## COURT OF APPEALS SECOND DISTRICTOFTEXAS FORT WORTH
NO. 2 - 0 5 - 3 5 0 - CV
M AR GAR E TY OUN G, I NDI VI DUA L L Y AND AP P E L L ANT AS R E P R E S E NT AT I VE OFT HE E S T AT E OF W I L L I AM R . Y OUN G V . VENKA TE SW ARLU THO TA, M . D. AN D APPE L L EE S N O RTH TEX A S C A RD I O LO G Y C EN TER

----- ----- -- FR O M THE 30TH DI STRI CT CO URT O F W I CH I TA CO UN TY

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### OP I NI ON

----- ----- -- A ppel l antM ar gar etY oun g, i ndi vi dual l y and on behal f of t he est at e ofher d e c e a s e d h u s b a n d , W i l l i a m R . (“R o n n i e ” ) Y o u n g , a p p e a l s fro m a n a d v e rs e j u ry
v e r d i c to n h e rme d i c a l ma l p r a c t i c e c l a i m a g a i n s tVe n k a t e s wa r l u T h o t a , M . D.
a n d h i s e m p l o y e r, N o rt h T e x a s C a rdiol o g y C e n ter (N T C C ), i n co n n e c ti o n w i th2

t hei rt r ea t m entdur i ng Ronni e’ s ca r di ac ca t het er i z at i on. W e r eve r sean d r em and f o ra n e w t r ia l. Fac t ualBac kground A p p e lla n tis R o n n ie ’s w id o w . R o n n ie d ie d o n M a r c h 1 0 , 2 0 0 5 . R o n n ie h a d s u ffe re d fro m a b l o o d d i s o rd e r c a l l e d P o l y c y th e m i a V e ra (P V ) a n d c o ro n a ry art er y di sease, i ncl udi ng hy pert ensi on and angi na. H i s car di ol ogi st , D r . Th ot a,
w i t h NT C C ( col l ec t i vel y “ a ppe l l ee s” ) , r ec om m end ed t hatRonni e u nde r go a car di ac cat het er i zat i on t o eval uat e hi s heartcondi t i on. Th e cat het er i zat i on w as sc h e d u l e d for M a rch 4 , 2 0 0 2 at U n i ted R e g i o n a l H e a l th C a re S y ste m i n W i c h i ta Fal l s, Texas. D r . Th ot a per f or m ed t he pr ocedu r e t hat m or ni ng, and R onn i e w as di schar ged t hataf t er noo n. A tt he t i m e, Ro nni e w as f i f t y- f i ve year s ofage. A f t erRonni e beg an f ee l i ng poor l y athom e a nd f el l f r om hi s cha i rar ound 1 1 :4 5 p .m ., a p p e l l a n t c a l l e d 9 1 1 , a n d R o n n i e re tu rn e d to th e h o s p i ta l ’s
em er gen cy r oom ar ound 1: 15 a. m . O l yn W al ke r , M . D . ul t i m at el y op er at ed on R onn i e t hatni ght t o r epai ra t eari n hi s i l i ac art er y and t he r esul t i ng i nt er nal bl ee di n g al l ege dl y c aus ed by t he ca t het er i z at i on pr oce dur e. Dur i ng t he
e m e rg e n c ys u rg e ry , D r. W a l k e r d i s c o v e re d a l a rg e h e m a to m a fro m s e v e re bl ee di ng i n t he per i t one al ca vi t y. Af t ert he su rg e ry , Ronni e w aspl ac ed on a
v e n t ila t o r , s u f f e r e d a c u t e re n a l f a ilu r e t h a tre q u ir e d d ia ly s is , r e c e iv e d m u lt ip le b l o o d tr a n sfu sion s, u n d e rw e n t a s p l e n e c to m y , a n d u n d e rw e n t s u rge ry to1 ... N T C C ’sa l l e g e d l i a b i l i tyw a s b a s e d s o l e l yo n re s p o n d e a t s u p e ri o r. 3 r em ove hi s gal l bl add er onc e i tbe ca m e g ang r eno us duet o i sc hem i a c aus ed by t he bl eed. H e ul t i m at el y l ostvi si on i n one eye and suf f er ed num er ous st r okes
a n d b lo o d c lo t s , a ll a lle g e d lya s a r e s u lto ft h e n e g lig e n tc a t h e t e r iz a t io n . R o n n ie sta y e d i n the h o sp i tal i n W i c h i ta F a l l s fo r tw o m o n th s a n d l a ter tr a n sfe rr e d to Ba yl orUni ve r sit y M e di c a l Cen t e r( BUM C) i n Dal l a s , Te xa s , o n M a y 2, 2002 . W hi l e atBU M C , he w as di agno sed w i t h and t r eat ed f ort hr om bocytosi s, sepsi s,
r es pi r a t o ryf a i l u r e, de pr es si on, m al nour i sh m ent , gout , de ep vei n t hr om bos i s, an d p o rt a l v e i n thro m b o s is . W h e n h e l e ft B U M C , h e w e n t t o B a y l o r S p e c i a l ty H ospi t al f orr ehabi l i t at i on f oran addi t i onal t w o m onths. R onn i e di ed on M ar ch 10, 2005 , ab outt hr eeye ar s aft ert he or i gi nalp ro c e d u re , a tt he ageoff i f t ye i g h t. A f t e rR o n n ie d ie d , a p p e lla n tb r o u g h t s u it in d iv id u a llya n d o n b e h a lfo fh is
e s t a t e a g a i n s tDr . T h o t a a n d NTC C. Appel l antal l ege d a ppe l l ee s w er e n egl i gen t 1 i n fai l i n g to o b tai n a n a c c u rate m e d i c a l h i sto ry o n R o n n i e , i n fai l i n g to ta k e i n to
con si der at i on a ny o f R o n ni e’ s pr e- exi st i ng c ondi t i onst hatm i ghtha ve exacer bat ed potent i al com pl i cat i ons, i n f ai l i ng t o pr oper l y l ocat e t he f em or al
a rt e r ya n d la c e r a t in g t h e rig h t ilia c a rt e r yin s t e a d d u r in g t h e c a t h e t e r iz a t io n , in2 ... Th e t r i al court gave t he j ur y an i nf er ent i al r ebutt al i nst r uct i on on new

and i nde pen den tca us e a nd una voi dab l e ac ci den t as t o D r . Thot a b utonl y ga ve R o n n i e an i n fere n ti a l reb u ttal i n stru c ti o n o n u n a v o i d a b l e ac c i d e n t. 4 fai l i n g to d i sc o v e r t h e la c e rati o n b e fo re d i sc h a rging R o n n i e , a n d i n fai l i n g to p ro p e rl yd i a g n o s e a n d tre a t th e te a r. I n r es pons e, ap pel l ee s con t end ed t hat Ronni e’ s i nj ur i es w er e t he r es ul tof
a n u n a v o i d a b l e a c c i d e n t; i n o th e r w o rds , th e y w e re n o o n e ’s f a u l t. A l t er nat i vel y, t heyco nt end ed t hathi s i nj ur i esw er e t he r es ul tofa new an d i nde pen den tca us e o r th e r es ul tofpr e- exi st i ng c ondi t i onsors ubs equ ent
con di t i ons . Appel l ee s al so co nt end ed t hatt he occ ur r enc e w ast he r es ul tof Ron n i e ’s c o m par at i ve neg l i gen ceunde rch apt er33 oft he ci vi l pr ac t i ce s and
r em edi esco de and as se rt ed a c ount er cl ai m ag ai ns t Ronni e f or con t r i but i on a nd f orhi s al l ege d f ai l ur e t o m i t i gat e h i s dam age s. Appel l ee s’ de f ens esan d
coun t er cl ai m s gener al l y f ocused on t hei rcl ai m s th a t R onn i e’ s i nj ur i es w er e a
r e s u lto fh is p r e -e x is t in g c o n d i t i o n s , a s w e ll a s R o n n ie ’s f a ilu r e t o f o llo w h is di schar ge i nst r uct i ons. T h e tri a l c o u rt s u b m i tte d i s s u e s o n a p p e l l e e s ’ n e g l i g e n c e a n d R o n n i e ’s
con t r i but or y ne gl i gen cean d f urt her gav e t he j ur y i nf er ent i al r ebu t t al i ns t r uct i ons on n e w a nd i nd e pe nd e ntc a us e a nd u na vo i da bl e a c c i d e n t. I n a te n to tw o 25

ver di ct , t he j ur y f oun d t hat onl y R onn i e w as negl i gent and aw a rd e d n ei t her R o n n i e ’s e s ta te n o r a p p e l l a n t a n yd a m a g e s . I ssues on A ppeal I n fou r i ss u e s, ap p e l l a n t ch a l l e n g e s th e su ffi c i e n c yo f t h e e v id e n c e to suppo rtt he j ur y’ s answ er s t o Q uest i on O ne, com pl ai ns t hatt he t r i al courter r ed by s ubm i t t i ng Ronni e’ s con t r i but or y neg l i gen ce t o t he j ur y w i t hi n t hi s que st i on, and co nt end s t hatt he t r i al co urter r ed b y s u b m i t t i ng j ur y i ns t r uct i onson unavo i dabl e acci dent and new and i ndep enden tcause. C l ai m ed Jury Char ge Er r or Fi r st , w e a ddr es s t hos e i ss uescl ai m i ng j ur y cha r ge er r or . W e a ddr es s t he pr opr i et y oft he t r i al court ’ s char ge r egar di ng R onn i e’ s cont r i butory negl i gence f i r stbe ca us e t hati ss ue i s p ot ent i al l y di sp os i t i ve oft he app ea l an d c oul d gi ve a p p e l l a n t th e g re a te s t re l i e f. S ee T e x . R . A p p . P . 4 7 .1 ; s e eg en era lly V anD evender v. Woods, 2 2 2 S .W .3 d 4 3 0 , 4 3 3 n .9 (T e x . 2 0 0 7 ); Wes tv. Robi ns on, 1 8 0 S .W .3 d 5 7 5 , 5 7 6

– 7 7 (T e x . 2 0 0 5 ); Pro fitl iveP ’sh i

p v. Surb er, 2 4 8 S .W .3 d 2 5 9 , 2 6 2 (T e x . A p p .— F o rt W o rth 2 0 0 7 , n o p e t.); i d. a t263 (W a l k e r, J ., c o n c u rri n g a n d d i s s e n ti n g ). S t andar d ofRev i ew R u le 2 7 7 re q u ir e s a t r ia l c o u rt , w h e n e v e rf e a s ib le , t o s u b m ita c a u s e in b r o a d -f o r m q u e s t io n s . T e x . R . C iv . P . 2 7 7 . R u le 2 7 8 r e q u ir e s a c o u rtt o s u b m it6

i n stru c ti o n s a n d d e fi n it io n s to the j u ry a s a re n e c e ss a ry to en a b l e the j u ry to
re n d e r a v e rd i c t. T e x . R . C i v . P . 2 7 8 ; G o o s eCre ekCo n s o l. ISDv. Ja rra r’s Plum bi ng, I nc. , 74 S. W . 3d 48 6, 49 9 ( Tex . A pp. — T exar kana 2 00 2, pet s. d e n ie d ). I n f e r e n t ia l re b u t t a l q u e s t io n s a r e n o tt o b e s u b m itt e d t o a ju r y ; o n ly i nst r uct i ons and def i ni t i ons m ay be gi ven. Tex . R . C i v. P . 2 7 7 . W e r evi ew cl ai m ed j ury c har ge er r orf oran ab us e o fdi sc r et i on . In reV.L .K., 24 S. W . 3d 3 3 8 , 3 4 1 (T e x . 2 0 0 0 ); G oose Creek , 7 4 S .W .3 d a t 4 9 9 ; s e ea l s o T ex . D ep ’t
o f Hum a nS ervs . v. E.B., 802 S. W . 2d 647 , 649 ( Tex. 1990 ) . I ft he pl ea di ngs and ev i den cer ai se t he i ss ue, a part y i s ent i t l ed t o a j ur y qu es t i on, i ns t r uct i on, or def i ni t i on on t he m att er . Tex. R. C i v. P . 2 7 8 ; Un i on Pa c. R. R. Co. v. W illia m s , 8 5 S .W .3 d 1 6 2 , 1 6 6 (T e x . 2 0 0 2 ). The Char ge I n heri ssues, appel l antf ocuses on char ge er r ort hatshe cl ai m s occur r ed i n t he f i r stj ur y qu es t i on a nd t he cha l l eng ed def i ni t i ons . Q ues t i on One as ke d, as t o both appel l ee, D r . Th ot a, and R onn i e:

D i d t he neg l i gen ce , i fan y, oft hos e n a m ed bel ow , pr oxi m at el y c aus e t he i nj ur y i n que st i on, i fan y? “Negl i gen ce , ” w hen us ed w i t h r es pec tt o t he con duc tof V enkatTh ot a, M . D . , m eans f ai l ur e t o use o rd in a r y car e, t hati s, f a ilin g t o d o t h a t w h ic h a c a r d io lo g is to fo r d in a r yp r u d e n c e w o u ld have do ne und ert he sam e orsi m il a r c i r cum st ances ordoi ng t hat w hi ch a c ar di o l o g i s tofor di nary pr ude ncew oul d notha ve done und ert he sam e orsi m i l arci r cum st ances.7 “Or di nary c ar e, ” w hen us ed w i t h r es pec tt o t he con duc tof V enkatTh ot a, M . D . , m eans t hatdegr ee of car e t hat a car di ol ogi st ofor di nar y pr uden ce w oul d use under t he sam e orsi m i l ar ci r cum st ances.

“ P r o x i ma t e Ca u s e ” wh e n u s e d wi t h r e s p e c tt o t h e condu ct of V enk at Thot a, M . D . , m ea ns t hat ca us e w hi ch, i n a na t ur al an d conti nuo us sequence un br oken byany new and i ndep enden tcause, pr oduc esan eve nt , and w i t hout w hi ch ca us e su ch eve ntw oul d not hav e o cc ur r ed. I n or dert o bea pr oxi m at e c aus e, t he ac tor om i ss i on c om pl ai ned ofm us tbe s uch t hata ca r di ol ogi stus i ng or di nar y car e w oul d have f or eseen t hatt he event, or som e si m i l ar event , m i ght r easonabl y r esul t t her ef r om . Th er e m ay be m or e t han o n e p rox i m a te c a u se o f an ev e n t. “Ne wan d

i n dep en den t ca use,” wh enuse d withresp e c t to the con duc t of Venkat Thota, M. D . , m eansthe ac tor om i ssi on of a s epa rate and i

ndepen den t agency

, notrea so nably f

ores eeabl

e b y a cardi ologi stexerci

si ng ordi nary care, th a t destroys the causal connec ti

on, if an y, be t ween the ac tor om i ssi on i nqui red abo utan d the i nj ury i n questi on and therebybe com esthe i m m edi ate caus e o f su ch i nj ury. “Negl i gen ce ,” w hen us ed w i t h r es pec tt o t he con duc tof [ Ronni e] Young m ea nsf ai l ur e t o us e o r di nary ca r e, t hati s, f ai l i ng t o do t hatw hi ch a p er so n ofor di narypr ude ncew oul d ha ve done unde rt he sa m e o rs i m i l a r c i r cum st anc esordoi ng t hatw hi ch a per son ofor di nar y pr uden ce w oul d not have do ne und ert he sam e orsi m i l arci r cum st ances. “Or di nary c a re , ” w hen us ed w i t h r es pec tt o t he con duc tof [R o n n i e ] Y o u n g m e a n s th a t d e g re e o f c a re th a t a p e rs o n o f o rd i n a ry pr uden ce w oul d use under t he sam e orsi m i l arci r cum st ances. “Pr oxi m at e cause, ” w hen used w i t h r espect t o t he cond uct of[ Ronni e] Young m ea ns t hatca us e w hi ch , i n a n at ur al an d conti nuo us sequence, pr odu ces an event , and w i t hou tw hi ch cause su c h ev e n t w o u l d n o t ha v e o c c u rr e d . I n o r d e r t o b e a p rox i m a te c a u se , th e a c t o ro m i ss i o n co m p l a i n e d o f m u st b e su c h tha t a8

per so n us i ng or di nary c ar e w oul d hav e f or es ee n t hatt he eve nt , or som e si m i l arevent , m i ght r easonabl y r esul tt her ef r om . Ther e m ay b e m o re th a n o n e p rox i m a te c a u se o f an ev e n t. A n i nj ury m ay be an “unavoi dable a cci

den t , ” that i s, an event n o t proxi

m a telyca use d

b ythen egl

i g en c eo f an yp a rtyto it. A nsw er“Yes” or“N o”. V e n k a t T h o ta , M .D .: [N O ] [R o n n i e ] Y o u n g : [Y E S ] [E m p h a s i s a d d e d .] T h e n e x t j u ryq u e s ti o n c o n d i ti o n a l l y a s k e d a b o u t D r. T h o ta ’sa n d R o n n i e ’s
c o m par at i ve ( per ce nt age ) ne gl i gen cebutw asnotan sw er ed bec aus e o ft he j ury’ s ans w ert o t he f i r stque st i on. C ontr i butory N egl i gence ver sus M it i gat i on of D am ages I n pa rtofhe rs ec ond i ss ue, ap pel l antco m pl ai ns ofch ar ge er r ori n t he
su bm i ss i on ofRonni e’ s cl ai m ed con t r i but or y ne gl i gen cei ns t ea d o fan i ns t r uct i on on Ronni e’ s dut y t o m i t i gat e hi s dam age s. W hen con si der i ng t he pr opr i et y of
s u b m i ttin g a p l a i n ti ff’s c o n tri b u to ry n e g l i g e n c e a s o p p o s e d to a p l a i n ti ff’s fa i l u re t o m i t i gat e hi s orherdam ages, w e ar e to c o n s id erw het hert he al l eged
n e g l i g e n c e “ m e re l yi n c re a s e s o r a d d s to th e e x te n t o f th e l o s s o r i n j u ry occasi oned by an o th e r ’ s negl i gence, ” i n w hi ch case subm i ssi on of an i ns t r uct i on on m i t i gat i on ofd a m a g e s w oul d beap pr opr i at e a s oppos ed t o a9

