Title: Molchon v. Tyler

State: virginia

Issuer: Virginia Supreme Court

Document:

Present:  All the Justices 
 
ANDREW MOLCHON, M.D. 
 
OPINION BY 
v.  Record No. 002010 
JUSTICE LAWRENCE L. KOONTZ, JR. 
 
June 8, 2001 
 
SANDRA P. TYLER, AS ADMINISTRATRIX OF THE 
 ESTATE OF MICHAEL TYLER (DECEASED), ET AL. 
 
FROM THE CIRCUIT COURT OF FAIRFAX COUNTY 
Kathleen H. MacKay, Judge 
 
 
In this appeal, we consider whether the trial court 
properly confirmed a jury verdict in favor of the plaintiffs in 
a wrongful death action alleging medical malpractice in the 
negligent discharge of a psychiatric patient who subsequently 
died as a result of gunshot wounds inflicted by police officers 
in circumstances which the parties agree were the equivalent of 
suicide. 
BACKGROUND 
“According to settled principles of appellate review, we 
will consider the evidence in the light most favorable to the 
plaintiff, who comes to this Court armed with a jury verdict 
approved by the trial judge.”  Salih v. Lane, 244 Va. 436, 438, 
423 S.E.2d 192, 194 (1992). 
The decedent, Michael Lee Tyler, had a 20-year history of 
depression and substance abuse.  Following the death of his 
father from cancer in December 1993, Tyler became severely 
depressed and began to drink heavily.  Tyler was admitted to 
Dominion Hospital on May 5, 1994.  Dr. Andrew Molchon, a 
psychiatrist, was Tyler’s admitting and treating physician.  
Although Molchon determined that, once stabilized through 
inpatient treatment, Tyler would benefit from placement in a 
“structured residential situation,” Tyler was discharged from 
Dominion Hospital on May 10, 1994, without directions to enter a 
structured program.  Tyler subsequently failed to keep a 
psychiatric outpatient appointment scheduled for him on 
Molchon’s orders. 
On May 14, 1994, Tyler attempted to commit suicide.  
Following his suicide attempt, Tyler was treated at Fairfax 
Hospital and was then transferred to Dominion Hospital on May 
16, 1994, where he was again placed under Molchon’s care.  
Molchon’s admitting diagnosis reflects that Tyler was suffering 
from “[d]epression . . . most likely major depression . . . 
[a]lcohol dependence . . . [p]robable personality disorder of 
mixed type . . . overdose of multiple medications and self-
inflicted lacerations of both wrists.” 
On May 18, 1994, Molchon’s progress notes for Tyler state:  
“I think that it is absolutely necessary for [Tyler] to have a 
structured living situation after discharge.”  (Emphasis added).  
The following day, Molchon noted that Tyler “report[ed] 
continuing suicidal ideation but [had] no fixed plan at this 
 
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time.”  Molchon’s progress notes then state:  “The problem is 
that without a structured living situation . . . it is unlikely 
that [Tyler] will be able to maintain sobriety for more than a 
few days at most.  If he drinks, he will be a very high suicidal 
risk (as demonstrated by recent attempt).”  (Emphasis added). 
Over the course of the next several days, Tyler failed to 
respond satisfactorily to treatment and repeatedly indicated to 
hospital staff that he was “not ready” to be discharged because 
he was “not [yet] safe.”  Although various options for 
discharging Tyler to another psychiatric hospital or structured 
living situation were considered, no suitable facility had space 
immediately available.  Molchon’s progress notes during this 
period continue to emphasize the need to discharge Tyler to a 
structured living situation. 
On May 23, 1994, Molchon determined that Tyler was 
“clinically no longer in need” of hospitalization, but 
acknowledged that the “[p]roblem now is finding an adequately 
structured living situation since without this he would be at 
risk for relapse into drinking.”  The following day, Tyler again 
expressed his concern that he was “not ready” to leave the 
hospital and his fear that he would relapse into alcohol abuse 
and again attempt suicide.  Referring to this statement, 
Molchon’s progress notes state:  “My assessment of situation is 
that [Tyler] is using hospital[ization] inappropriately [and] is 
 
