wrigh
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