c o n tri b u to ryn e g l i g e n c e q u e s ti o n . E l b a o r v. Sm ith , 845 S. W . 2d 240, 245 ( Tex. 199 2) ( ci t i ng Ker

b yv. A b ilen eCh r

is tia nCo ll. , 503 S . W .2 d 526, 528 ( Tex. 1 9 7 3 )). Th e m i t i gat i on of dam ages doct r i ne r equi r es an i nj ur ed part y t o “exer ci se
r e a s o n a b le c a r e t o m in im iz e it s d a m a g e s ifd a m a g e s c a n b e a v o id e d w it h o n ly sl i ght expense and r easonabl e ef f ort . ” Cotten v. Weatherf ord Bancshares, I

nc. , 18 7 S . W . 3d 68 7, 70 8 ( Tex . A pp. — Fort W ort h 2 00 6, pet . deni ed) . A s not ed by t he Texa s Supr em e Courti n Moulton v. A l am o A m bul

ance S erv. , I

nc. , t he i nj ur ed per son’ s f ai l ur e t o c ar e f oran d t r ea t h i s i nj ur i esasa r ea so nab l e p r ude ntpe r so n w oul d und er the s am e o rs i m i l arci r cum st anc esw as‘ a b r anc h of t he doctr i ne of contr i butory negl i gence[ ’ ] . . . onl y i n t he sense t hat d a m a g e s re s u lt in g f r o m s u c h f a ilu r e a r e u lt im a t e lyn o tp r o x im a t e ly caused by t he w r ong doer ’ s act s or om i ssi ons, but by th e in jur ed per so n’ s ow n subs equ ent negl i gence. 414 S. W . 2d 444, 449 ( Tex. 1967 ) ( em pha si s add ed) ( quot i ng G ulf , C. & S. F. R y. Co . v. Ma nn e witz , 70 Te x . 73, 8 S. W . 66, 67 ( 188 8) ) . I n Moulton , t he
courtnot ed t hatth e pl ai nt i f f ’ s f ai l ur e t o f ol l ow com pet entm edi cal advi ce agg r ava t ed t he i nj ur i eshe s us t ai ned i n a col l i si on a nd t husal l ow ed su bm i ss i on of a n i ns t r uct i on on f ai l ur e t o m i t i gat e d am age s asoppo se d t o oneon c o n tri b u to ryn e g l i g e n c e . Id. a t448– 49. “C ontr i butory negl i gence go es t o t he p ro xi m at e cause oft he or i gi nal i nci dent. ” H ygei

a D ai ry Co. v. G onzalez , 994 S . W . 2d 220, 226 ( Tex.10

A pp. — San Ant oni o 1999, no p et . ) . “M i t i gat i on of dam age s, on t he ot herha nd,
a r is e s f r o m [t h e in ju r e d p a rt y ’s ] s e p a r a t e d u t yt o a c tre a s o n a b lyin re d u c in g h is dam ages. ” Id .; see al so Har r i s Coun ty v. Sm oker, 934 S . W . 2d 714, 721 ( Tex. A pp. — H ous t on [ 1st D i st . ] 199 6, w r i tde ni ed) ( su m m ar i z i ng Mo ulto n ’shol di ng t h a ta n in s t r u c t i o n o n m it ig a t io n o fd a m a g e s is a p p r o p r ia t e w h e n t h e r e is
e v i d e n c e o f n e g l i g e n c e o n th e p a rt o f th e p l a i n ti ff i n fa i l i n g to c o n s u l t a d o c to r, i n doi ng s o unt i m el y, i n f ai l i ng t o f ol l ow a d oct or ’ s adv i ce , ori n notca r i ng f or a n d tre a ti n g i n j u ri e s th a t d o n o t re q u i re a d o c to r’sa tte n ti o n ). The pa rt y t hatas se rt s t he i nj u re d p art y’ s f ai l ur e t o m i t i gat e h ast he bur den ofpr ovi ng t he f ai l ur e t o m i t i gat e a nd m us ts how t he ext entt o w hi ch t he d a m a g e s w e re i n c re a s e d b yth e fa i l u re to m i ti g a te . Cotten , 18 7 S . W . 3d at 7 0 8 ; U.S . Res t. Prop s . Op era ti ng L .P. v. Mo tel

E n ters ., I n c ., 104 S. W . 3d 284, 2 9 3 (T e x . A p p .— B e a u m o n t 2 0 0 3 , p e t. d e n i e d ). I n Ker by, t he pl ai nt i f fdr i vers uf f er ed i nj ur i esw hen t he def end ant ’ s sc hool busr an a r ed l i ghtan d st r uck hi m . 503 S. W . 2d at 527 . The p l ai nt i f f , dr i vi ng a l i nen van , w as t hr ow n f r om hi s van t hr oug h i t s open sl i di ng do orw hen i tw as s tru c k . Id. T h e v a n l a n d e d o n h i m , a n d h e s u ffe re d i n j u ri e s . Id. Att r i al , t he
courtsubm i t t ed quest i ons t o t he j ur y i nqu i r i ng of t he pl ai nt i f f ’ s pot ent i al
c o n tri b u to ryn e g l i g e n c e i n l e a v i n g h i s v a n d o o r o p e n . Id. The j ur y answ er ed af fi rm a ti v el y, f i ndi ng t he pl ai nt i f ft hi rt y- f i ve per ce ntne gl i gen ti n c aus i ng t he3 ... W hen Ker byw ast r i ed i n Ju ne 197 3, ourcu r r ent sy st em ofi nqui r i ng i nt o t he com par at i ve f aul toft he part i esha d not yet bee n cr ea t ed; a f i ndi ng of c o n tri b u to ryn e g l i g e n c e o n th e p a rt o f a p l a i n ti ff c o n s ti tu te d a b a r to a p l a i n ti ff’s re c o v e ry , u n l i k e a n a ffir m a ti v e fi n d i n g o n a m i ti g a ti o n q u e s ti o n . S eeTe x. R. C i v . P . 2 7 7 , 4 9 3 -4 9 4 S .W .2 d (T e x . C a s e s ) x x x i i

– i i i (1 9 7 3 , a m e n d e d 1 9 8 7 ); see a ls o Tex . Wo r

ker s ’ Co mp . Co m m ’n v. G a rcia , 893 S . W . 2d 504, 529 ( Tex. 1 9 9 5 ); c f. T e x . C i v . P ra c . & R e m . C o d e A n n . § § 3 3 .0 0 1

– .0 1 7 (V e rn o n 2 0 0 8 ). 11 a c c i d e n t. Id. T h e tr i al co urten t er ed j udgm enti n t he pl ai nt i f f ’ s f avo ron t he j ury’ s ver di ctbutr edu ce d t he am ount of dam age s i t f ound by t he per ce nt age o f n e g l i g e n c e a ttri b u ta b l e to th e p l a i n ti ff. Id. The app ea l s cou rt r eve r se d t he tr i a l co u rt ’s j u d g m e n t a n d ren d e red j u d g m e n t so l e l yi n fav o r of the d e fen d a n t,
con cl udi ng t hatt he sp ec i al i ss uesi nqui r i ng ofpl ai nt i f f ’ s neg l i gen cei n l ea vi ng th e v a n d o o r op e n c o n sti tu ted fi n d i n g s o f c o n tr i b u to ry n e g l i g e n c e an d p rox i m a te
c a u se , req u i ri n g a c o m p l e te d e fen se v e rdict. Id. The suprem e courtr ever sed 3 bot h t he t r i al c o u rt ’ s j udgm entan d t he cou rtofap pea l s’ s j udgm entan d
r ender ed j udg m ent f or t he pl ai nt i f ff ort he ent i r e am oun tofdam ages asses sed by t he j ur y, unr edu ce d byt he per ce nt ageo f n e g l i gen cei tatt r i but ed t o t he p l a i n ti ff. Id. at52 9. The suprem e courthel d, “Even i ft her e w er e pr oof t hat t he part i cul ari nj ur y suf f er ed w oul d not have been suf f er ed had K er by avoi ded bei ng t hr ow n f r om hi s t r uck , i tw oul d n o t s u p portt he j ur y’ s f i ndi ng of per cent age contr i buti on. ” Id. T h e c o u rtn o t e d , “ N e g lig e n c e w h ic h m e r e ly i n c re a s e s o r a d d s to th e e x te n t o f th e l o s s o r i n j u ryo c c a s i o n e d b ya n o th e r’s negl i gence i s not such contr i butory negl i gence as w oul d def eatr ecover y. ” Id.12

at 52 6. Th us, t he supr em e courthel d t hatt he t r i al courter r oneo usl y i ncl uded
an i ss ue on t he pl ai nt i f f ’ s al l ege d c ont r i but or y ne gl i gen cei ns t ea d ofa m i t i gat i on i n s tru c ti o n . Id. a t528. A l t er nat i vel y, i n El

bao r, pl ai nt i f f S m i t h, w ho had al so been i nj ur ed i n an aut om obi l e acci dent, w ent t o a hospi t al f ort r eat m entf orherm ul t i pl e i nj ur i es, i ncl udi ng a b l ee di ng, co m pound an kl e f r ac t ur e. 845 S. W . 2d at241–4 2. She unde r w entem er gen cy su r gery t o s t op t he bl ee di ng, and s he r em ai ned unde rt he
a d m i ttin g d o c to r’s c a r e fo r th e fi rs t w e e k . Id. at242. She t r ans f er r ed t o a di f f er enthospi t al and w as t hen un dert he car e ofJam es E. E lbaor , M . D . , an o rt h o p e d i c su rge o n , a m o n g o th e rs, i n c l u d i n g an i n fec ti o u s d i se a se sp e c ia li st,
w h o p u t h e r o n i n tra v e n o u s a n ti b i o ti c s . Id. W hi l e t her e, s he al so unde r w ent tw o w o u n d d e b ri d e m e n ts i n a n e ffo rt to s to p a n y i n fe c ti o n i n h e r a n k l e . Id. A f ew w eeks l at er , she w as t r ansf er r ed to anot herhospi t al w her e hert hen p h y s i c i a n re m o v e d a tw o -i n c h s e c ti o n o f b o n e fro m h e r a n k l e . Id. D e sp i te conti nued t r eat m entovert he next t hr ee year s, herankl e ul tim at el y becam e fu s e d . Id. W h i l e s e ttli n g w i th s o m e o f th e p r o v i d e rs , sh e w e n t to tri a l a g a i n s t D r. E l b a o r a n d D r . S y r q u i n , o n e o f h e r o th e r tre a ti n g p h y s i c i a n s , a n d th e j u ry
r et ur ned a su bs t ant i al ver di ct i n he rf avo r , al l oca t i ng e i ght y- ei ghtpe r ce ntoft he l i a b i l i ty to D r. E l b a o r a n d tw e l v e p e rc e n t to D r. S y rq u i n . Id. W h e th e r S m i th ’s4 ... T h e tri a l c o u rt re fu s e d D r. E l b a o r’sre q u e s te d q u e s ti o n o n S m i th ’s

c o n t r ib u t o r yn e g l i g e n c e an d i n ste a d i n stru c ted the j u ry “ to ex c l u d e fr o m i ts ver di ctan y da m age s att r i but abl e t o M s . Sm i t h’ s neg l i gen ce . Thi s i ns t r uct i on c o n tai n e d n o d e fi n i ti o n o f ne g l i g e n c e u p o n w h i c h th e j u ry c o u l d h a v e b a se d i ts deci si on. ” E

l b a o r, 8 4 5 S .W .2 d a t 2 4 5 . T h e i n s tru c ti o n re a d , D o noti ncl udean y a m ountf oran y c ond i t i on r es ul t i ng f r om t he f ai l ur e, i fan y, ofCar ol e M er ce rSm i t h t o ha ve ac t ed asa per so n of or di nar y pr uden ce w oul d h a v e undert he sam e orsi m i l ar ci r cum st anc esi n c ar i ng f orhe r se l f and coo per at i ng i n t he t r ea t m ent ofhe ri nj ur i es , i f any , t hat r es ul t ed f r om t he m edi ca l ca r e m adet he b a sis o f t h e l a w su i t. Id. a t245 n. 8. 13 ank l e w asi nf ec t ed w ashot l y c ont es t ed att r i al , butev i den ces how ed t hats he had been uncoo per at i ve and had r ef used t o f ol l ow som e ofherdoct or s’ i n s tru c ti o n s c o n c e rn i n g h e r a n ti b i o ti c m e d i c a ti o n s a n d tra c ti o n . Id. The t r i al
c o u rt re fu s e d to s u b m i t D r. E l b a o r’sre q u e s te d q u e s ti o n o n S m i th ’sc o n tri b u to ry neg l i gen ce , f i ndi ng t he evi den ce i ns uf f i ci ent t o su pport t he su bm i ss i on oft he i ss u e a n d , i n ste a d , i n stru c ted th e j u ry o n i ts ri g h t t o co n side r S m i th ’s fai l u re to
m i t i gat e dam ages. Id. at 24 5. O n appeal , D r . El baorchal l enged , am ong ot her 4 th i n g s , th e tri a l c o u rt’ s f a i l u re to s u b m i t h i s re q u e s te d i s s u e o n S m i th ’s
c o n tri b u to ryn e g l i g e n c e . Id. at 24 4. Th e appel l at e courtagr eed w i t h t he t r i al
cou rtan d a f f i r m ed i t s dec i si on t o i ns t r uctonl y on m i t i gat i on ba se d on Ker by . Id. at24 4– 45 . Th e Texas S upr em e C ourtr ever sed, how ever , concl udi ng t hat t he f ac t s i n El

bao r w er e d i st i ngui sh abl e f r om Ker byan d r equ i r ed t he su bm i ss i on14

oft he pl ai nt i f f ’ s con t r i but or y ne gl i gen ceas o p p o se d t o onl y a n i ns t r uct i on a d d re s s i n g h e r fa i l u re to m i ti g a te h e r d a m a g e s . Id. a t2 4 5 . T h e T e x a s S u p r e me C o u rt p o in t e d t o t h e d is t in c t io n e x e m p lif ie d in Ker by : w e l ookt o w het hert he pl ai nt i f f ’ s conduct contr i buted t o t he acci dent or occur r ence or onl y i ncr eased t h e i n j u ri e s s u ffe re d . Id. “ Co n t r i b u t o r yn e g l i g e n c e mu s th a v e t h e c a u sal
con nec t i on w i t h t he ac ci den tt hatbut f or t he con duc tt he ac ci den tw oul d not have hap pened . ” Ker by , 503 S. W . 2d a t528. I n r evi ew i ng r ul es277 and 278 , t he cou rti n El bao r n o ted tha t t ri a l co u rt s a r e r e qu i r e d t o s ub m i tr e qu e s t e d qu e s t i on s i ft hee vi de nc e s up po rt s t he m . 845 S . W . 2d at24 3. Fi r st , t he courtconsi der e d w het herany evi dence exi st ed sh ow i ng t hatSm i t h’ s r ef us al t o t ak e ant i bi ot i cs pr ec ede d t he ons etofi nf ec t i on to h e r a n k l e . Id. Fi ndi ng s uch ev i den cet o exi st , t he cou rtne xtnot ed so m e o f t he f act ual di st i nct i ons bet w een t he El bao r case and t he Ker

byc a s e . Id. Fo r e x a m p le , it o b s e r v e d t h a t d r iv in g w it h a v a n d o o r o p e n w a s n o t “ i n t r i n s ic a lly har m f ul ” ora “b re a ch ofa l ega l dut y”asoppo se d t o t he doc t or - pat i ent
r e la t io n s h ip in El

bao r th a t pre su p p o se s a “d u ty o f co o p e rati o n w h i c h p a ti e n ts
ow e t r eat i ng ph ysi ci ans w ho assum e t he duty t o car e f ort hem . ” Id. a t245. Per haps m or e i m port ant l y, t he Ker by courtnot ed t hathavi ng t he van do oropen d i d n o t ac tu a l l yco n tr i b u te to the v e h i c u l a r ac c i d e n t, the b a sis f o r t h e su i t, “r at her , i tonl y i ncr eased t he i nj ur i es suf f er ed i n t he acci dent. ” Id. Conver se l y,15

i n t he El

bao r case, t he “acci dent”or“occur r ence” at is s u e in t he sui tw as S m i t h’ s i nf ect ed ankl e ( as opposed t o t he or i g in a l vehi cul aracci dent t hat
c a u se d h e r ori g i n a l co m p o u n d an k l e fr a c tu re), an d h e r c o n d u c t c o n tr i b u ted to
o r e v e n re s u l te d i n th e i n fe c ti o n . Id. W h ile t h e “ a c c id e n t ” o r “ o c c u r r e n c e ” in Ker byw oul d hav e hap pen ed w i t h or w i t hout t he van door bei ng l eftope n, t he “i nf ec t ed ank l e”t hatSm i t h c l ai m ed El bao r ’ s m al pr ac t i ceca us ed m i ghtnotha ve o c c u rre d h a d S m i th s i m p l yfo l l o w e d h e r d o c to r’s i n s tru c ti o n s . Id. Ther ef or e, t he su pr em e c ourthe l d t hatt he t r i al c o u rt’ s su bm i ss i on ofan i ns t r uct i on on
m i ti g a ti o n o f d a m a g e s i n s te a d o f a q u e s ti o n o n S m i th ’sa l l e g e d c o n tri b u to ry
n e g l i g e n c e w a s e rro r a n d re v e rs e d a n d re m a n d e d fo r a n e w tri a l . Id. a t241. I n R onn i e’ s case, t he “i nj ur y, ” “acci dent, ” or “occur r ence” w as t he t ear i n t he art ery a nd t he dam ag e s w er e t he r es ul t i ng pe r i t one al bl ee d. The i ss ue
w asw hatorw ho c aus ed t he t ea r . A ppe l l ant ’ s t heo r y w as t hatD r . Thot a m ade t he cat het er i zat i on i nci si on t oo hi gh so t hat suf f i ci entcl ot t i ng att he si t e never o c c u r r e d . A p p e lla n t c o n t e n d e d t h a t t h e b le e d in g in t o R o n n ie ’s a b d o m e n w o u ld notha v e occ ur r ed i fD r . Thot a’ s i nci si on ha d be en m adeatorbe l ow t he i ngu i nal l i gam ent . Speci f i cal l y, A ppel l ant ar gued t hat i f t he pun ct ur e si t e had b e e n p ro p e rl y p l a c e d , th e b l e e d i n g , i f a n y , w o u l d h a v e o c c u rre d a t th e p u n c tu re si t e, w hi ch w oul d have been i m m edi at el y appar ent , l i kel y bef or e R onn i e w as eve n di sc har ged . C onve r se l y, D r . Thot a t heo r i z ed t hat th e ca t het er i z at i on5 ... A p p e l l e e s a l so p l a c e d si g n i fi c a n t b l a m e o n a p p e l l a n t fo r h e r fai l u re to

