Case Title: Wilkins v. Lamoille County Mental Health Services, Inc.

Citation: 179 Vt. 107, 2005 VT 121, 889 A.2d 245

Docket Number: 

State: vermont

Court: Vermont Supreme Court

Date: 2005-10-21T00:00:00Z

Document:
Wilkins v. Lamoille County Mental Health Services, Inc. (2003-552); 179 Vt. 107; 
889 A.2d 245

2005 VT 121

[Filed 21-Oct-2005]


       NOTICE:  This opinion is subject to motions for reargument under
  V.R.A.P. 40 as well as formal revision before publication in the Vermont
  Reports.  Readers are requested to notify the Reporter of Decisions,
  Vermont Supreme Court, 109 State Street, Montpelier, Vermont 05609-0801 of
  any errors in order that corrections may be made before this opinion goes
  to press.


                                 2005 VT 121

                                No. 2003-552


  Sheryl R. Wilkins	                         Supreme Court

                                                 On Appeal from
       v.	                                 Lamoille Superior Court


  Lamoille County Mental Health  	         November  Term, 2004
  Services, Inc. andCopley Hospital


  Edward J. Cashman, J.
  	
  James A. Dumont of Law Office of James A. Dumont, P.C., Bristol, for
    Plaintiff-Appellant.

  John D. Monahan, Jr. and Angela R. Clark of Dinse, Knapp & McAndrew, P.C.,
    Burlington, for Defendant-Appellee.


  PRESENT:  Dooley, Johnson, Skoglund and Reiber, JJ., and 
            Gibson, J. (Ret.), Specially Assigned

       ¶  1.  JOHNSON, J.   This appeal arises out of the suicide of
  twenty-two-year-old Melissa Issler, whose estate filed this action against
  Lamoille County Mental Health Services, Inc., (hereafter "defendant")
  alleging that defendant's negligence in treating Ms. Issler's suicidal
  condition was the cause of her death.  The estate (hereafter "plaintiff")
  appeals from a summary judgment in favor of defendant.  Although we do so
  on slightly different grounds, we affirm the judgment of the trial court. 
  Based on controlling law and the undisputed material facts, we hold that
  plaintiff failed to adduce evidence sufficient to prove that defendant's
  conduct was the proximate cause of death. 
   
       ¶  2.  The material facts are undisputed.  On January 19, 1999, Ms.
  Issler (hereafter "decedent") was brought to Copley Hospital in Morrisville
  after taking an overdose of Xanax tablets.  There, as alleged in the
  complaint, she "received treatment and was evaluated by emergency room
  staff and an Emergency Service Worker" employed by defendant, which had
  contracted with the hospital to provide mental health evaluations.  After
  her physical condition was stabilized, decedent was interviewed by the
  emergency services worker, Kathleen Greenmun, for a period of between
  fifteen and twenty-five minutes.  In her notes from the interview, Greenmun
  reported that decedent appeared "groggy" and "pale," that she had recently
  experienced a series of seizures, and that after a particularly severe
  seizure "she felt something snapped, and she attempted to swallow a bottle
  of medication not her own."  According to Greenmun's notes, decedent stated
  that "things had piled up" and that "she felt overwhelmed."  Decedent
  acknowledged, however, that "taking the overdose was a stupid, impulsive
  act."  She "denie[d] any current suicidal ideation or plan," and indicated
  that she wanted to go home to rest at her boyfriend's residence.   

       ¶  3.  Based on the interview, Greenmun concluded that decedent was
  not a suicide risk, and could safely go home.  The interview notes indicate
  that Greenmun encouraged decedent to call Lamoille County Mental Health to
  discuss counseling, and to contact the mental health agency if she again
  felt overwhelmed.  Decedent's boyfriend and another friend met her at the
  hospital.  Greenmun recalled that she talked with them about removing
  medications from the house, but said nothing about firearms.  Decedent's
  boyfriend stated that he removed and destroyed a number of medications from
  the home, but that it did not occur to him to remove a loaded pistol that
  he kept in his truck.  Six days after the initial incident, on the morning
  of January 25, 1999, decedent entered the truck, removed the pistol from
  its holster, and shot herself in the head.  She died shortly thereafter.

       ¶  4.  In January 2001, plaintiff filed this action against defendant,
  alleging that decedent's suicide was a proximate result of Greenmun's
  "negligence in treating [decedent's] suicidal condition." (FN1)   
  Plaintiff alleged specifically that Greenmun had been negligent in failing
  to determine whether any guns were available to decedent at her boyfriend's
  home, neglecting to enter into a "safety contract" with decedent, failing
  to initiate and schedule a follow-up appointment for decedent, and failing
  to contact decedent's treating physician regarding the reported seizures.  
  In support of the claim, plaintiff's expert witness, Dr. David Ellenbrook,
  Ph.D., offered his opinion that Greenmun had deviated from professional
  standards of care in evaluating and treating patients at risk of suicide in
  several respects, including her decision to conduct the evaluation while
  decedent was still groggy rather than to wait until she was more alert, and
  her omissions in failing to conduct an adequate suicide assessment, to
  enter into a written safety contract with decedent, and to schedule
  follow-up appointments with decedent before her discharge.  It was Dr.
  Ellenbrook's opinion that these additional steps would have resulted in "a
  decreased probability" of decedent's committing suicide.