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using the spectre of further suicide attempts [and] relapse” to 
avoid being discharged.  However, noting Tyler’s history of 
suicide attempts, Molchon decided to seek a second opinion as to 
Tyler’s “readiness for [discharge].” 
On May 26, 1994, Molchon’s progress notes reflect his view 
that Tyler’s “[treatment] plan is at stalemate.”  Tyler’s social 
worker at Dominion Hospital arranged for Tyler to have a pre-
admission interview at the Northern Virginia Mental Health 
Institute (NVMHI).  However, Molchon cancelled Tyler’s pass to 
leave the hospital to attend this interview, apparently out of 
concern that the two or three day waiting period for admission 
to NVMHI was incompatible with his plan to discharge Tyler as 
soon as possible and because Molchon did not “believe . . . that 
[Tyler] is [a] danger to self/or others” so as to meet the 
requirements for admission to NVMHI. 
Molchon further indicated that he had discussed Tyler’s 
case with the doctor from whom he had sought a second opinion, 
and that “it [was Molchon’s] understanding” that this doctor 
agreed that Tyler did not need further acute, inpatient 
hospitalization.  Nonetheless, Molchon delayed making a final 
decision to discharge Tyler “over [Tyler’s] protest” out of 
concern that there was a “risk that [Tyler] may ‘act out’ in 
order to get back into the system.” 
 
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On May 27, 1994, Tyler’s social worker arranged for him to 
have a pre-admission interview on June 3, 1994 for residential 
treatment at one of two facilities operated by Loudoun County 
Mental Health Services.  The social worker advised Tyler that, 
in the interim between his discharge and this interview, he 
could seek assistance through an emergency services telephone 
line and that he should attend Alcoholics Anonymous meetings.  
Tyler indicated to the social worker that he might “sleep in his 
van” following discharge.  Molchon’s progress notes for that day 
indicate that Tyler had “reached MHB,” meaning that he had 
reached the “maximum hospital benefit” provided by his insurance 
coverage and directed that he should be “discharg[ed] tomorrow — 
follow up plan as described above,” apparently referring to the 
social worker’s notes. 
Molchon had no further contact with Tyler after May 27, 
1994.  On May 29, 1994, Tyler was discharged from Dominion 
Hospital on the order of Molchon’s partner, who was on call for 
Molchon during the Memorial Day holiday weekend. 
Late in the evening of May 30, 1994, after having attended 
an Alcoholic Anonymous meeting, Tyler went to the apartment of 
Sandra Tyler, his estranged wife.  Tyler was distraught and 
indicated to his wife that he wanted to be readmitted to 
Dominion Hospital, saying that he did not “feel safe.”  Tyler’s 
wife contacted the hospital and CMG, Tyler’s medical insurance 
 
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carrier, but was advised that Tyler was not eligible for further 
inpatient treatment.  Tyler became agitated and attempted to cut 
his wrists with a knife.  He then barricaded himself in the 
bathroom. 
Lieutenant John B. Patton, another police lieutenant, and 
two deputies of the Loudoun County Sheriff’s Office arrived at 
the apartment in response to a telephone call from Tyler’s wife.  
After two or three hours, Tyler emerged from the bathroom 
brandishing the knife and began to “scream and yell” at the 
deputies.  Tyler’s behavior was erratic; one moment calm and the 
next highly agitated.  Tyler repeatedly asked the deputies to 
shoot him.  Still brandishing the knife, Tyler rushed Lt. 
Patton, who fired his service weapon six times, killing Tyler.  
Although Tyler’s wife testified that her husband did not appear 
to be intoxicated, an autopsy revealed that Tyler’s blood 
alcohol level was .18 at the time of his death. 
On April 7, 1999, the plaintiffs filed a wrongful death 
suit alleging that Molchon’s discharge of Tyler from Dominion 
Hospital violated the applicable standard of care and was a 
proximate cause of Tyler’s death.1  Following a jury trial in 
                     
1Sandra Tyler filed suit in her capacity as administratrix, 
personal representative, and next friend of Tyler’s minor 
children, and on behalf of herself and other statutory 
beneficiaries.  We will refer to all of these parties 
collectively as “plaintiffs.” 
 