assi stori nsur e t hat R onn i e r et ur ned t o t he hospi t al t i m el y; how ever , appel l ees di d not r equ e s t a char ge on app el l ant ’ s al l eged con t r i butory negl i gence. B e c a u s e i t w a s n o t s u b m i tte d to th e j u ry , w e d o n o t c o n s i d e r a p p e l l a n t’s a l l e g e d n e g l i g e n c e i n o u r a n a l y s i s . S ee Bar ker v. Eckm an , 213 S. W . 3d 306, 3 1 3 (T e x . 2 0 0 6 ); Moore v. K itsm i l ler, 20 1 S . W . 3d 14 7, 15 3 ( Tex . A pp. — Ty l er 2 0 0 6 , p e t. d e n i e d ). 16 i nci si on si t e w as pr oper , t hathem ost asi s had occur r ed bef or e Ro nni e w as di schar ged, t hata spont aneou s bl ood cl ot or t ear occur r ed l at eri n t he day, t hat Ronni e’ s r et r ope r i t one al bl ee d w ast he r es ul t of hi s f ai l ur e t o t i m el y r et ur n t o t he hos pi t al asdi r ec t ed i n t he di sc har ge i ns t r uct i ons , and t hat Ronni e w oul d ha ve
n e v e rs u f f e r e d s u c h m a s s iv e b le e d in g if h e h a d t im e lyre t u r n e d t o t h e h o s p it a l. A s t o appel l ees’ t heor y of R onn i e’ s al l eged contr i butory negl i gence, t hey
assertt hatRo nni e had a duty t o f ol l ow D r . Th ot a’ s i nst r uct i ons, w hi ch i ncl uded a dut y “t o r et ur n f oreval uat i on and possi bl e t r eat m enti fcom pl i cat i ons ar ose post - di schar ge. ” D r . Th ot a r equest ed t he subm i ssi on of R onn i e’ s negl i gence, despi t e t he f actth a tD r . Th ot a speci f i cal l y t est i f i ed t hathe di d not bl am e R o n n i e f orw hatha d ha ppe ned . A c c o r d i n g t o D r . T h o t a , R o n n i e ’ s ma s s i ve 5 b le e d w a s t h e re s u lto fa n a t u r a l b l o o d c lo te v e n to rt e a rt h a tw o r s e n e d o n ly bec aus e o f Ronni e’ s del ay i n r et ur ni ng t o t he hos pi t al . Dr . Thot a p r ovi desno evi den ceofRonni e’ s con t r i but or y ne gl i gen cei n ca usi ng t he t ear . Reg ar dl ess, D r . Thot a’ s pr em i sei s bas ed upon Ronni e’ s al l ege d ne gl i gen ceoc cur r i ng after t he t ea r , not Ronni e’ s neg l i gen cei n ca usi ngt he t ea r . The evi den ces upport i ng17

D r . Th ot a’ s t heor y of R onn i e’ s contr i butory negl i gence bl am es Ron ni e o n lyf or hi s br each ofdut y i n f ai l i ng t o f ol l ow D r . Th ot a’ s di schar ge i nst r uct i ons, w hi ch he con t end s r es ul t ed i n t he i ncr ea se d bl ee di ng. I nde e d , a r evi ew oft he evi den ces how s t hatD r . Thot a’ s t heo r y w ast hatno p art y w asr es pons i bl e f or a new or nat ur al l y f or m ed bl ood cl otand t earbutt hatal l ofRo nni e’ s dam ages
w er e a r es ul tofRonni e’ s f ai l ur e t o t i m e l y r et ur n t o t he hos pi t al . Agai n, c o n tr i b u to ry n e g l i g e n c e g o e s to the p rox i m a te c a u se o f t h e o ri g i n a l i n c i d e n t, and m i t i gat i on a r i se s f r om an i nj ur ed part y’ s dut y t o a ctr ea so nab l y i n r edu ci ng hi s da m a g e s . S e eH yg ei aD a i ryCo ., 9 9 4 S .W .2 d at 2 2 6 . T h u s, D r. T h o ta poi nt s onl y t o R onn i e’ s subs equ ent n e g lig e n c e t h a tm ig h th a v e in c r e a s e d h is d a m a g e s a s o p p o s e d to D r. T h o ta ’so ri g i n a l n e g l i g e n c e . T h e re fo re , w e con cl udet hatRonn i e’ s neg l i gen ce , i fan y, onl y i ncr ea se d t he dam age s he
s u ffe re d a fte r th e c a th e te r i z a t i o n o r te a r, a s o p p o s e d to c a u s i n g th e “ i n j u ry ,”

“ a c c i d e n t,” o r “ o c c u rre n c e ” i t s e l f. Se eMo ulto n, 414 S . W . 2d a t448– 49; H yg ei aD a i ryCo ., 9 9 4 S .W .2 d a t 2 2 5 . Res pons e t o Di ss ent T h e d i s s e n t fi rs t c o n te n d s th a t w e h a v e e rro n e o u s l yd e s c ri b e d R o n n i e ’s i nj ur y a s bei ng t he t ea ri n h i s r i ghtex t er nali l i acart ery. I ns t ea d, t he di ss ent contends t hatt he i nj ur y w as th e e x te nsi ve bl eedi ng f r om t he pun ct ur e si t e. Thi s con t ent i on s t and s t he w hol e t r i al on i t s hea d by a l l o w i n g a d ef ens i ve18

i ss ue— t he pl ai nt i f f ’ s al l ege d f ai l ur e t o m i t i gat e h i s dam age s— to t r um p t he pl ai nt i f f ’ s ent i r e t heo r y of t he ca se — t he def end ant ’ s neg l i gen cei n pl ac i ng t he
ca t het er i z at i on s t i ckt oo hi gh. The ext en s i ve bl ee di ng a nd t he r es ul t i ng “c as ca de ofco m pl i ca t i ons ” ar e f i r stt he r es ul toft he neg l i ge nti nj ur y; t he p la i nti f f ’ s al l eg ed f ai l ure t o ti m el y ret urn an d se ekm ed i ca l i nterven t i on o n ly i ncr eased t he dam ages t he pl ai nt i f fsuf f er ed as opposed to causi ng t hem . W h e n th e d i s s e n t s a y s th a t th e “ ‘te a r’ w a s re l e v a n t o n l yb e c a u s e D r. W a l k e r’s rep o rtsta ted tha t he rep a i red a ‘t e a r’ i n Y o u n g ’s a rt e ry a fter Y o u n g retu rne d to t he hos pi t al , ” i t t ot al l y unde r m i nes t he so l e t heo r y oft he pl ai nt i f f ’ s ca sean d t he
ca set hat w as t r i ed t o t hi s j ur y. A n app el l at e cou rt ca nnot dec i de a c as e o n a t h e o r y d i ffe re n t fro m th e o n e th a t w a s p l e d a n d tri e d to th e j u ry . L o erav. I nter state I nv. Cor p. , 9 3 S .W .3 d 2 2 4 , 2 2 8 (T e x . A p p .— H o u s to n [ 1 4 t h D i s t.] 2 0 0 2 , p e t. d e n i e d ). I n suppo rtoft he m aj or i t y’ s posi t i on on w hati nj ur y t he pl a in ti f fw as ac t ual l y s ui ng f o r w e n ot e t he f ol l ow i ng. A r evi ew ofPar agr aph 4. 4 of Pl ai nti f f ’ s Fourt h Am end ed Pet i t i on s t at esqui t e c l ea r l y, “ U nf ort una t el y, D ef endan tTh ot a had t or n t he r i ght i l i ac art er y dur i ng t he c a r di ac cat het er i zat i on, and had d i schar ged M r . Y oun g f r om t he hospi t al w hi l e he w as st i l l bl eedi ng i nt er nal l y. ” A nd i n par agr aph 5 . 1 i tst at es, “D r . W al keroper at ed on M r . Y oun g t o r epai r a bl eed f r om t he i l i ac art er y w hi ch had been l acer at ed19

and t or n byD ef end antThot a d ur i ng t he ca t het er i z at i on . . . . ” A nd i n pa r agr aph V I i ts t at est hatD ef end ant s Thot a and N TC C w er e neg l i gen ti n t hei rt r ea t m ent i n t hatt hey
c. neg l i g e nt l y l ac er at ed t he r i ghti l i ac art ery du r i ng t he ca t het er i z at i on; d. f ai l ed t o m ak e a punc t ur e at t he cor r ec tl oca t i on i n t he f em or al art ery; [ and ] e . fai l e d to d i sc o v e r t h e tea r i n the arteryp ri o r t o d is c h a r g in g h im f r o m t h e h o s p it a l. F u rth e r m or e, t he t er m “ i nj ur y”w asnotgi ven a sp ec i al de f i ni t i on i n t he cha r ge. The onl y ge ner al di r ec t i on r ega r di ng t he us e of t er m s and w or ds i n t he
c h a r g e w a s in p a r a g r a p h s e v e n w h ic h s a id , “ W h e n w o r d s a r e u s e d in t h is
c h a rg e i n a s e n s e th a t v a ri e s fro m th e m e a n i n g c o m m o n l y u n d e rs to o d , y o u a re gi ven a pr ope rl ega l de f i ni t i on, w hi ch you ar e b ound t o ac ce pti n pl ac e o fan y ot herm eani ng. ” See Kroger Co. v. Bro wn, No. 14- 06- 00510

- CV , 2008 W L 2 8 4 1 6 1 5 , a t * 2 (T e x . A p p .— H o u s to n [ 1 4 t h D i s t.] J u l y2 4 , 2 0 0 8 , n o p e t.). Becau se t he w or d “i nj ur y” w as t he w or d used i n t he char ge and because i tw as notgi ven a s p e c i a l m ea ni ng w i t hi n t he cha r ge, w e a r e t o us e i t s com m on
m eani ng i n l i ght oft he case t hatw as t r i ed. Th e case t he appel l ant t r i ed w as l i m i t ed t o onet heo r y: t he al l ege d ne gl i gen ceofD r . Thot a i n p l a c i ng t he
ca t het er i z at i on s t i ckt oo hi gh; t hi s w as t he i nj ur y t he pl ai nt i f f al l ege d, and t he bl ee di ng w ast he r es ul toft hati nj ur y.20

The f ocu s oft he t r i al w as on w hat ca us ed t he t ea r . Agai n, t he di ss ent b o l d l ysa y s, “T h e re [i s] n o e v i d e n c e th a t D r. T h o ta c a u se d the tea r or tha t i ts exi st ence w a s a ca us al f ac t ori n a ny o fYoung’ s bl ee di ng ors ubs equ ent
com pl i cat i ons. ” The act ual r ecor d, and al l t he expert s, even D r . Th ot a, agr ee and co nce de t hatw her eve rt he t ea r w as , t hat w as t he punc t ur e si t e; t hatt he t ea rl oca t i on and t he punc t ur e si t e w er e one and t he sa m e; an d t hati tw ast he si t e oft he bl eed. R onn i e’ s ent i r e cl ai m r evol ved ar oun d w het hert he st i ck w as t oo hi gh. The di ss ent sa ys t he t ea r or st i ck ca nnotbe t he “i nj ur y. ” I ns t ea d, i ts ays th e “ i n j u ry ” i s th e e x te n s i v e b l e e d i n g fro m t h e p u n c tu re s i te i n to R o n n i e ’s
r e t r o p e r it o n e a l c a v it y . W h ile itis t r u e t h is h a p p e n e d , t h e e x t e n s iv e b le e d in g is
m or e i n t he nat ur e of t he r es ul t antda m age ; t he “t ea r ” i s t he “i nj ur y”an d t he “b l ee d” i s t he r es ul t antda m age . B u t fo r th e t ea r , t her e w oul d ha ve bee n no bl ee d and t her ef or e no dam age s. Agai n, “ neg l i gen cet hatm er el y i ncr ea se s or a d d s t o t h e e x t e n t o f t h e lo s s o rin ju r yo c c a s io n e d b ya n o t h e r ’s n e g lig e n c e is
n o t s u c h c o n tri b u to ryn e g l i g e n c e a s w i l l d e fe a t re c o v e ry ” b u t i s i n th e n a tu re o f n e g l i g e n c e th a t c o n tri b u te s to th e d a m a g e s s u s ta i n e d i n s te a d . Ker by , 503 S . W . 2d at52 8. I m port ant l y, D r . Th ot a’ s onl y t heor y ofl i abi l i t y assert ed agai nstRo nni e i s hi s f ai l ur e t o t i m el y seek m edi cal advi ce; D r . Th ot a concedes t he t earw as att he pun ct ur e si t e, t hatRo nni e di d not cause t he t ear , and t hat21

R o n n i e ’s o n l ym i s d e e d w a s h i s fa i l u re to re tu rn to th e h o s p i ta l o r to c a l l D r. T h o ta. E v e n i f w e , a s th e m a j o ri ty, c o n c e d e tha t as to Dr. Thota’ s def ensive th e o ryth eo n lyi

n j uryi sth eb le e d

, t h is c o n c e s s io n t h a t t h e in ju r ya s t o R o n n ie
w a s t h e t e a ra n d t h e in ju r y a s t o D r . T h o t a w a s t h e e x t e n s iv e b le e d w o u ld p ro v e o n l yth a t th e re w e re tw o d i ffe re n t th e o ri e s o f l i a b i l i tytri e d . The di ss ents ayst hi s ca sei s m or e c l os el y a nal ogoust o El bao r . A g a i n , we di s a g re e ass how n byourdi sc us si on a bove . I n El bao r, b u t fo r th e p a ti e n t’s
r ef usal t o t ake ant i bi ot i cs, she w oul d m or e l i kel y t han not have evergot t en an i nf ec t i on, w hi ch occ ur r ed and ca us ed herf urt heri nj ur i esw ee ks , m ont hs , an d yea r s aft erhe ri ni t i al ca r ac ci den t . 845 S. W . 2d at 242 . H er e, t he “i nj ur y”( or i fone pr ef er s t o cal l i t t he “acci dent” or “occur r ence”) i s t he t ear ; i toccur r ed t hatm or ni ng du r i ng t he cat het er i zat i on pr ocedu r e, and t he bl e ed occur r ed
w i t hi n hou r s ofRo n n i e’ s di sm i ss al . The bl ee d w oul d ha ve occ ur r ed w i t h or
w i t hou tRo nni e’ s del ay i n seeki ng m edi cal advi ce; he w oul d have r e q u i r ed
s u r g e r yt o re p a irt h e t e a r r e g a r d le s s . D r . T h o t a n e v e rc la im e d t h a tR o n n ie caused t he t ear ; t her e w as onl y a cl ai m t hat hi s dam ages w oul d have been f ar l e s s s i g n i fi c a n t h a d h e s o u g h t m e d i c a l i n te rv e n ti o n s o o n e r. I n El bao r, t he pat i enthad und er gon e a sur gi cal pr ocedu r e o n h e rankl e, t w o pos t- s ur ge r y w ou nd d e br i de m e nt s a nd s e ve r a l h os pi t a l t r a ns f e r s . 845 S. W . 2d at242. The evi den ce at t r i al sh ow ed t hat sh e had be en unc oope r at i ve22

and no ncom pl i anti n t aki ng t he pr escr i bed anti bi ot i cs and t hatshe had been f r ee o f i n fe c ti o n p o s t o p e ra ti v e l y . Id. H ercondu ctcont r i buted di r ect l y t o hernew i n j u ry — h e r i n fe c te d a n k l e . Id. B u t fo r h e r re fu s a l to ta k e th e m e d i c i n e , th e re
m a yh a v e b e e n n o i n fe c ti o n . Id. C o n v e rse l y , i n R o n n i e ’s ca se , h i s fa i l u re to t i m el y se ek m edi ca l i nt erven t i on w ast he bas i s f ort he i ncr ea se d bl ee di ng, but i t di d not eve n ca us e t he bl ee di ng. I t w as t he t ea r t hat ca us ed th e b l e e di ng. A n d t h e b le e d in g is t h e s o le b a s is o f D r . T h o t a ’s c la im b a c ka g a in s tR o n n ie ; it qui t e si m pl y i s i n t he nat ur e ofRo nni e’ s f ai l ur e t o m i t i gat e. T h e d i s s e n t a l s o c o n te n d s th a t th e re i s a m p l e e v i d e n c e o f R o n n i e ’s
c o n t r ib u t o r yn e g lig e n c e d u e t o h is f a ilu r e t o r e t u r n t o t h e h o s p it a l s o o n e r . W h ile
w e a ck now l edg e t hatpa t i ent s ow e a dut y of coo per at i on t o t r ea t i ng ph ys i ci ans
w h o as su m e a d u ty o f ca re fo r t h e m a n d th a t su c h a d u ty i n c l u d e s a d u ty to
r et ur n f orev al uat i on a nd t r ea t m ent , t hatdut y do esnotj us t i f y t he su bm i ss i on ofRonni e’ s neg l i gen cei n c ont r i but i ng t o t he i nj ur y; i tm er el y j us t i f i esa que st i on o n h i s fa i l u re to m i ti g a te h i s d a m a g e s . S ee Jackson v. A xel rad, 221 S. W . 3d 6 5 0 , 6 5 4(T e x . 2 0 0 7 ); Gross v. Burt , 1 49 S. W . 3d 213, 225– 27 ( Tex. A pp. — FortW ort h 2004, pe t . de ni ed) . A gai n, Ronni e’ s f ai l ur e t o r et ur n di d not
c a u s e th e te a r, w h i c h w a s R o n n i e ’s th e o ry o f D r. T h o ta ’sn e g l i g e n c e . R o n n i e ’s f a ilu r e t o re t u r n t o t h e h o s p i t a l o n lyin c r e a s e d h is b le e d in g a n d t h e r e f o r e h is d a m a g e s . See Ker

by , 5 0 3 S . W . 2 d a t5 2 8 (s t a t in g , “ N e g lig e n c e t h a tm e r e ly23

i n c re a s e s o r a d d s to th e e x te n t o f th e l o s s o r i n j u ryo c c a s i o n e d b ya n o th e r’s
n e g l i g e n c e i s n o t s u c h c o n tri b u to ryn e g l i g e n c e a s w i l l d e fe a t re c o v e ry ” ). A ddi t i onal l y, t he di s s entm akes not e ofouri nt er chang e oft he t er m s,