       ¶  5.  Defendant moved for summary judgment on the ground that
  plaintiff had failed to adduce expert testimony establishing the requisite
  causal link between the alleged negligence and decedent's suicide. 
  Plaintiff opposed the motion and filed a cross-motion for partial summary
  judgment, alleging that defendant had violated certain safety regulations,
  requiring a finding of negligence per se.  The trial court issued a written
  decision in October 2003, ruling that the expert's testimony was deficient
  on several grounds, and that defendant was therefore entitled to summary
  judgment.  This appeal followed.    

       ¶  6.  Plaintiff principally contends the court erroneously rejected
  the testimony of her expert witness, Dr. Ellenbrook.  The court found that
  Dr. Ellenbrook's testimony failed to establish the requisite causal link
  between defendant's conduct and decedent's suicide because, in the court's
  view, "it is an opinion without basis, without substance."  The court
  asserted that the testimony offered "no explanation as to the mechanistic
  steps of causation[,] . . . no analytic brick building."  Accordingly, it
  concluded that the opinion failed to establish the necessary causal element
  of 12 V.S.A. § 1908(3), which requires the plaintiff to prove "[t]hat as a
  proximate result" of the defendant's failure to exercise the requisite
  degree of care "the plaintiff suffered injuries that would not otherwise
  have been incurred" in order to establish medical negligence. (FN2)
    
       ¶  7.  We are uncertain as to the precise meaning of the court's
  ruling or the basis of the "substantive" or "mechanistic" deficiencies to
  which it refers.  Nevertheless, it is axiomatic that a judgment predicated
  on one theory that proves to be unfounded will be affirmed if it may be 
  correctly resolved on another.  See Gochey v. Bombardier, 153 Vt. 607, 613,
  572 A.2d 921, 925 (1990) (this Court "may affirm a correct judgment even
  though the grounds stated in support of it are erroneous").   In this case,
  it is undisputed that plaintiff failed to adduce an expert opinion that
  decedent's suicide would not have occurred in the absence of defendant's
  alleged negligence. Accordingly, as explained more fully below, we agree
  with the trial court's fundamental conclusion that plaintiff failed to
  establish the essential causal element of her claim, and that defendant was
  therefore entitled to summary judgment. 
   
       ¶  8.  The principal basis of defendant's motion for summary
  judgment, and the focal point of dispute between the parties, was the legal
  sufficiency of an expert opinion that failed to assert  decedent's suicide
  would not have occurred in the absence of defendant's alleged negligence. 
  Plaintiff's expert-witness disclosure statement had described her expert,
  Dr. Ellenbrook, as holding the opinion that defendant's negligence "was a
  substantial and significant factor in the patient's death."  Defendant's
  attorney attempted to explore this statement at Dr. Ellenbrook's
  deposition, asking whether it "mean[s] that except for those failures to
  meet the standard of care that you have testified to, Melissa Issler would
  not have killed herself?"  Dr. Ellenbrook responded, "I would say that
  there is a decreased probability that she would have."  Defendant's
  attorney had the question re-read on the ground that the answer was
  nonresponsive, but Dr. Ellenbrook maintained the same response, stating:
  "Other than the answer I gave you, I can't answer that question, other than
  to give you that answer."  When pressed again, Dr. Ellenbrook's response
  remained essentially the same,  to the effect that the risk of decedent's
  suicide would have been "[s]ignificantly decreased if the standards of care
  had been met, or at least decreased."  Beyond that he would not, or could
  not, go. 

       ¶  9.  As noted, defendant argued below that Dr. Ellenbrook's
  testimony failed to establish a necessary statutory element of plaintiff's
  claim, to wit, that "as a proximate result" of defendant's failure to meet
  the standard of care "the plaintiff suffered injuries that would not
  otherwise have been incurred."  12 V.S.A. § 1908(3).   Plaintiff argued, in
  response, that to establish proximate cause it was sufficient merely to
  show-as Dr. Ellenbrook had essentially stated-that defendant's negligence
  was a "substantial factor" in placing decedent at a "greater risk" of harm. 
  The trial court appeared to accept plaintiff's formulation, but rejected
  the testimony as inadequate on other grounds.
   
       ¶  10.  We have recently reaffirmed the common-law and statutory
  principle that in medical malpractice, as in tort law generally, "the
  plaintiff must prove that as a result of the defendant's conduct the
  injuries 'would not otherwise have been incurred,' " and therefore "an act
  or omission of the defendant cannot be considered a cause of the
  plaintiff's injury if the injury would have occurred without it."  Smith v.
  Parrott, 2003 VT 64, ¶ 12, 175 Vt. 375,