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which the trial court received evidence in accord with the 
above-recited facts, the jury returned its verdict in favor of 
the plaintiffs and awarded $1,304,456 in damages.  The verdict 
included jury interrogatories in which the jury expressly stated 
that it found Tyler to have been of unsound mind at the time of 
his death and that Molchon’s negligence was a proximate cause of 
Tyler’s death.  In a final order dated May 19, 2000, the trial 
court confirmed the jury’s verdict and reduced the award to 
$875,000, reflecting the statutory cap on recoveries for medical 
malpractice actions, Code § 8.01-581.15, and a credit under Code 
§ 8.01-35.1 for amounts already received in a settlement with 
the hospital. 
Because Molchon’s appeal of this judgment is limited to 
certain discrete issues, we will recite other relevant facts and 
proceedings within the discussion of the assignments of error. 
DISCUSSION 
At the outset, we note that Molchon has not assigned error 
to the issue whether his treatment fell below the applicable 
standard of care and, thus, that he was negligent in discharging 
Tyler without assuring that Tyler would be immediately placed in 
a structured living situation.  Furthermore, both parties 
concede that Tyler’s assault on Lt. Patton was committed with 
the intent of provoking a lethal response and, thus, was, in 
their terms, a “suicide by cop.” 
 
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In his first assignment of error, Molchon contends that the 
trial court erred in failing to strike the plaintiffs’ evidence 
on the ground that Tyler’s conduct, whether considered an 
assault or a suicide, was an illegal act which resulted in his 
death and, thus, bars any recovery in tort.  Molchon asserts 
that although the evidence showed that Tyler was legally 
intoxicated at the time of his death, voluntary intoxication is 
not a defense to his illegal act of suicide, and was not 
evidence that Tyler was of unsound mind at that time. 
In the abstract, Molchon’s contention that a plaintiff may 
not recover for an injury received as the result of another’s 
negligence if the plaintiff voluntarily was involved in an 
illegal act at the time the injury occurred is a correct 
statement of law.  See Lee v. Nationwide Mutual Insurance Co., 
255 Va. 279, 282, 497 S.E.2d 328, 329 (1998); Miller v. Bennett, 
190 Va. 162, 164-65, 56 S.E.2d 217, 218 (1949).  Molchon 
concedes, however, that if the illegal act in question is the 
victim’s suicide, and the suicide was the result of the victim 
being of unsound mind at the time of his death, the defense of 
illegality will not bar recovery.  See Wackwitz v. Roy, 244 Va. 
60, 65-66, 418 S.E.2d 861, 865 (1992). 
Molchon’s argument on this issue is directed entirely to 
the fact that Tyler was voluntarily intoxicated at the time of 
his death.  However, there is considerable evidence in the 
 
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record supporting the conclusion that, for reasons unrelated to 
his intoxication, Tyler was of unsound mind at the time he 
assaulted Lt. Patton in an effort to commit suicide.  In 
addition to the testimony offered by several experts on behalf 
of the plaintiffs, Molchon’s own diagnosis of Tyler during the 
time he was under Molchon’s care establishes that Tyler suffered 
from multiple psychological conditions.  Thus, the evidence 
amply supported submission of the issue as to whether Tyler was 
of unsound mind at the time of his death to the jury. 
Molchon’s second assignment of error states: 
 
The trial court erred in its jury instruction on 
unsound mind as it was not an accurate or correct 
statement of the law as intoxication is not evidence 
of unsound mind. 
 