“ i n j u ry ,” “a cc i den t , ” or“ occ ur r enc e. ” Thi s i s a r ed her r i ng t hatm ak esno di f f er enc e. W e c l ea r l y a ck now l edg e t hat t he cha r ge con t r ol s, an d i tus ed t he t er m “i nj ur y. ” W e have used t he ot hert er m s onl y w hen ci t i ng othercases t hat used “acci dent”or“occur r ence” i n t hei rchar ges. The di ss ental so bol dl y s t at es , “Young di d not di e f r om t he com pl i ca t i ons a n d s y s t e m s f a ilu r e s t h a tf o llo w e d c a r d ia c c a t h e t e r iz a t io n b y D r . T h o t a ,” a s if hi s f ai l ur e t o di e a bs ol ved t he def end ant s f r om l i abi l i t y f o r th e su r vi valac t i on t hatappel l antbr oug ht ; she w as pur sui ng a sur vi val act i on on behal fofher h u s b a n d ’se s ta te fo r th e to rtu ro u s l i fe h e e n d u re d fro m th e ti m e o f D r. T h o ta ’s
c a th e te ri z a ti o n u n ti l h e d i e d . S ee Te x. Ci v. Pr a c . & Rem . Cod e Ann . §71. 021 (V e rn o n 2 0 0 8 ); Pa ckv. Cro ssro a ds, I n c ., 53 S. W . 3d 492, 51 5

– 1 6 ( Tex. A p p .— F o rt W o rth 2 0 0 1 , p e t. d e n i e d ). Foral l of t hese r easons, w e concl ude and ho l d t hatt he t r i al courtabused i tsd i s c re ti o n b ys u b m i ttin g R o n n i e ’sa l l e g e d c o n tri b u to ry n e g l i g e n c e to th e j u ry in s t e a d o fg i v i n g t h e ju r ya n in s t r u c t io n o n R o n n ie ’s d u t yt o m it ig a t e h is dam age s. W e t her ef or e su st ai n t he partofap pel l ant ’ s se con d i ss ue cha l l eng i ng t he subm i ssi on of R onn i e’ s cont r i butory negl i gence.24

N ow w e m us tco nduc t a h ar m an al ys i s on t he er r one ouss ubm i ss i on of t he j ur y quest i on on Ro nni e’ s cont r i butory negl i gence. H a r m A n a ly s is G ene r al l y, th e rul esofap pel l at e p r oce dur e p r ovi de t w o ba se s f or re v e rs i n g a n e rro r o f l a w . T e x . R . A p p . P . 4 1 .1 , 6 1 .1 ; Ha rr i s Co un ty v. Sm ith , 9 6 S .W .3 d 2 3 0 , 2 3 4 (T e x . 2 0 0 2 ). T h e e r r o rm u s tb e o n e w h ic h “ p r o b a b ly
ca us ed th e r end i t i on ofan i m pr ope rj udgm ent ”— 44. 1( a) an d 61. 1( a)

— ort he
er r orm us tbe onew hi ch “p r oba bl y pr eve nt ed t he pet i t i one r[ app el l ant ] f r om p ro p e rl yp re s e n ti n g th e c a s e to th e a p p e l l a te c o u rts ”

— 4 1 .1 (b ) a n d 6 1 .1 (b ). T e x . R . A p p . P . 4 1 .1 , 6 1 .1 . Ca s te el ’s“pr esum ed har m ” char ge analy s is has been l i m i t ed t o char ge er r ori n w hi ch er r oneo us t heor i es ofl i abi l i t y ordam ages
w er e m i xed w i t h va l i d t heo r i esan d t he r evi ew i ng cou rtw asuna bl e t o de t er m i ne
w h e th e r th e i m p ro p e rl ys u b m i tte d th e o ri e s fo rm e d th e s o l e b a s e s o f th e j u ry ’s
v e rd i c t o r d a m a g e s . Ha rri sCo un ty, 9 6 S .W .3 d a t 2 3 5

– 3 6 ; Crown L if e I ns . Co.
v. Casteel, 2 2 S .W .3 d 3 7 8 , 3 8 9 (T e x . 2 0 0 0 ). H o w e v e r , w h e n t h e e r r o rs im p ly i n v o l v e s e rro n e o u s s u b m i s s i o n o f i n fe re n ti a l re b u tta l i n s tru c ti o n s , Uri sta t el l s us th a t w e m u st sh o w tha t t h e erro r ca u se d ren d i ti o n o f an i m p rop e r j u d g m e n t. Be d , Ba than d

Be yo n d

v. Uri sta , 2 1 1 S .W .3 d 7 5 3 , 7 5 7 (T e x . 2 0 0 6 ); see al so To r res v. Tessi

er, 2 3 1 S .W .3 d 6 0 , 6 3 n .2 (T e x . A p p .— H o u s to n [1 4 th D i s t.] 2 0 0 7 , n o p e t.).25

H er e, t her e w er e t w o com pet i ng t heo r i es of l i abi l i t y su bm i t t ed w i t hi n one br oad- f or m l i abili ty q uest i on t hatasked oft he t w o pr i m ar y act or s’ pot ent i al l i a b i l i ty : o n e w a s v a l i d a n d th e o th e r i n v a l i d . T h u s , Casteel’sp re s u m e d h a rm a n a l y s i s a p p l i e s . Ca s te el , 22 S. W . 3d at 388 –89 . The j ur y’ s ans w er s, f i ndi ng
n o n e g l i g e n c e a t t ri b u tab l e to D r. T h o ta a n d allthe n e g l i g e n c e attri b u tab l e to Ronni e, co m m i ngl ed val i d a nd i nva l i d t heo r i es of l i abi l i t y bec aus e t her e w asno e v i d e n c e o f R o n n i e ’s n e g l i g e n c e i n ca u sing the tea r an d n o clai m b yD r. T h o ta t hatRo nni e’ s negl i gence caused t he t ear . W hi l e one m i ght ar gue t hatw e, as t he ap p e l l a t e c o u rt , c a n s t i l l a f f i r m t h e j u r y ’ s v e r d i c t b e c a u s e i t mi g htha ve fo u n d tha t D r. T h o ta w a s n o t n e g l i g e n t, w h e n l o o k i n g at th e j u ry c h a rge i n i ts enti re ty a s w e m us t , w e c ann otkn ow i ft he j ur y t r ul y f ound D r . Thot a n ot
n e g l i g e n t or w h e th e r t h e j u ry e x c u se d a n yn e g l i g e n c e attri b u tab l e to D r. T h o ta b e c a u se o f pro p e rl ysu b m i t t e d i n fere n ti a l reb u ttal i n stru c ti o n s. T h e refo re, t o answ ert hi s quest i on, w e m ustal so eval uat e th e pr opr i et y oft he chal l enged i n fe re n ti a l re b u tta l in s tru c ti o n s ; i f th e i n fe re n ti a l re b u tta l i n s tru c ti o n s w e re er r one ous l y s ubm i t t ed asw el l , t hen t he j ur y’ s no l i abi l i t y f i ndi ng c oul d a l so ha ve b e e n b a s e d o n a n i n c o rre c t th e o ry . See i d. at38 9 ( st at i ng, “I ti s ess ent i al t hat t he t heo r i es su bm i t t ed be aut hor i z ed and s upport ed by t he l aw gov er ni ng t he
c a s e. . . [a n d i]ft h e ya r e n o t , t h e a p p e lla t e c o u rtm u s t , a ta m in im u m , b e a b le26

t o de t er m i ne w het herpr ope r l y su bm i t t ed t heo r i es con st i t ut ed t he bas i s oft he j u ry ’s v e rd i c t” ). U nav oi dab l e Acci den t The c ourtga ve t hi s def ens i ve i n s tru c ti on a s t o bot h Dr . Thot a’ s and Ronni e’ s pot en ti a l n e gl i gen ce . “ A n una voi dab l e a cc i den ti s ‘ an eve ntnot pr oxi m at el y caused by t he negl i gence of any part y t o i t . ’ ” Rei nha rtv. Young , 9 0 6 S .W .2 d 4 7 1 , 4 7 2 (T e x . 1 9 9 5 ); TXI Transp. Co. v. Hugh es , 224 S. W . 3d 8 7 0 , 905 ( Tex. A pp. — FortW ort h 2007, pe t . gr ant ed) ( quot i ng D al l as R y. & Term i nal Co. v. Bai

ley , 151 Tex. 359, 250 S. W . 2d 379 , 385 ( 195 2) ) . Usual l y, t hi s i ns t r uct i on i s i ncl ude d w hen t her e i s a q ues t i on ofs om e p hys i ca l co ndi t i on o rc ir c u m s t a n c e t h a tm ig h to b v ia t e t h e n e c e s s it yo ff in d in g t h a ts o m e p a rt yis
n e g l i g e n t. Rei

nh a rt, 90 6 S . W . 2d at 47 2. Th i s i nst r uct i on i s al so gi ven w hen t he evi den ces how s t hatt he eve nt w asca us ed by s om e “ nonhu m an con di t i on and not by t he negl i gence of any part y t o t he event. ” Hill v. W i n nD i xi eT ex ., I nc. , 849 S . W . 2d 8 0 2 , 8 0 3 ( Tex. 1992 ) . Typi ca l l y, i ti s us ed w hen s om e env i r onm e nt al co ndi t i on s uch asf og, s now , s l ee t , w etors l i ckpa vem ent , or s o m e o b s tru c ti o n o f v i e w i s i n v o l v e d . Id. C ourt s have al so pr evi ousl y appr oved ofan i nst r uct i on i n si t uat i ons of“unexpected ca ta st r oph e” orsom e “pecul i ar c i rc u m s ta n c e ” o th e r th a n th e n e g l i g e n c e o f th e p a rti e s . Id. “ C o u rt s s h o u ld
r ef r ai n f r om subm i t t i ng an un avoi d abl e acci dent i nst r uct i on i n ot her27

ci r cum st anc esduet o t he r i skt hatt he j ur y w i l l be m i sl ed orco nf us ed by t he per cept i on t hatt he i nst r uct i on r epr esent s a s epar at e i ssue di st i nctf r om gener al pr i nci pl es ofnegl i gence. ” Id. W h i l e h i sto ri c a l l yp e rm i tted i n the m e d i c a l m a l p rac ti c e are n a , T e x a s c o u rt s have r equi r ed a def endan tt o “f i r st pr esentevi dence t hatt he event w as caused by som e cond i t i on ot her t han t he negl i gence of t he part i es. ” Crawf ord v. Hope , 898 S.W .2 d 9 37, 941 ( Tex. A pp. — A m ar i l l o 1995, w r i tde ni ed) . O nl y i ft he d e fen d a n t co m e s fo rw a rd w i th su c h ev i d e n c e w o u l d a c o u rtb e req u i red to
s u b m i t th i s i n fe re n ti a l re b u tta l q u e s ti o n i n i ts c h a rg e . Id. A t r i al cou rt doe s not
a b u se i ts d i sc reti o n b ysu b m i tti n g the i n stru c tio n i f t h e re i s a n yev i d e n c e to
s u p p o rt i t. Ker

r v. Bro wn , No. 07- 05- 0004 3- CV , 2007 W L6138 47, a t*2 (T e x . A p p .— A m a ri l l o F e b . 2 8 , 2 0 0 7 , p e t. d e n i e d ). In th i s c a s e , D r. T h o ta p re s e n te d s o m e e v i d e n c eth a t th e te a r i n R o n n i e ’s
a rt e r yc o u ld h a v e b e e n a n a t u r a l r e s u lt o f s o m e o f R o n n ie ’s d is e a s e s o rc o u ld h a v e c o m e fro m a b l o o d c l o t th a t fo rm e d a n d b ro k e a w a y f r o m t h e p u n c tu re si t e. The t r i al courtcoul d have deter m i ned t hatt hi s w as an unexpected
ca t as t r opheorev ent , an d a l t hough a hum an con di t i on, nota hum an con di t i on ca us ed by t he neg l i gen ceofei t heroneoft he part i es . Ther ef or e, w e c onc l ude t h a tt h e t r ia l c o u rtd id n o t a b u s e it s d is c r e t io n b ys u b m it t in g t h e u n a v o id a b le
ac ci den ti ns t r uct i on a s t o bot h D r . Thot a a nd Ronni e a nd t hatt hi s i ns t r uct i on28

w oul d ha ve no e f f ec ton our har m an al ys i s r ega r di ng t he er r one ouss ubm i ss i on o f R o n n i e ’sc o n tri b u to ryn e g l i g e n c e . S e eg en era lly D i l l ard v. Tex. Elec . Co- op. , 1 5 7 S .W .3 d 4 2 9 (T e x . 2 0 0 5 ). N ew and I ndep enden tC ause O nl y Dr . T h o t a r e c e i v e d t h e b e n e f i t o f a n e w a n d i n d e p e n d e n t cause i nf ere n t i al r ebu t t al i ns t r uct i on. Thi s i ns t r uct i on i s r equ i r ed onl y w hen t he evi dence show s t hat“an actor om i ssi on of a separ at e and i ndep enden tagency
w hi ch des t r oyst he ca us al co nne ct i on bet w ee n t he neg l i gen t ac t orom i ss i on of t he def end antan d t he i nj ury c om pl ai ned of , an d t her ebybe com esi n i t se l f , t he i m m e d i a te c a u s e o f s u c h i n j u ry ” h a s o c c u rre d . Ha l l v. Hu ff, 957 S. W . 2d 90, 95 ( Tex . A pp. — Tex ar kana 1 99 7, pet . deni ed) . I t i s not an af f i r m at i ve def ense b u t i s a fac to r t o b e co n side red b ythe j u ry i n d e term i n i n g w h e th e r pro x i m a te
c a u s e e x i s ts . Jam esv. Kloos , 7 5 S .W . 3 d 1 5 3 , 1 6 1 ( T e x . A p p .— F o rtW o rt h 200 2, no p et . ) . I n c onne ct i on w i th an i ns t r uct i on on ne w an d i nde pen den t cause, a def endan tm ustshow t hat t he i nt er veni ng cause dest r oys t he causal
con nec t i on be t w ee n t he def end ant ’ s al l ege d ne gl i gen ce and t he r es ul t anti nj ury. Kloos , 7 5 S .W .3 d a t 1 6 1 ; Hu ff, 957 S. W . 2d a t95. I n K l oos, w e sta ted tha t Tex as court s di st i ngu i sh bet w e e n a new and i ndep enden tcause a n d a co ncu r r entac t . A concu r r entac tco ope r at esw i t h t he or i gi nal ac t i n br i ngi ng a boutt he i nj ur y a nd do esnotcu tof ft he l i abi l i t y oft he or i gi nal act o r . A new and i ndep enden tcause,29

som et i m es r ef er r ed t o as a super sedi ng cause, how ever , i s an act orom i ss i on of a se par at e and i nde pen den t age ncy t hat des t r oyst he ca us al c o n n e ct i on be t w ee n t he neg l i gen tac torom i ss i on oft he def endan t and t he i nj ur y com pl ai ned of . . . . A n i nt er veni ng cause th a t i s re a so n a b lyforese e a b leb ythede fen da n t, tho u g h , i s n o t a new an d i nde pen den tca us e t hatbr ea kst he cha i n ofca us at i on. 75 S. W . 3d at161 ( ci t at i onsom i t t ed) ( em pha si s add ed) . Bec aus e a new an d i nde pen den tca us e “ ext i ngui sh est he l i abi l i t y of a part y[ , i t ] ca nnot ar i se outof an af f i r m at i ve act of negl i gence by ei t hert he pl ai nt i f fort he def endan t . ” Bi aggi
v. Patr i zi o Rest. , I

nc. , 1 4 9 S .W .3 d 3 0 0 , 3 0 5 ( T e x . A p p .— D a l l a s 2 0 0 4 , p e t. d e n ie d ). I t i s a l s o c le a rt h a t“ m e r e lyg u e s s in g a tp o s s ib le c a u s e s ” is i nsuf f i ci ent ; m edi cal expertt est i m ony that goes “no f urt her t han t o t est i f y t hat
cert ai n i nt er veni ng even t s could have caused ” an i nj ur y i s “e qui voc al t es t i m ony” t hati s i nsuf f i ci entt o w ar r antan i nst r uct i on on new and i ndep e n d entcause. He rsh v. Hendley , 6 2 6 S . W . 2 d 1 5 1 , 1 5 7 ( T e x . Ap p . — F o rt W o rt h 1 9 8 1, no
w ri t) (e m p h a s i s a d d e d ). H er e, t he t r i al court i nst r uct ed t he j ur y, as t o D r . Th ot a onl y, t hat a new and i nde pen den tca us e m a y b e t he “a ctorom i ss i on ofa se par at e a nd i ndep enden tagency, notr easonabl y f or seeabl e by a car di ol ogi st. . . t hat dest r oys t he causal connecti on . . . and t her eby becom es t he i m m edi at e cause ofsuch i nj ur y. ” A l l part i es agr eed t o th e s ta n d a rd ofcar e f ora car di ol ogi st perf or m i ng a cat h e ter i z at i on: t o i ns ertt he nee dl e a nd c at het eri nt o t he r i ght f em or al art er y, as opposed t o t he r i ght ext er nal i l i ac art er y. Th e i ssue her e w as30

not w hatt he appr opr i at e st andar d of car e w as but w het herD r . Th ot a br eached th a t s ta n d a rd a n d w h e th e r th a t b re a c h w a s w h a t c a u s e d R o n n i e ’s
r et r op e ri t one al bl ee d. The evi den ce , i ncl udi ng t he evi den cepr ovi ded by t he
su r geo n w ho r epa i r ed t he bl ee d, w as t hat t he art er i al t e a r a n d h em at om a occur r ed at th e p unctur e si t e i n t he ext er nal i l i ac art er y. Thi s evi dence w as c o r r o b o r a t e d b yD r . S u d a r s h a n , D r . T h o t a ’s p a rt n e r w h o h e lp e d c a r e f o rR o n n ie t hatni ght, and by D r . D ohert y, appel l ant ’ s expertw i t ness. M or eover , D r . Th ot a speci f i cal l y agr eed t hat t he bl eedersi t e had t o be at th e o ri g i n a l p u n c tu re s i te; h e si m p l y c la im s th a t t h e tea r w a s a res u l t of a d i s l o d g e d c l o t a n d th a t th e e x te n s i v e b l e e d i n g w a s th e re s u l t o f R o n n i e ’sfa i l u re t o r et ur n. W hi l e D r . D ohert y conced es t hati ti s a p o ssi b i l ityt hata cl otove rt he
s it e c o u l d h a v e d is lo d g e d , t h e r e is n o e v id e n c e t h a tt h is w a s w h a ta c t u a lly h a p p e n e d ; a p o s s i b i l i tyi s n o t e n o u g h . S e ei d. a t157. R e g a rdles s, b o th su b se q u e n t disl o c a ti o n o f a c l o t ov e r th e p u n c tu re s i te and bl e e d i ng f r om t he punc t ur e s i t e a r e f or es ee abl e r i sk s i n a ca t het er i z at i on pr ocedu r e. Thu s, nei t heri s a new and i ndep enden t cause but r at her a pot ent i al
con cur r i ng c aus e. Ther ef or e, w e h ol d t hati t w as er r ort o s ubm i tan i ns t r uct i on on new and i ndep enden tcause on ei t heroft hese t heor i es as t o D r . Th ot a. A ppe l l ee s al so ar guet hatt he cl ai m ed f ai l ur e o fbot h Ronni e a nd a ppe l l ant t o t i m el y se ek m edi ca l i nt erven t i on a f t ert he pr oce dur e c ons t i t ut ed a n ew an d31

i ndep enden tcause. H ow ever , as not ed abov e, w e m ay not l ook t o orconsi der app el l ant ’ s cl ai m ed neg l i gen cei n notas si st i ng her hus ban d w i t h t i m el y s ee ki ng
m edi cal hel p af t ert he pr ocedu r e, and w e m ay not consi derRo nni e’ s cl ai m ed
n e g l i g e n c e b e c a u s e h i s n e g l i g e n c e w o u l d n o t b e th a t o f a n o n p a r t y o r a th i rd per so n. M or eov er , w e c ann o t s ay t hata pat i ent ’ s f ai l ur e t o f ol l ow di sc har ge i nst r uct i ons i s a new and i ndep enden tcause because such a fa i l ur e i s al so re a s o n a b l y fo re s e e a b l e . S e eK n o l l v. Neb le tt, 966 S. W . 2d 622, 634 ( Tex. A pp. — H ous t on [ 14t h Di st . ] 1998 , pe t . de ni ed) . Ther ef or e, w e c onc l ude an d hol d t hatt he t r i al co urtab us ed i t s di sc r et i on by s u b m i tt i ng a n i ns t r uct i on on new and i ndep enden t cause i n conn ect i on w i t h D r . Th ot a’ s al l eged neg l i gence. W e now r et ur n t o ourhar m anal ysi s. O urquest i on no w becom es, w hat i s t he ef f ectofan i m pr oper l y subm i t t ed
con t r i but or y ne gl i gen ceque st i on w i t h a pr ope r l y su bm i t t ed neg l i gen ceque st i on i n c onj unc t i on w i t h a pr ope r l y su bm i t t ed una voi dab l e a cc i den ti ns t r uct i on a nd an i m pr oper l y subm i t t ed new and i ndep enden tcause i nst r uct i on? I n ot her
w o rd s , w h i c h h a rm a n a l y s i s d o w e a p p l yw h e n w e h a v e h y b ri d c h a rg e e rro r? A re w e to ap p l ythe p res u m e d h a rm tes t of Casteel t o t he imp rop er

lysubm i t t ed j u ryq u e s ti o n o n R o n n i e ’s c o n tri b u to ryn e g l i g e n c e y e t a p p l y th e tra d i ti o n a l h a rm a n a l y sis o f Uri

sta to th e i nco r r ec t l y s ubm i t t ed i ns t r uct i on on ne w an d i ndep enden tcause? Uri sta , 2 1 1 S .W .3 d a t 7 5 6

– 5 7 ; Casteel, 22 S. W . 3d at32

38 9. W e bel i eve t he answ ercan be f oun d i n t he supr em e court ’ s ow n w or ds,

“ [A ]lt h o u g h h a r m c a n b e p r e s u m e d w h e n m e a n i n g f u l a p p e lla t e re v ie w is p re c l u d e d b e c a u s e v a l i d a n d i n v a l i d th e o ri e s o rd a m a g e e l e m e n ts a re com m i ngl ed [ Ca steel], w e a r e n otpe r su ade d t hatha r m m us tl i ke w i sebe pr es um ed w h e n proper j ur y quest i ons ar e subm i t t ed al ong w i t h i m pr oper i nf er ent i al r ebutt al i nst r uct i ons. ” Uri sta , 2 1 1 S .W .3 d a t 7 5 7 (e m p h a s i s a d d e d ). Th e Uri sta c o u rt’s u s e o f t h e w o rd s , “proper j ur y qu es t i ons , ” i s ke y t o t he analy s i s her e; i n Uri sta th e s o l e n e g l i g e n c e th e o ry — th a t o f th e d e fe n d a n t’s negl i gence— was p rop er lys u b m i tte d . Id. Thusi n Uri sta , t he re w a s onl y on e neg l i gen cet heo r y s ubm i t t ed and i tw aspr ope r , s o t he er r one ouss ubm i ss i on of t he i nf er ent i al r ebu t t al i ns t r uct i on w asea si l y de t er m i ned t o beha r m l es s i n l i ght
o f th e e n ti re s ta te o f th e e v i d e n c e a n d th e c h a rg e . Id. H e re , h o w e v e r, th e j u ry
w as not onl y gi ven an er r one ousde f ens i ve i ns t r uct i on on ne w an d i nde pen den t
ca us e t hatbe nef i t t ed onl y Dr . Thot a b utal so a n er r one ousj ur y qu es t i on on l i abi l i t y— Ronni e’ s con t r i but or y ne gl i gen ce — a t heo r y no t s upport ed by t he evi den ce . So, w e s h o u l d notbe l i m i t ed t o Uri s ta ’st r a d it io n a l h a r m a n a ly s is
w hen t r yi ng t o de t er m i ne t he i m pac t of t he i m pr ope r l y s ubm i t t ed i ns t r uct i on on
n ew and i ndep enden tcause w hen com bi ned w i t h t he i m pr oper l y subm i t t ed que st i on of Ronni e’ s con t r i but or y neg l i gen ce . W e si m pl y ca nnot det er m i ne, on t h is e v id e n c e , w h e t h e rt h e ju r y p r o p e r lyf o u n d D r . T h o t a n o tn e g lig e n t , p r o p e r ly33

f ound t hathi s neg l i gen cew asex cus ed bas ed upon t he una voi dab l e a cc i den t i ns t r uct i on, ori m pr ope r l y f ound t ha t hi s neg l i gen cew asex cus ed bas ed upon t he new and i ndep enden tcause i nst r uct i on al one orcom bi ned w i t h i t s i m pr oper fi n d i n g o f R o n n i e ’s n e g l i g e n c e . R e s p o n s et o D is s e n t ’sC r it iq u eo fO u rH a r m A n a ly s is N ow , i n r es pons e t o m anyoft he cl ai m s m ade by t he di ss ent , w e d o not agr eet hatt he j ur y “ se par at el y”an d c l ea r l y f ound “n o” as to w het heran y neg li g ence ofD r . Th ot a w as a pr oxi m at e cause ofRo nni e’ s i nj ur y. I tw as a br oad- f or m l i abi l i t y subm i ssi on qu est i on t hater r oneo usl y subm i t t ed one pr oper l i abi l i t y qu es t i on ( D r . Thot a’ s) an d onei m pr ope rl i abi l i t y qu es t i on ( Ronni e’ s) an d obscur ed t he ef f ectofs u c h a n e r r oneo us quest i on w i t h t he subm i ssi on of at l ea stoneer r one ousde f ens i ve i ns t r uct i on t hatw asco m pl et el y a toddsw i t h t he fac ts o f th e c a se , th e e v i d e n c e su b m i tted , a n d the b a ttl e fou g h t bythe ex p e rt s i n t he ca se . M or e i m port ant l y, t he su bm i ss i on f ai l s t o t r ac k t he pl ea di ngsoft he case and t he evi dence and t heor i es t hatw er e act ual l y pur sued dur i ng t he t r i al oft he case. Th e di ssentsays t hatt he m aj or i t y has sua spont e i ncor r ect l y appl i ed Ca s te el ’s“pr esum ed har m ” anal ysi s e venif wea ss um eth etr

ia l c o urter

re d in
s ubm itti

ng t he que st i on of Ronni e’ s con t r i but or y neg l i gen ce and gi vi ng D r. Th ot a an i nf er ent i al r ebutt al i nst r uct io n o n new and i ndep enden tcause.34

H ow eve r , i ti s not j us t t hat com bi nat i on t hat r equ i r es us t o pr es um e h ar m but th e in c o r r e c t s u b m i s s i o n o f o n e c o rre c t th e o ryo f l i a b i l i ty
— D r. T h o ta ’s
n e g l i g e n c e — w i th o n e i n c o rre c t th e o ry o f l i a b i l i ty
— R o n n i e ’sa l l e g e d c o n tri b u to ry neg l i gen ce — w hi ch, ac cor di ng t o Casteel, w h e n s u b m i tte d i n o n e b ro a d -fo rm l i abi l i t y i nst r uct i on r equi r es us t o pr esum e har m . 22 S . W . 3d at 38 9. Because Ronni e’ s t heo r y ofne gl i gen ceag ai ns tD r . Thot a i s bas ed upon t he t ea ran d b e c a u s e D r. T h o ta ’sth e o ryo f n e g l i g e n c e a g a i n s t R o n n i e i s b a s e d u p o n R o n n i e ’s f ai l ur e t o t i m el y seek m edi cal hel p, i ti s qui t e cl eart hatRo nni e’ s al l eged contr i butory negl i gence cou l d not have avoi ded D r . Th ot a’ s i ni t i al negl i gence; i t c o u l d o n l yh a v e re d u c e d th e d a m a g e s R o n n i e s u ffe re d . The di ss ental so co nt end s t hat w e a re rev er si ng on una ss i gne d e r r or app ar ent l y j us tbe ca us e a ppe l l ant ’ s br i ef doe s nots pec i f i ca l l y c i t e t o Casteel. H er br i ef does, ho w e v e r, ci t e W al
-MartStores, I

nc. v. Johns on , 106 S. W . 3d 7 1 8 , 7 2 3 (T e x . 2 0 0 3 ) a n d q u it e p la in lyf o c u s e s o n it s p r im a r yp o in to n a p p e a l: [ B] ec aus e t hi s i ns t r uct i on ( una voi dab l e a cc i den t ) w aspr em i se d on a d i f f er ent‘ i nj ury’ ( an al l ege d c l ot b re ak i ng l oos e) t han w er e t he
‘ con t r i but o r y ne gl i gen ce ’ que st i on a nd ‘ new an d i nde pen den t ca u s e ’ i n s t r u c t i o n , i ti s a n e a rc e rt a i n t yt h a ti ts e r v e d t o conf use th e j u ry s u c h tha t i t l e d to th e ren d i ti o n o f an i m p rop e r j u d g m e n t. A ppe l l antal so not ed i n heror i gi nalbr i ef i ng, “ The s ubm i ss i on oft hi s i ns t r uct i on pr oba bl y ca us ed t he r end i t i on ofan i m pr ope rj udgm ent , ” al so ci t i ng W a l-Ma rt .35

T h u s , w e b e lie v e t h e is s u e o ft h e c o r r e c th a r m a n a l y s is t o a p p lyt o p r o p e r ly pr eserved char ge er r ori s pr oper l y bef or e us. N e x t, th e d i s s e n t a l s o c o n te n d s th a t s o l e l yb e c a u s e c o n tri b u to ry negl i gence i s an af f i r m at i ve def ense i t i s not i t s ow n t heor y of l i abi l i t y and t hat
w e ar e w r ong w hen w e hol d t hat th e fi r stj ur y quest i on com bi nes a pr oper l i abi l i t y qu es t i on ( Thot a’ s neg l i gen ce ) an d a n i m pr ope r l i a b i l i t y qu es t i on (R o n n i e ’s co n tr i b u to ry n e g l i g e n c e ). R e m a rka b l y , th e d i ss e n t i tse l f ba se s i ts t heo r y ofRonni e’ s neg l i gen ceon h i s b rea ch ofa dut y t o t i m el y r et ur n t o t he hos pi t al an d t ha t th i s i s t he pr oxi m at e c aus e o fRonni e’ s bl ee di ng, w hi ch t he di ss ents aysi s t he “i nj ur y”i ns t ea d oft he dam age s. Butac cor di ng t o A xel rad, “Ther ul esw hi ch det er m i ne t he con t r i but or y neg l i gen ce of a pl ai nt i f f ar e . . . t he
s a m e a s t ho s e w hi c h de t e r m i ne t hen e gl i ge nc e o ft hed e f e nd a nt . ” 221 S. W . 3d
a t 6 5 7 ( q u o ti n g R e sta tem e n t ( S e c o n d ) o f T o rt s § § 2 8 9 cm t. a, 4 6 4 ). “[D ]uty i s an el em entofcont r i butory negl i gence. ” Nat ’ l Uni on Fi re I ns . C o . of Pittsbur gh, Pa . v. I

n s . Co . o f

N. A m. , 955 S . W . 2d 120, 136 ( Tex. A p p .— H o u s to n [1 4 th D i s t.] 1 9 9 7 ) , a ff’d, 2 0 5 S .W .3 d 6 9 2 (2 0 0 0 ). C o n tr i b u to ry n e g l i g e n c e i s a n d a lw a y s h a s b e e n n e g l i g e n c e o n the p a rto f a pl ai nt i f ft h a ti s a b r ea ch ofa dut y, ow ed t o one se l f , t hats upe r se dest he
c a u s a ti o n o f d a m a g e s to o n e s e l f. Id. Jus t bec aus e i t i s r ai se d as an af f i r m at i ve d e fen se d o e s n o t m e a n i t i s n o t i ts o w n the o ry o f l i a b i l i ty th a t do e s n o t ha v e to36

be pr oved by t he def ense. A l t hou gh D r , Th ot a t est i f i ed t hathe di d not bl am e R o n n i e , h i s d e fe n s i v e th e o ryw a s th a t R o n n i e d i d n o t fo l l o w D r. T h o ta ’s di schar ge i nst r uct i ons and t hatRo nni e shoul d have cal l ed D r . Th ot a orr et ur ned t o t he em er gen cy r oom ea r l i eri n t he eve ni ng; t hat , i fheha d, hew oul d notha ve bl ed asm uch . Dr . Thot a nev er sa i d t hat Ronni e w oul d ha ve nev err ec ei ved t he t e a ri n h i s r i g h ti l i a c a rt e r y . I n f a c t , h e a c k n o wl e d g e d t h a tt h e r e wa s a t e a r . He
e v e n a d m i tte d i t w a s a t th e p u n c tu re s i te , i .e ., w h e re h e i n s e rte d th e c a th e te r. H e j u s t d e n i e d w h e re th a t i n s e rti o n w a s a n d i ts c a u s e . I m p o rta n tl y , h i s th e o ry o f l i a b i l i ty a g a i n st R o n n i e , h o w e v e r, w a s b a se d so l e l yu p o n R o n n i e ’s fai l u re to t i m el y seek m edi cal i nt er vent i on; he says t hi s i s t he cause oft he ext ensi veness oft he bl eed, w hi ch i s t he basi s ofhi s al l egat i on of R onn i e’ s negl i gence. By ar gui ng t hatonl y on e t heo r y ofl i abi l i t y w ass ubm i t t ed i n j ur y qu es t i on
n u m b e r o n e , a l b e i t i n tw o s u b p a rts , th e d i s s e n t a tte m p ts to fo rc e th e d e fe n s e ’s t heor y of l i abi l i t y f or i nj ur y onto Ronn i e’ s t heor y ofl i abi l i t y agai nstD r . Th ot a. I n ot her w or ds , t he di ss ent att em pt s t o f or cet he def ens e’ s t heo r y ofi nj ur y ( t he ext ensi ve bl eedi ng) on t o R onn i e’ s t heor y ofi nj ur y ( t he t ea r). B ecause t hese t w o t heo r i esofne gl i gen cew er e c om m i ngl ed i n one br oad

- f or m que st i on, one i n c o rre c t a n d o n e c o rre c t, th e re w a s h a rm . S ee Casteel, 22 S. W . 3d at 3 8 8

– 8 9 . M o re o v e r, th e i n c o rre c t s u b m i s s i o n o f R o n n i e ’sa l l e g e d c o n tri b u to ry neg l i gen cew as exa ce r bat ed by t he add i t i ona l i nco r r ec ti ns t r uct i on on ne w an d37

i n d e p e n d e n t ca u se tha t D r. T h o ta rec e i v e d . I t i s th e co m b i n a ti o n o f t h e se tw o i nco r r ec tt heo r i est hatpre v e n ts u s f r om be i ng a bl e t o de t er m i ne w het hert he j ury’ s f i ndi ng ofno l i abi l i t y a s t o Dr . Thot a w asa f i ndi ng ofno n egl i gen ceon hi s part , an er r oneo us f i ndi ng ofcont r i butory negl i gence on Ro nni e’ s part , oran er r oneo us f i ndi ng of new and i ndep enden tcause. I mp o rt a n t l y , we a r e n o t t r y i n g t o ex t end Ca s te el ’sp re s u m e d h a rm a n a l y s i s to d e fe n s i v e th e o ri e s ; w e a re a p p l y i n g i t to a s i n g l e b r o a d -fo rm que st i on t hat er r one ous l y i ncl ude s t w o di f f er entt heo r i esofl i abi l i t y. Thi s er r or i s onl y e xac er bat ed by t he er r one ousde f ens i ve i ns t r uc ti o n o f new an d i ndep enden tcause. C onc l us i on

“ [A ] l it ig a n tt o d a yh a s a rig h tt o a f a irt r ia l b e f o r e a ju r yp r o p e r ly i ns t r uct ed on t he i ss ues‘ aut hor i z ed and s upport ed by t he l aw g o v e rn i n g t he
case. ’ ” Ha rr

i s Co un ty , 96 S. W . 3d at 234 ( quot i ng Casteel, 2 2 S .W .3 d a t 3 8 9 ). W e th e re fo re c o n c l u d e th a t th e tri a l c o u rt e rre d b y o v e rru l i n g a p p e l l a n t’s
o bj e c ti o n s to th e c h a rg e re g a rd i n g s u b m i s s i o n o f R o n n i e ’sc o n tri b u to ry negl i gence and t he new and i nd e p e n d e ntcause i nst r uct i on. Because t hese i n stru c ti o n s l i k e l yca u se d ren d i ti o n o f an i m p rop e r j u d g m e n t or, at l e a st, pr eve nt ed app el l ant f r om pr ope r l y pr es ent i ng her ca se on app ea l , w e c onc l ude38

th a t s u c h e rro r w a s h a rm fu l . S ee Tex . R . A pp. P. 44 . 1. W e t her ef or e r ever se a n d re m a n d f o ra n e w t r ia l. Becau se w e have f oun d t r i al court er r ori n t he char ge suf f i ci entt o cause h a r m re q u ir in g re v e r s a l, w e n e e d n o t r e a c h a p p e lla n t ’s o t h e r is s u e s o n a p p e a l. S ee Tex. R. A p p. P. 47. 1. W e r eve r set he j udgm entoft he t r i al co urtan d
re m a n d th e c a u s e to th e tri a l c o u rt fo r a n e w tri a l . T e x . R . A p p . P . 4 3 .2 (d ).