On brief, Molchon contends that the trial court’s 
“instruction of unsound mind did not state that Mr. Tyler, due 
to disease of mind, had an irresistible impulse to kill himself 
(the criminal act at issue in this suicide case) but rather that 
he had an irresistible impulse to drink.”  He further contends 
that “[u]nder the Circuit Court’s instruction, every alcoholic 
who had an irresistible impulse to drink would be permitted to 
argue insanity as a defense to any crime.” 
The portion of the jury instruction upon which Molchon 
relies provided that the jury could find that Tyler was of 
unsound mind if “he was unable to resist the impulse to engage 
 
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in the behavior that led to his death.”  Nothing in this 
instruction, or in any of the other instructions proffered by 
the plaintiffs and approved by the trial court on the issue of 
Tyler’s mental state at the time of his death, addresses the 
issue of Tyler’s intoxication.  Molchon’s reading of the 
instruction is premised on his contention that the plaintiffs 
relied solely on Tyler’s intoxication as the basis for his 
behavior on the night of his death, a premise that we have 
already demonstrated is not supported by the record.  Moreover, 
Molchon proffered and the trial court approved an instruction 
which expressly stated that “the fact of intoxication is not in 
and of itself evidence of a person’s unsoundness of mind.”  
Accordingly, we find no merit in Molchon’s contention that the 
trial court erred in instructing the jury on this issue. 
In his third assignment of error, Molchon contends that the 
trial court erred in failing to strike the plaintiffs’ evidence 
on the ground that there was insufficient evidence that his 
negligence was a proximate cause of Tyler’s death.  Molchon’s 
position, as stated in the assignment of error, is again 
premised on his contention that “the decedent’s intoxication was 
the direct cause of decedent’s death” and that “even had the 
alleged negligent act not occurred, the same opportunity for 
drinking would have occurred.” 
 
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Even apart from the reasons we have already given for 
rejecting Molchon’s premise that Tyler’s death could have 
resulted from no other cause than Tyler’s being intoxicated, we 
find no merit in this assignment of error.  There may be more 
than one proximate cause of an event.  Panousos v. Allen, 245 
Va. 60, 65, 425 S.E.2d 496, 499 (1993).  Moreover, when the 
evidence does not wholly exclude a defendant’s negligence as a 
contributing cause of the plaintiff’s injuries as a matter of 
law, proximate causation becomes a question of fact for the 
jury’s determination.  See Brown v. Koulizakis, 229 Va. 524, 
531-32, 331 S.E.2d 440, 445 (1985). 
Here, the evidence showed that Molchon was acutely aware of 
Tyler’s suicidal tendencies and the likelihood that he would 
suffer a relapse if he were not properly supervised upon his 
discharge from Dominion Hospital.  This evidence alone raised a 
jury question whether Molchon’s allowing Tyler to be discharged 
was a proximate cause of his suicide less than 48 hours later.  
Accordingly, we hold that the trial court did not err in 
overruling Molchon’s motion to strike the plaintiffs’ evidence 
on this ground. 
 
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CONCLUSION 
For these reasons, the judgment of the trial court will be 
affirmed.2
Affirmed. 
                     
2Molchon also contends that the trial court erred in ruling 
during pre-trial motions that he could not present evidence that 
Tyler’s insurance carrier improperly denied coverage for his 
request to be readmitted to Dominion Hospital on the night of 
his death.  However, the argument Molchon makes on brief does 
not relate to the basis of the objection he made at the time of 
the ruling to which he has assigned error.  Rather, the argument 
is one that was subsequently raised in a post-trial motion to 
set aside the verdict.  Molchon has not assigned error to the 
trial court’s denial of that motion, and, indeed, he makes no 
reference on brief to this aspect of the trial whatsoever.  
Accordingly, the argument was not the basis of “the objection 
. . . stated with reasonable certainty at the time of the 
ruling” to which the assignment of error relates, and we will 
not consider that argument as a basis for reviewing that ruling.  
Rule 5:25; Cardinal Holding Co. v. Deal, 258 Va. 623, 629, 522 
S.E.2d 614, 618 (1999).  Similarly, we will not consider 
Molchon’s further contention, made within the same argument, 
that the trial court erred in giving a “concurrent negligence” 
instruction, since this argument bears no relation to this or 
any other assignment of error.  Rule 5:17(c). 
 
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