T E R R I E L I VI NGS T ON J U S T I C E
PA N EL: L I V I N G STO N , G A RD N ER, an d M C C O Y, JJ. G A RD N ER, J. f i l ed a d i ss ent i ng op i ni on. DEL I VERE D: Nov e m be r20, 2008

## COURT OF APPEALS SECOND DISTRICTOFTEXAS FORT WORTH
NO. 2 - 05 - 35 0- CV
M AR GAR E TY OUN G, I NDI VI DUA L L Y AND AP P E L L ANT A S REPRES EN TA TI V E O F TH E ESTA TE O F W I L L I AM R . Y OUN G V . V EN KA TESW A RLU TH O TA , M . D . A N D A PPELL EES N O RTH TEX A S C A RD I O LO G Y C EN TER

----- ----- -- FR O M THE 3 0 TH DI STRI CT CO URT O F W I CH I TA CO UN TY

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### DI SS E NTI NG OP I NI ON

----- ----- -- I t hi nk t he t r i al cou rt got t he j ur y cha r ge r i ght . Butev en as su m i ng e r r or i n su bm i s s i o n o fb o t h c o n t r i b u t o r yn e g l i g e n c e a n d t h e n e w a n d i n d e p e n d e nt
c a u se i n stru c ti o n , I d i sa g ree tha t t h e “p res u m e d h a rm ” a n a l y sis o f Casteel
a p p l i e s . T h e j u rys e p a ra te l yfo u n d “ n o ” a s to w h e th e r a n yn e g l i g e n c e o f D r. Thot a w asa pr oxi m at e c aus e o fW i l l i am R. ( “Ronn i e” ) Young’ s i nj ury. E x a m in a t io n o ft h e e n t ir e r e c o r d s h o w s t h a t t h e ju r y w a s f a c e d w it h a “ b a t t le2

ofexpert s” as t o D r . Th ot a’ s negl i gence. I t i s pr obab l e t hatt he j ur y r esol ved t he confl i ct s i n t est i m ony i n f avor of D r . Th ot a i n r ef usi ng t o f i nd t hathe w as negl i gent. Ther e i s no cl eari ndi cat i on t hat t he j ur y w as i nf l uenced by t he new and i nde pen den tca us e i ns t r uct i on. I w oul d hol d th a tev en i ft her e w aser r or i n th e c h a rg e , i t p ro b a b l yd i d n o t re s u l t i n a n i m p ro p e r j u d g m e n t. T h e re fo re , I
m u st d i ss e n t. I . B AC K GR OUN D I NF OR M AT I ON I tw as undi sput ed t hatRo nni e had ext ensi v e pr e- exi st i ng m edi cal cond i t i ons i ncl udi ng chr oni c obst r uct i ve pul m onar y di sease, c a r di ac di sease
w i t h hyp ert ensi on, and a com pl et el y occl uded r i ght cor onar y art er y di agno sed i n 1 99 2 w hen he had a pr evi ous car di ac cat het er i zat i on. A s t he m aj or i t y notes , h e h a d a l s o b e e n d ia g n o s e d w it h p o ly c y t h e m ia v e r a (“ P V ” ), a ra r e , in c u r a b le bonem ar r ow di so r derr es ul t i ng i n ove r pr oduc t i on of bl ood ce l l s, f or w hi ch he had been t r eat ed w i t h bi-m o n t hl y phl ebotom y and nu m er ous m edi cat i ons, i ncl udi ng i nt erf er on. R o n n i e p re s e n te d to D r. T h o ta w i th c o m p l a i n ts o f s e v e r e a n g i n a . D r. T h o ta re c o m m e n d e d th e s e c o n d d i a g n o s ti c c a rd i a c c a th e te ri z a ti o n i n F e b ru a ry 2 0 0 2 to d e te rm i n e i f a n e w b l o c k a g e h a d d e v e l o p e d . T h a t D r. T h o ta ’s
r ec om m end at i on w asr ea so nab l e a nd app r opr i at e w asundi sp ut ed. Pr eop er at i ve l abor at or y st udi es w er e accept abl e f or R o n n ie t o und er go t he pr ocedu r e.3

A cc or di ng t o Dr . Cooper , Ronni e’ s t r ea t i ng he m a to l o gi stbe f or e a nd a f t ert he pr ocedu r e per f or m ed by D r . Th ot a, any per son w i t h PV w i l l have an i ncr eased
r is ko fb o t h b le e d in g a n d c lo t t in g c o m p lic a t io n s e v e n ife v e r y t h in g iso p t im a lly
con t r ol l ed. R onn i e di d not di e f r om t he com pl i cat i ons and syst em s f ai l ur es t hat fo l l o w e d the ca rdiac ca th e teri za ti o n b yD r. T h o ta. P V i s a form o f ca n c e r; i f a pe rs o n l i vesl ong e nough w i t h i t , t heyw i l l de vel op l euk em i a, asRonni e d i d. R onn i e w as di agno sed w i t h l eukem i a i n O ct ober20 04 and di ed fr o m t hat di sease on M ar ch 1 0, 20 05 . H i s w i dow pr osecut ed t hi s s u it a s a survi val act i on on behal fofhi s est at e. I I . CON T R I B UT OR Y NE GL I GE NC EW AS P R OP E R L Y S UB M I T T E D. A . The “ i nj ury” w asnott he “t ea r ” i n t he art ery. A s a p rel i m i nar y m at t er , I di sagr ee t hatt he “i nj ur y” t o R onn i e t hatw as t he bas i s f orl i abi l i t y s oughtag ai ns tD r . Thot a w ast he “t ea r ” i n Ronni e’ s art ery. Th er e w as no evi dence t hatD r . Th ot a caused t he t earort hati t s exi st ence w as a causal f act ori n any of R onn i e’ s bl eedi n g o r s u bsequen tcom pl i cat i ons. A p p e l l a n t’s th e o ryo f l i a b i l i tyw a s th a t D r. T h o ta i n c o rre c tl yp l a c e d th e p u n c tu re si t e f ort he ca t het er i z at i on. The “i nj ur y”w as e x te n s i ve bl ee di ng f r om t he punc t ur e s i t e i nt o Ronni e’ s r et r ope r i t one al ca vi t y a nd t he ca sca d e of
c o m p l i c a ti o n s h e s u ffe re d th e re a fte r. T h e “ te a r” w a s re l e v a n t o n l yb e c a u s e D r.4

W a lk e r ’s re p o rts t a t e d t h a t h e r e p a ir e d a “ t e a r ” in R o n n ie ’s a rt e r ya f t e rR o n n ie
r et ur ned t o t he hos pi t al , f r om w hi ch t he exp ert w i t nes se s so ughtt o de t er m i ne t he l ocat i on of t he pun ct ur e si t e. T h i s d i s ti n c ti o n i s i m p o rta n t. D r. T h o ta ’sth e o ryo f R o n n i e ’sc o n tri b u to ry
n e g l i g e n c e w a s t h a t R o n n i e fai l e d to fo l l o w h i s i n stru c ti o n s to ca l l h i m o r t o
r et ur n t o t he hos pi t al w hen he beg an t o su f f er se ver e pai n. The m aj or i t y s ays th i s c o n d u c t m e rel yi n c rea se d h i s i n j u ri e s a s o p p o se d to c a u sing the “a c c i d e n t”
o r “o c c u rr e n c e .” I n so d o i n g , th e m a j o ri ty fo c u se s o n the w o rd “ tea r” to try to p i n p o i n t th e “ a c c i d e n t” o r “ o c c u rre n c e .” B . T h ej u ryw a sn o t a s k e d a b o u t a n “ a c c i d e n t” o r “ o c c u rre n c e .” D espi t e i t s pr ot est at i ons ot her w i se, I bel i eve t he m aj or i t y confuses “i nj ur y” w i t h “a cc i den t ” or “o cc ur r enc e”i n a nal ogi z i ng t hi s ca set o Moulton v. A l am o A m bul

ance S erv. , I

nc. , 4 1 4 S. W . 2d 444, 449 ( Tex. 1967 ) ( hol di ng ex c lusi onar y i nst r uct i on on m i t i gat i on r at hert han con t r i butory negl i gence q u e s t io n p r o p e rb a s e d o n p la in t if f ’s f a ilu r e t o f o llo w m e d ic a l a d v ic e t h a tm e r e ly agg r ava t ed dam age s r ec ei ved i n a ut o a cc i den t ) , an d Ker by v. A bi

lene Chr

i sti an Col lege , 5 0 3 S . W . 2 d 5 2 6 , 5 2 8 ( T ex . 1 9 7 3 ) ( ho l di ng t r i al co urterro n e o u s ly
s u b m i tte d c o n tri b u to ryn e g l i g e n c e i n s te a d o f m i ti g a ti o n i n s tru c ti o n w h e re pl ai nt i f f ’ s negl i gence i n l eav i ng van dooropen di d not contr i bute t o cause col l i si on bu t , atm os t , co ul d onl y ha ve i ncr ea se d orad ded t o e xt ent ofl os s or5

dam age ) . Ju r y Q ues t i on No. O ne on l i abi l i t y (as w el l ast he con di t i one d a nd
u n a n s w e r e d q u e s t io n s a s t o a p p o rt io n m e n t o fre s p o n s ib ilit ya n d d a m a g e s ) d id notas kab o u t an y“a c c i d e n t” o r “o c c u rr e n c e ” b u t e x p res sly i n q u i red as to
w h e th e r n e g l i g e n c e o f D r. T h o ta o r R o n n i e p ro x i m a te l yc a u s e d R o n n i e ’s

“ i n j u ry .” C . C ontr i butory negl i gence t hatcont r i buted t o t he “i nj ury ” w as pr ope r l y s ubm itt ed. Th i s case m or e cl osel y r esem bl es E l b a o r v. Sm ith , 845 S. W . 2d 240, 245 ( Tex. 1992 ) . Unl i ket he f ac t s i n Mo ulton a n d Ker by , t h e s u p r e m e c o u rtin El b a o r em pha si z ed t hatt he “a cc i den t ” i n El bao r “equat es t o t he m edi cal p rob l e m co m p l a i n e d o f: M s. S m i th ’s i n fec ted a n k l e . H e r c o n d u c t [r e fu sing to ta k e a n ti b i o ti c s a s o rd e re d ] a rg u a b l yd i d c o n tri b u te to th e i n fe c ti o n . . . . [ T ]h e re
m i ght have been no i nf ect i on, and t hus no cl ai m f or m edi cal m al pr act i ce, had M s. Sm i t h f ol l ow ed herdoct or ’ s i nst r uct i ons. ” 84 5 S . W . 2d at24 5. Because D r. E l b a o r pl e a d e d tha t M s. S m i th w a s c o n tr i b u to r il y n e g li g e n t i n refu sing to t ak e h eran t i bi ot i csan d be ca us e t her e w asev i den ces upport i n g h i s as se rt i on th a t h e r re fu s a l c o n tri b u te d to h e r i n j u ry , th e c o u r t h e l d th a t a c o n tri b u to ry neg l i gen ceque st i on sh oul d hav e bee n su bm i t t ed, r at hert han an i ns t r uct i on on
m i ti g a ti o n o f d a m a g e s . Id.6 ... A ppe l l ant ’ s br i efon a ppe al ope ns w i t h a n ac kno w l edg m ent t hatt he

j ur y char ge w as not bas ed on t he “t ea r ” t o t he ext er nali l i ac art ery, buton t he dam age s t hatr es ul t ed f r om t he i nj ur y, t he sh ockt hatr es ul t ed f r om t he bl ee d, and t he m ul t i pl e p r o bl em s t hatar os e a s t he r es ul t . Appel l antnow co m pl ai ns t hatt he char ge w as ba s ed on t he w r ong f oun dat i on and l ed t o an i m pr oper j udgm ent . I W e d i sa gr eef ort he r ea so ns s t at ed a b o v e . M or eov er , an y com pl ai nton t hi s gr ound w asw a i ved by A ppe l l ant ’ s f ai l ur e t o obj ec tt o t he t er m “i nj ur y” i n Jur y Q uest i on N o, . O ne. 6 Li ket he i nf ec t i on ofM s . S m i t h’ s ank l e i n El bao r, a n y“ a c c i d e n t” h e re equ ate d t o Ronni e’ s i nj ur y, t he r et r ope r i t one al bl ee di ng a nd s ubs equ ent
c o m p lic a t io n s , n o tt h e “ t e a r .” R o n n ie ’s c o n d u c ta r g u a b lyd id c o n t r ib u t e t o h is i n j u ry , i .e ., th e b l e e d i n g a n d s u b s e q u e n t c o n s e q u e n c e s , l i k e M s . S m i th ’s
con duc ti n El

bao r an d unl i ket hati n Moulton and Ker by . T h e tri a l c o u rt c o rre c tl y fo l l o w e d th e c u rre n t P a tte rn J u ryC h a rg e s ta n d a rd quest i ons f or negl i gence and contr i butory negl i gence, usi ng “i nj ur y, ” r at hert han “occur r ence” or “acci dent” i n t hi s case. The j ur y que st i on r ec om m end ed by 6 t he Patt er n Ju r y Char ge pr ovi des f or al t er nat i ves of “o cc ur r enc e, ” “i nj ur y, ” or “occur r ence ori nj ur y” i n t he f or m f or subm i t t i ng contr i butory negl i gence w hen t he r e i s e v i d e n c e o fa p l a i n t i f f ’ s n e g l i g e n c e t h a ti s i n j u r y - c a u s i n g o ri n j u r ye n h a n c i n g b u t no t oc c u rr e n c e -ca u sing . C o m m . o n P a ttern J u ry C h a rge s, S tate Bar ofTexas, Texas Patt er n Jur y C har ges: G ener al N egl i gence & I nt ent i onal P e rs o n a l T o rts P J C 4 .1 & c m t. (2 0 0 6 ); se e al so C om m . on Pa tte rn J u ry7 ... S ee al so Ru ssel l H . M cM ai ns, Co n tr ib u tio na n d

In dem n ityPro b lem sin Texa s Multi

-Party L iti

gati on , 17 S T . M A R Y ’S L. J. 653 , 676

-77 ( 198 6) ( not i ng t hatt he su pr em e c ourtt r ea t ed i nj ur y- ca us i ng c ont r i but or y neg l i gen cean d occ ur r enc e- ca u s i n g co nt r i but or y ne gl i gen cei den t i ca l l y i n D unc an v. Cessna A i rcraftCo. , 665 S . W . 2d 414, 429 ( Tex. 1984 ) , i nco r por at i n g w i th i n t he c o n c e p t of tr a d i ti o n a l co n tr i b u to ry n e g l i g e n c e the n e g l i g e n t fai l u re o f a p l a i n ti ff to m i ti g a te d a m a g e s ). 7 C har ges, S t at e BarofTexas, Texas Patt er n Jur y C har ges: M edi cal M al pr act i ce PJC 51 . 1 & cm t . ( 20 06 ) . The P JC C om m i t t ee’ s com m ent s st at e t hat
u s e o f ‘o c c u rre n c e ’ o r ‘i n j u ry ’. . . c o u l d a ffe c t a c a s e i n w h i c h th e re i s e v i d e n c e o f th e p l a i n ti ff’s n e g l i g e n c e th a t i s ‘i n j u ry -c a u s i n g ’. . . but not ‘ occur r ence- causi ng’ : f orexam pl e, car r yi ng gasol i ne i n an u n p ro te c te d c o n ta i n e r w h i c h e x p l o d e d i n th e c ra s h . . . o r f a i l i ngto f ol lowdoc tor ’

s order s dur i n g re covery, therebyaggrava ti ng the i nj ur i es ( post-acci

dent negl

i gence) . In s u c h a c a s e t h e ju r ys h o u ld notco ns i dert hi s neg l i gen cei n a ns w er i ng t he [ l i abi l i t y a nd p r o p o rt io n a t e r e s p o n s ib ilit y q u e s t io n s ] if‘o c c u r r e n c e ’ is u s e d , w h ile i ts houl d c ons i dert he neg l i gen cei f‘ i nj ur y’ i s us ed. P J C 4 .1 c m t. (e m p h a s i s a d d e d ). The PJC com m ent s al s o s ta t e t hat , i ft he 7 l i a b i l i ty q u e sti o n fo r n e g l i g e n c e a n d c o n tr i b u to ry n e g l i g e n c e i s su b m i tted w i th th e te rm “ i n j u ry ,” ra th e r th a n “ o c c u rre n c e ” o r “ a c c i d e n t,” t h e e x c l u s i o n a ry i ns t r uct i on f or m i t i gat i on ofda m age s sh oul d notb e s u b m i tte d . P J C 4 .1 , 8 .9
c m t; see al

so PJC 51. 1, 80. 9 cm t . Undert he evi den cei n t hi s ca se , t he i ss ue
w as w hos e neg l i gen ce , i f any , ca us ed or con t r i but ed t o t he “i nj ur y, ” notw ho
o r w h a t c a u s e d a n “ a c c i d e n t” o r “ o c c u rre n c e .” D . A m pl e e vi den ces upport ed t he su bm i ssio n a nd f i ndi ng of contr i butory negl i gence.8

I n El bao r, th e supr em e courtr ecogn i zed a dut y ofcooper at i on t hat pa t i e nt s o w e t r e a t i ng p hy s i c i a nsw ho a s s um e t he du t y t o c a r e f ort he m . 845 S. W . 2d at245. The cou rt hel d t hat evi den ce of t he pat i ent ’ s f ai l ur e t o t ak e t he
a n ti b i o ti c s p re s c ri b e d fo r h e r re q u i re d s u b m i s s i o n o f a q u e s ti o n o n c o n tri b u to ry
n e g l i g e n c e . Id. The dut y t o c oope r at e a l so i ncl ude s t he du ty to re t ur n f or e v a l u a ti o n a n d p o s s i b l e t r e a tm e n t i f c o m p l i c a ti o n s a ri s e p o s t-d i s c h a rg e . S ee Jo n esv. L ur

ie , 32 S . W . 3d 737, 743 ( Te x. App . — Hous t on [ 14t h Di s t . ] 2000 , n o p e t . ) (h o ld in g e v id e n c e p la in t if fig n o r e d p h y s ic ia n ’s o r d e r s t o re m a in in p s y c h o l o g i c a l tre a tm e n t c e n te rs a n d h o s p i ta l s fa c tu a l l ys u fficie n t to s u p p o rt 1 0 0 p e rc e n t c o n tri b u to ry n e g l i g e n c e fi n d i n g ); Eof f v. Hal & Char

l i e Pe ter so n Foun d ., 8 1 1 S .W .2 d 1 8 7 , 1 9 1 ( T e x . A p p .— S a n A n t o n io 1 9 9 1 , n o w ri t) (h o l d i n g e v i d e n c e fa c tu a l l ys u fficie n t to s u p p o rt 1 0 0 p e r c e n t c o n tri b u to ry
n e g l i g e n c e fi n d i n g b a s e d o n e v i d e n c e p l a i n ti ff v o l u n ta ri l yl e ft h o s p i ta l b e fo re
r ec ei vi ng em er gen cy t r ea t m ent , i gnor ed adv i ce of phys i ci an t o r et ur n t o ER, an d fa i l e d to o b ta i n m e d i c a l c a re fo r s e v e n h o u rs a fte r l e a v i n g h o s p i ta l ). R o n n i e h a d p re v i o u s l yu n d e rg o n e a c a rd i a c c a th e te ri z a ti o n a n d w a s a w a re ofnor m al pos t pr oce dur e d i sc om f ort s. He w asgi ven w r i t t en di sc h a r ge i ns t r uct i onst o r et ur n i f he had any of se ver al l i st ed sy m pt om s, i ncl udi ng “ pai n”
o r “ a n yp ro b l e m s .” In h i s d e p o s i ti o n , R o n n i e a d m i tte d h e e x p e ri e n c e d a s e v e re9

p a i n i n h i s g roin a t 6 :0 0 p .m ., so se v e re h e h a d to b e n d o v e r an d h o l d h i m se l f, and t hat i t w as obvi ous t o hi s el even- year - ol d son, w ho r eport ed t o hi s m ot her t hat R onn i e “w ent dow n. ” H e t est i f i ed t hat short l y af t er w ar ds, he f el tw or se and exp er i enced backach e and nausea. Th ose sym pt om s w er e di f f er ent f r om w hat R onn i e had exp er i enced af t er hi s f i r stca t het er i z at i on. By 9: 00 p. m . , he w as hurt i ng so m uch i n hi s bac k a nd st om ac h t hatheco ul d not get out ofhi s r ec l i nerw hen hi s w i f e g othom e. The pai n w or se ned un ti l h e f el l outoft he r ec l i neri n “ exc r uci at i ng pa i n” atab out 11:0 0 p .m ., s cr ea m ed t o hi s w i f e, an d l ay i n a f et al pos i t i on. Despi t e t he pr ogr essi on of sym pt om s, R onn i e di d not cal l D r . Th ot a orseek hel p and, even at11: 00 p. m . , r ef us ed hi s w i f e’ s pl ea s t o c al l a nei ghboror9- 1- 1. Accor di ng to the am b u l a n c e rec o rds , i t w a s 1 2 :4 3 a.m . w h e n the yrec e i v e d the ca l l to
r es pond. D r . T h o t a t e s t if ie d t h a t , w it h t h e k n o w le d g e R o n n ie p o s s e s s e d a b o u th is cond i t i on as w el l as f r om hi s pr i or car di ac cat het er i zat i on, he shoul d have cal l ed f orhel p by 6 : 00 p. m . D r . D o h e rt y agr eed t hat , w i t h t he pr obl em s ofnausea a n d b a c k a c h e R o n n i e w a s e x p e ri e n c i n g , s o m e ti m e s re fe rre d to a s “ fl a n kp a i n ,” R o n n i e s h o u l d h a v e c a l l e d fo r h e l p a t 6 :0 0 p .m . o r a t l e a s t b y9 :0 0 p . m . D r. D ohe rt y f urt hert es t i f i ed on cr os s- exa m i nat i on t hat , bas ed upon hi s r evi ew of10

t he ca t h l og no t es , D r . Thot a’ s not es , an d t hos e o ft he nur se s w h o c ar ed f or R o n n ie a f t e r t h e p r o c e d u r e , t h e r e w a s a n in e t y -n in e p e r c e n t c h a n c e t h a tR o n n ie
w as notbl eedi ng w hen he w as di schar ged at2: 40 p. m . D r . D ohert y bel i eved th e b l e e d i n g sta rt e d a t a b o u t 9 :0 0 p .m . a n d sta ted R o n n i e h a d l o st th ree u n i ts ofbl ood b y t he t i m e h e g ott o t he ope r at i ng r oom . I f Ronni e h ad gonet o t he ho s pi t a l , s ou gh t m e di c a l c a r e , or c a l l e d Dr . Th ot a a t 6: 00 p. m . , or e ve n by9: 00 p. m . , D r . D ohe rt y s ai d, he l i ke l y w oul d h a v e a voi ded orl es se ned al l oft he
se ri o u s c o m p l i c a ti o n s, i n c l u d i n g the sh o c kl e a d i n g to th e co a g u l o p a th i c sta te th a t l e d to th e a d d i ti o n a l p ro b l e m s , i n c l u d i n g R o n n i e ’sg a n g re n o u s g a l l b l a d d e r,
w hi ch r equ i r ed f i ve m ont hsofhos pi t al i z at i on a nd r ec ove r y. D r . M cC r acken, A ppel l ant ’ s causat i on exp ert , al so a c k now l edged t hat Ronni e p r oba bl y w oul d notha ve exp er i enc ed anyoft h e co m pl i ca t i onsi ft he bl eedi ng had been r ecogn i zed ear l i er and t r eat ed. M or eover , D r . D ohert y agr eed t hati fRonni e h ad gonet o t he hos pi t al at6: 00 p. m . , he co ul d h a v e h ad t he “b l e e d e r” rep a i red as i t w a s o r i n tr a v a sc u l a rl yw i th a ste n t, fo r w h i c h D r. T h o ta had t he nec es sa r y t r ai ni ng. I w o u l d h o l d th a t th e tri a l c o u rt c o rre c tl ys u b m i t te d th e P J C ’ss ta n d a rd j ury qu es t i on on ne gl i gen ce and con t r i but or y ne gl i gen cei n Ju r y Q ues t i on No. O ne, r at hert han an excl usi onar y i nst r uct i on on m iti gat i on of dam ages, t hat8 ... A p p e l l a n t h a s n o t c o m p l a i n e d th a t th e s u b m i s s i o n o f c o n tri b u to ry

n e g lig e n c e o rt h e in s t r u c t io n im p r o p e r lyc o m m in g le d t h e o r ie s o rp r e v e n t e d h im f r om pr ope r l y pr es ent i ng hi s ca se on app ea l , and nei t herpa rt y ha s br i ef ed t he p o ss i b l e ap p l i c a ti o n o f Casteel t o t hi s ca se . I n e f f ec t , t he m aj or i t y i s r eve r si ng o n u n a s s i g n e d e rro r, i s s u e s n o t ra i s e d b y t h e a p p e a l . See Pa tBaker Co. v. W i l so n , 97 1 S . W . 2d 44 7, 45 0 ( Tex . 19 98 ) (ho l di ng i ti s “axi om at i c t hatan a p p e l l a te c o u rt c a n n o t re v e rs e . . . a b s e n t p ro p e rl ya s s i g n e d e rro r” ). 11 t her e w as am pl e evi den ce t hat Ronni e’ s f ai l ur e t o f ol l ow D r . T h o ta ’s in s t r u c t i o n s t o c a ll o rt o re t u r n t o t h e h o s p it a l ifh e h a d a n yp r o b le m s o rp a in
s u p p o rte d th e s u b m i s s i o n o f c o n tri b u to ryn e g l i g e n c e , a n d th a t R o n n i e ’s
con t r i but or y ne gl i gen cew asa pr oxi m at e c aus e o fhi s i nj ur y. III. H A R M A N A L Y S IS A . Casteel

“ pr es um ed er r or ” ana l ys i s doe s notap pl y. Eve n i ft he t r i a l c ourter r ed by s ubm i t t i ng bo t h t he j ur y qu es t i on on c o n tri b u to ryn e g l i g e n c e a n d t h e i n s tru c ti o n o n n e w a n d i n d e p e n d e n t c a u s e , I d i s a g re e w i th th e m a j o ri ty ’ s s u a s p o n te a p p l i c a ti o n o f th e “ p re s u m e d h a rm ”
a n a l y s i s a d o p t ed i n Crown Lif e I ns. Co. v. Casteel, 22 S. W . 3d 378 ( Tex. 2 0 0 0 ). I n Ca s te el, th e s u p re m e c o u rt h e l d th a t “ [w ]h e n a s i n g l e b r o a d -fo rm

8 l i abi l i t y qu es t i on er r one ous l y com m i ngl es val i d and i nva l i d l i abi l i t y t heo r i esan d t h e a p p e lla n t ’s o bje c t io n is t im e ly a n d s p e c if ic , t h e e r r o r is h a r m f u l w h e n it
ca nnotbe de t er m i ned w het hert he i m pr ope r l y s ubm i t t e d th e or i esf or m ed t he sol e basi s f ort he j ur y’ s f i ndi ng” because t he appel l ant is th er eby pr event ed12

f r om pr ope r l y de m ons t r at i ng t he con se que nce s oft he er r one ouss ubm i ss i on on a p p e a l . Id. a t 3 8 9 ; se e al so T e x . R . A p p . P . 4 4 .1 (b ); 6 1 .1 (b ). I n Ha rr i s Co un ty v. Sm ith , t he cou rtex te nde d Casteel to a b ro a d -fo rm quest i on t hati m pr oper l y com m i ngle d d a m a ge el em ent s w hen on e oft hose
e l e m e n ts w a ss u p p o rte d b yn o e v i d e n c e . 9 6 S .W .3 d 2 3 0 , 2 3 5 (T e x . 2 0 0 2 ). I n Rom ero v. KPHConsol. , I nc. , t he cou rtf urt herex t end ed Casteel t o a s in g le br oad- f or m quest i on t hat i ncl uded a t heor y ofl i abi l i t y suppo rt ed by no evi dence. 1 6 6 S .W .3 d 2 1 2 , 2 2 7

– 2 8 (T e x . 2 0 0 5 ). T h e m a j o ri ty s a y s w e c a n n o t d e te rm i n e w h e th e r th e j u rytru l yfo u n d D r. Th ot a notnegligentori m pr oper l y r el i ed on t he contr i butory negl i gence subm i ssi on. I di sagr ee. The t heor i es ofnegl i gence and cont r i butory negl i gence her e w er e not i m pr oper l y “com m i ngl ed. ” Th er e w er e t w o separ at e answ erl i nes pr ovi ded t o t he j ur y t o a ns w er“ yes ” or“ no” as t o D r . Thot a and “y es ” or“ no” as t o R onn i e. The j ur y answ er ed “no” as t o D r . Th ot a and “yes” ast o R onn i e. I n c o n tra s t , i n Casteel, t he j ur y quest i on i nst r uct ed t he j ur y on t hi rt een i nd e pe nd e ntg r ou nd s o f l i a bi l i t y bu t r e qu e s t e d on l y a s i ng l e a ns w e r . 22 S. W . 3d at387. Si m i l ar l y, i n Ha rr i s Co un ty , t he dam ages que st i on c om pl ai ned of i ns t r uct ed t he j ur y t hati tco ul d c ons i derva r i ousel em ent s ofda m age s, i ncl udi ng an el em entsupport ed by no evi dence, i n aw ar di ng a si ngl e am oun t ofdam ages.9 ... I n Ha rr i sCo un ty , th e c o u rt n o te d th a t th e C o m m e n ts to th e P a tte rn Jur y C har ge have l ong r ecom m en d e d t hatdam age el em ent s be subm i t t ed “s e p a rate l y ” i f th e re i s a su b sta n ti a l d o u b t as to w h e th e r t h e re i s e v i d e n c e to s u p p o rt a n e l e m e n t. 9 6 S .W .3 d a t 2 3 5 ; seePJC 8. 02 cm t . ( suggest i ng “use ofa separate answer l i ne f orea ch el em entof dam age s m i ghtav oi d t he nee d f or a n ew t r i a l i f th e app el l at e c ourtf i ndst hatoneorm or e, butnotal l , oft he e le m e n t s la c kle g a l o re v id e n t ia r ys u p p o rt .” ) ( e m p h a s is a d d e d ). T h u s , s u r e ly “separ at el y” m ay m ean ei t her separ at e j ur y quest i ons orsepar at e answ erl i nes w i t hi n t he sa m e q ues t i on. 13 96 S. W .3 d at231. L i ke w i se , i n Ro m ero , th e j u ry w a s i m p rop e rl yall o w e d to app ort i on r es pons i bi l i t y a m ong t he def end ant s i n a s i ngl e a ns w erba se d upo n ei t heran unc hal l eng ed f i ndi ng ofor di nary neg l i gen ce oran af f i r m at i ve f i ndi ng on a t he ory of m a l i c i ou s c r e de nt i a l i ng f or w hi c h t he r e w a s n o e vi de nc e . 166 S. W . 3d at 215 . The j ury’ s si ngl e ans w er i n ea ch of t hos e ca se s i s w hatm ade it im p o s s ib le t o d e t e r m in e w h e t h e r t h e v e r d ic tw a s b a s e d u p o n t h e im p r o p e r ly subm i t t ed t heor y orel em entofdam ages. H er e, t he negl i gence of D r . Th ot a and t hat of R onn i e w e re s u b m itt ed “separ at el y, ” al bei ti n t he sam e quest i on. W e ar e t hus abl e t o det er m i ne t hat t he j ur y’ s f i ndi ng a s t o D r . Thot a w as not bas ed on an i m pr ope rs ubm i ss i on of
con t r i but or y ne gl i gen cebe ca us e t her e ar e t w o s epa r at e a ns w er s. Com bi ni ng tw o q u e sti o n s i n to o n e w i th se p a rate an sw e r l i n e s s i m p l yd o e s n o t co n sti tu te
a com m i ngl i ng t hatt r i gger s t he “pr esum ed har m ” anal ysi s. 914

I al so ca nnotag r eet hatt he j ur y qu es t i on he r e s ubm i t t ed t w o c om pet i ng

“ t h e o r ie s o flia b ilit y .” C o n t r ib u t o r yn e g lig e n c e is n o ta t h e o r y o flia b ilit y ; itis
a n a ffir m a ti v e d e fe n s e . S eeTex. R. C i v. P. 94 . Th e j ur y quest i on i n t hi s case
w as a uni ver sa l l y us ed, st and ar d br oad

- f or m su bm i ss i on of onl y one t heo r y of l i a b i l i ty
— th e n e g l i g e n c e o f D r. T h o ta
— a l o n g w i th th e d e fe n s e o f c o n tri b u to ry ne gl i gence, as r ecom m ended by t he PJC . C om m . on Patt er n Jur y C har ges, S ta te B a r o f T e x a s , T e x a s P a tte rn J u ryC h a rg e s : M e d i c a l M a l p ra c ti c e P J C 5 1 .3 ( 200 6) . The s upr em e c ourtha s nev erex t end ed Casteel t o def ensi ve t heor i es. I n Be d , Ba th& Be yo n d

v. Uri sta , 211 S. W . 3d 753 , 757 ( Tex. 2006 ) , t he
su pr em e c ourtnot ed t hati tha d l i m i t ed i t s hol di ngsi n Casteel an d Ha rr

i s Co un ty t o “m ul t i pl e t heor i es ofl i abi l i t y orm ul t i pl e dam age el em ent s” and t hati thad “neverext ended a pr esum e d har m r ul e t o i nst r uct i ons on defensi ve t heor i es” and r ef us ed t o e x te nd Casteel t o t h e “ d e f e n s iv e t h e o r y ” o fu n a v o id a b le
a c c i d e n t, sta ti n g : “[U ]na v o i d a b l e ac c i d e n t i s n o t a n a l tern a ti v e the o ry o f l i a b i l i ty b u t i s ‘a n i n fe re n ti a l re b u tta l i s s u e . . . .” A s t o t he i nf er ent i al r ebutt al i nst r uct i on on new and i ndep enden tcause, th e m a j o ri ty re c o g n i ze s th a t Uri sta hel d t hati m pr opersubm i ssi on of an i nf er ent i al r ebutt al i nst r uct i on i s not s u b j e c tt o t h e “ p r e s u m e d e r r o r ” a n a ly s is
u n d e r Casteel. B u t i t th e n c o n c l u d e s th a t w e m u s t n e v e rth e l e s s p re s u m e h a rm15

her e b e c a us e w e c ann otde t er m i ne w het hert he j ur y i m pr ope r l y r el i ed on t he
n e w a n d i n d e p e n d e n t c a u s e i n s tru c ti o n a l o n e o r c o m b i n e d w i th th e c o n tri b u to ry
n e g l i g e n c e su b m i ss i o n . I b e l i e v e the m a j o ri ty o p in io n c o n fl i c ts w i th b o th Ca steel an d Uri

sta i n a ppl yi ng a “ pr es um ed har m ” ana l ys i s bas ed on s om e hybr i d t heo r y. Ev en as su m i ng t hatco nt r i but or y ne gl i gen cean d ne w an d i nde pen den tca us e w er e b ot h i m pr ope rl y s u bm i t t ed, t w o e r r or s t hatdo n ot t r i ggera “pr esum ed har m ” anal ysi s do notequal one t hatd o e s . I t hi nk w e
m u s t a p p l yth e tra d i ti o n a l h a rm a n a l y s i s . S eeTex. R. A pp. P. 44 . 1( a) . U nder t hatan al ys i s, er r ori n t he j ury c har ge r equ i r esr eve r sa l onl y i f , aft erco ns i der i ng t h e r e c o r d a s a w h o le , in c lu d in g t h e p le a d in g s , t h e e v id e n c e , a n d t h e c h a r g e in i ts e n ti rety , w e co n c l u d e tha t t h e erro r pro b a b l yres u l ted i n an i m p rop e r ve rdict. S e e Islan d Re cre a ti

o n a l D e v. Co rp . v. Rep ub l i co f T ex . Sa v. A ss ’n , 710 S . W . 2d 5 5 1 , 5 5 5 (T e x . 1 9 8 6 ); W al
-MartStores, I

nc. v. Reddi

ng , 56 S. W . 3d 141, 149 (T e x . A p p .— H o u s to n [1 4 th D i s t.] 2 0 0 1 , p e t. d e n i e d ). B. The t r adit i ona lha r m an al ys i s app l i est o t he j ury qu es t i on. U n d e r Casteel, i ti s st i l l t he l aw t hatw hen que st i ons ar e su bm i t t ed i n a
m annert hatdoes al l ow t he appel l at e courtt o det er m i ne t hat t he ver di ctw as act ual l y based on a val i d l i abi l i t y t heor y, w hi ch i s t he case her e, t he er r orm ay beh a r m l e s s u nd e rt het r a di t i on a l h a rm a n a l ys i s . 22 S. W . 3d a t389.16

“ S u b m i s s s i o n o f a n i m p ro p e r j u ryq u e s ti o n c a n b e h a rm l e s s e r r o r i f th e j u ry ’s
answ er s t o ot her quest i ons r ender t he i m pr operquest i on i m m at er i al . ” City of Browns vi

l le v. A lvar

ado , 897 S. W . 2d 750 , 752 ( Tex. 199 5) . A j ur y qu es t i on i si m m a te ri a l w h e n i ts a n s w e r c a n n o t a l te r th e e ffe c t o f th e v e rd i c t. Id . ( hol di ng any er r or i n subm i t t i ng deceased’ s negl i gence i n j ur y char ge w as har m l ess; once j ury f ound def end antnotne gl i gen t , i t s f i ndi ng t hatde ce a s e d w a s ne gl i gen t
c o u l d n o t h a v e a l te re d e ffe c t o f v e rd i c t); se e al so Boatl

and of Hous ton, I

nc. v. Bai ley , 60 9 S .W .2 d 74 3, 74 9– 50 ( Tex . 19 80 ) ( hol di ng po t ent i al l y i m pr oper s u b m i s s i on ofde f ens i ve i ss uesha r m l es s w hen j ur y f ound f orde f end anton i n d e p e n d e n t g ro u n d s ); Her nan dezv. A ti

eh, N o . 1 4

- 0 6

- 0 0 5 8 2

- C V , 2 0 0 8 W L 2 1 3 3 1 9 3 , a t * 3 , 4 (T e x . A p p .— H o u s to n [1 4 th D i s t.] M a y 2 0 , 2 0 0 8 , n o p e t.) ( m em . op. ) ( hol di ng— w hen f i ndi ng ofno l i abi l i t y of def end ants upport ed by evi dence— once j ur y f oun d def endan tn otnegl i gent, subm i ssi on of addi t i onal p e rs o n a s re s p o n s i b l e th i rd p a rtyi n n e g l i g e n c e q u e s ti o n h a rm l e s s ); Hutchi so n
v. Ph a r r is , 1 5 8 S .W .3 d 5 5 4 , 5 6 7

– 6 8 (T e x . A p p .— F o rt W o rth 2 0 0 5 , n o p e t.) (h o l d i n g fi n d i n g o f c l a i m a n t s ’ c o n tri b u to ryn e g l i g e n c e h a rm l e s s w h e n j u ry ’s f ai l ur e t o f i nd defendant s’ negl i gence w as pr oxi m at e cause ofi nj ur y w as s u p p o rte d b ye v i d e n c e ). C . The t r adit i ona lha r m an al ys i s app l i est o j ury i ns t r uct i on.17

L ik e w is e , t o d e t e r m in e w h e t h e rs u b m is s io n o fa n in s t r u c t io n p r o b a b ly caused an i m pr operj udg m entand w a s , th e ref or e, har m f ul er r or , w e m ust
e x a m i n e th e e n ti re re c o rd . Uri sta , 211 S . W . 3d at757 ( ci t i ng T im b er wa lk A p a rtm en tsPa rtn er s, I n c . v. Ca in , 9 7 2 S .W .2 d 7 4 9 , 7 5 6 (T e x . 1 9 9 8 )); Q uantum Chem . Cor p. v. To ennies , 4 7 S .W .3 d 4 7 3 , 4 8 0 (T e x . 2 0 0 1 ); see al so T e x . R. A pp. P. 44 . 1( a) . Speci f i cal l y, w hen t he r ecor d pr ovi des “no cl ear i ndi ca t i on”t hatt he j ury r el i ed upon an i m pr ope ri nf er ent i al r ebu t t al i ns t r uct i on, Uri sta i ns t r uc t s u s t ha tw e m us to r di na r i l y c on c l ud e t hee r r ori s h a r m l e s s . 211 S. W . 3d at758– 59. W hen , as i n t hi s ca se , t he j ur y m ak esa neg at i ve f i ndi ng ast o l i abi l i t y and , unde r t he evi den ce , cou l d r ea so nab l y hav e con cl ude d t hatt he pl ai nt i f f f ai l ed t o car r y i t s bur den t o est abl i sh def endan t ’ s negl i gence r at hert han
r el yi ng up on such an i nst r uct i on, subm i ssi on of an i m pr operi nf er ent i al r ebutt al i n s tru c ti o n i s o rd i n a ri l y h a rm l e s s e rro r. Id. a t7 5 7

– 5 9 (h o ld in g u n a v o id a b le
a c c i d e n t s u b m i s s i o n h a rm l e s s w h e n c ro s s -e x a m i n a ti o n d i s c re d i te d p l a i n ti ff’s cl ai m s and evi den ce f ai l ed t o i ndi ca t e r es ul t w oul d hav e bee n di f f er entab se nt i n s tru c ti o n ); Rei

nh a rt v. Young , 906 S. W . 2d 471, 473 ( Tex. 1995 ) ( hol di ng unavo i dabl e acci dent i nst r uct i on har m l ess w hen am pl e evi dence supp ort ed f i ndi ng of no neg l i gence bydef endan t , w i t nesses di d not r ef er t o t er m , counsel
m ade l i t t l e m ent i on of i ti n cl osi ng, sudden em er gency w as al so subm i t t ed18

w i th o u t o bj e c ti o n , a n d v e rd i c t w a s u n a n i m o u s ); To r res v. Tessi

er, 231 S. W . 3d 60 , 64 ( Tex . A pp. — H oust on [ 14 t h D i st . ] 20 07 , no pet . ) ( hol di ng sudd en em er gen cy i ns t r uct i on har m l es s w hen j ur y cou l d r ea so nab l y ha ve f ai l ed t o f i nd causat i on ordam ag e s based on cr edi bi l i t y det er m i nat i ons r egar di ng evi dence
w i th o u t re g a rd to i n s tru c ti o n ); se ealso Eo ff, 81 1 S . W . 2d at19 3 ( hol di ng new a nd i nd e pe nd e ntc a us e i ns t r uc t i on h a rm l e s s w he n j ury f ou nd p l a i nt i f f100 p e rc e n t c o n tri b u to ri l yn e g l i g e n t). D . A ny c har ge e rro r w asha r m l es s i n l i ghtofev i den ces upport i ng j ury’ s f i ndi ng of “n o” as t o neg l i gen ce of D r . Thot a and i n l i ghtof t he ent i r ety oft he r ec or d. Ther e w asev i den cef r om t he m edi ca l r ec or ds asw el l ast he t es t i m ony of D r . Th ot a, w i t h w hi ch D r . D ohert y agr eed, t hat goo d “hem ost at i s” w as m ost l i kel y obtai ned— m eani ng t he i ni t i al bl eedi ng f r om t he cat het er i zat i on st i ck had been st opp ed by app l i ed pr essur e and a bl ood cl othad f or m ed, t hatRo nni e had
n o p a i n an d a g o o d p u l se , i n d i c a ti n g tha t R o n n i ew a s s tab l e b ythe ti m e h e l e ft th e hos pi t al at2: 40 p. m . , an d t hatt he “i nj ur y”co m pl ai ned of

— ext ens i ve bl eedi ng, shock, and m ul t i

- or gan f ai l ur e— di d not begi n unti l sever al hour s aft er he l eft t he hos pi t al . D r . Thot a t es t i f i ed t hatt he ext ens i ve bl ee di ng c aus ed by t he c l o t b ei ng di sl odge d w asa com pl i ca t i on heco ul d notpr edi ctatt he p u n c tu re s i te w h e re th e c l o t h a d fo rm e d e a rl i e r. D r. D o h e rtya g re e d th a t th e re19

w asan “ eve nt ” t hatca ughtRonni e’ s att ent i on a t6: 00 p. m . and a p r ogr es si ve det er i or at i on af t ert hatt i m e. W hen R onn i e r et ur ned t o th e hospi t al ’ s em er gency r oom at app r oxi m at el y 1: 15 a. m . , he w as se en by D r . Thot a’ s part ner , D r . Sudar sh an. A CT s c a n wa s d o n e , d e s c r i b e d b y D r . S u d a r s h a n i n h i s r e p o rt a s s how i ng app ar entbl ee di ng f r om an ext er nal i l i ac art ery punc t ur e si t e but w i t h a f i ndi ng t h a t th e s i te w a s a t “ a b o u t” th e i l i a c l i g a m e n t. T h e o p e ra ti v e re p o rt o f D r. W al ke r , w ho op er at ed on Ronni e t hatni ght , des cr i bed a “h i gh t ea r ” oft he r i ght ext er nal i l i ac art ery t hatha d bl ed i nt o t he r et r ope r i t one al ca vi t y, f or m i ng a l ar ge hem at om a. Nei t herD r . Sudar sh an nor D r . W al ke r t es t i f i ed. The exp ert s w ho d i d te s ti fy b a s e d th e i r o p i n i o n s l a rg e l y o n th e i r re s p e c ti v e i n te rp re ta ti o n s o f D r. S udar shan’ s and D r . W al ker ’ s w r i t t en r eport s. T h e t e s t im o n y o f t h o s e e x p e rt s c o n f lic t e d . D r . D o h e rt yt e s t if ie d o n b e h a lf
o f A p p e l l a n t t h a t t h e sta n d a rd o f ca re fo r t h e ca rdiac ca th e teri za ti o n w a s to i nsertt he needl e and cat het eri nt o t he r i ght f em or al art er y bel ow t he i ngu i nal l i gam ent . I n D r . D ohert y’ s opi ni on, D r . Th ot a m ade t he pun ct ur e f or t he car di ac ca t het er i z at i on i n t he w r ong l oca t i on, abo ve t he i ngui nall i gam enti nt o t he r i ght
e x te rn a l i l i a c a rte ry , ra th e r th a n b e l o w th a t l i g a m e n t i n to th e fe m o ra l a rte ry . D r. D ohe rt y s upp ort ed hi s opi ni on byt he f ac toft he bl ee di ng i nt o t he20

r et r oper i t oneal ar ea, w hi ch coul d occurw i t h a punctur e t hat i s t oo hi gh, r at her t han i nt o t he gr oi n, w her e t he bl ee di ng c oul d ha ve bee n di sc ove r ed qui ck l y a nd
cor r ec t ed. D r . T h o ta t est i f i ed on hi s ow n behal ft hathe m ett he st andar d ofcar e, t hathe di d not and coul d not m ake a st i ck i nt o t he ext er nal i l i ac art er y because h e w o u l d n o t fe e l th e p u l s e a t th a t p o i n t. S ee Her sch v. Hendley , 626 S. W . 2d 1 5 1 , 1 5 5 (T e x . A p p .— F o rt W o rth 1 9 8 1 , n o w ri t) (h o l d i n g d e fe n d a n t p h y s i c i a n ’s
o w n tes ti m o n ym a yes t a b l i sh sta n d a rd o f ca re). H e furth e r t e sti fi e d tha t a
r et r oper i t oneal bl eed can happ en w i t h a f em or al art er y st i ck as w el l as an i l i ac a rt e ry sti c k . H e p o i n ted o u t t h a t D r. S u d a sh a n ’s fi n d i n g tha t t h e p u n c tu re s i te
w as at“aboutt he i ngu i nal l i gam ent ” w oul d i ndi cat e t hat t he pun ct ur e si t e w as c o r r e c t , a n d f u rt h e rt e s t if ie d t h a t D r . W a lk e r ’s re p o rtw a s a m b ig u o u s in
r ef er e n c e to w hathe r epai r ed and w her e, r ef er r i ng t o t he i ngu i nal “ar ea”— a vastar ea t hatcovers th e gr oi n— r at hert han “l i gam ent . ” D r . Th ot a f urt her poi nt ed outt hatD r . W al ke r ’ s ope r at i ve r epo rtdi d notd e s c ri b e the “ t ea r ” or h o w h e re p a i re d i t. D r. D o h e rtya l s o a d m i tte d th a t D r. W a l k e r’s o p e ra ti v e re p o rt st at ed t hat he had t o di vi de t he i ngu i nal l i gam entbef or e he coul d act ual l y see t he si t e o ft he t ea r i n t he art ery. D r . Thot a t es t i f i ed t hat , ba se d on t hatl oca t i on21

o f t h e si te o f t h e b l e e d i n g , i .e., u n d e r th e i n g u i n a l l i g a m e n t, the p u n c tu re s i te f ort he cat het r i zat i on w as i n t he cor r ectar ea. Bo t h D r . T h o t a a n d Dr . Do h e rt y t e s t i f i e d t h a t , i f t h e r e h a d b e e n an i m pr ope rhi gh s t i ckpr eve nt i ng a deq uat e hem os t as i s, Ronni e w oul d l i ke l y ha ve dev el ope d si gns of bl ee di ng bef or e di sc har ge. ButRonni e r em ai ned s t abl e a nd exper i enced no pai n orsi gns ofbl eedi ng a ft e r th e pr ocedu r e and f orsever al h o u rs a fter his d i sc h a rge . D r. T h o ta te sti fi e d , a n d ev e n D r. D o h e rt y a c k n o w le d g e d , t h a tt h e o bje c t iv e e v id e n c e in t h e re c o r d s in d ic a t e d t h a tR o n n ie
w a s n o tb le e d in g a tt h e t im e h e w a s d is c h a r g e d , f r o m w h ic h t h e ju r yc o u ld
re a s o n a b l yi n fe r th a t th e p u n c tu re l o c a ti o n w a s n o t i m p ro p e r. A s i n m anym edi ca l m al pr ac t i ceca se s, t he r ec or d c ons i st s ofco nf l i ct i ng o p i n i o n s o f e x p e rts . S e e, e .g., Cruzexrel. Cruzv. Pa so D el No rteHe a lth Foun d . , 44 S. W . 3d 622 , 646 ( Tex. A pp. — El Pas o 2001, pe t . de ni ed) ( hol di ng f ai l ur e t o f i nd nur se negl i gent not agai nst over w hel m i ng w ei ght o f e v id ence
w h e n o p i n i o n s o f e x p e rts fo r b o th p a rti e s c o n fl i c te d ); Magee v. Ul rey , 993 S. W . 2d 332, 336 ( Tex. A pp .— H ous t on [ 14t h Di st . ] 1999 , no p et . ) ( hol di ng f ai l ur e t o f i nd physi ci an negl i gent not agai nstover w hel m i ng w ei ght ofevi dence
w h e n j u ryc o u l d h a v e b e l i e v e d d e fe n s e e x p e rt); Crawf ord v. Hope , 898 S. W . 2d 937 , 942– 43 ( Tex. A pp. — A m ar i l l o 1995, w r i tde ni ed) ( not i ng “ batt l e o f22

e x p e rts ” i n s u i t a g a i n s t p h y s i c i a n a n d h o l d i n g w e i g h t o f e v i d e n c e w a s fo r j u ry t o eva l uat e a nd j ur y’ s f ai l ur e t o f i nd pr oxi m at e c aus e n otag ai ns tove r w hel m i ng
w ei ghtofev i den ce ) . I n a batt l e of com pet i ng exp ert s, i t i s t he so l e p r er oga t i ve o f th e j u ryto d e te rm i n e th e c re d i b i l i ty a n d w e i g h t o f th e w i tn e s s e s . Cruz , 44 S. W . 3d a t646. B e c a u s e o f (1 ) th e a m b i g u i ty o f D r. W a l k e r’sre p o rt, (2 ) th e fa c t th a t D r. D ohe rt y’ s opi ni ons w er e bas ed pr i m ar i l y on t hatr epo rt , an d ( 3) t he con f l i ct i ng t es t i m ony of D r . Thot a and D r . D ohe rt y bas ed on t hei rr es pec t i ve i nt er pr et at i ons oft he r epo rtast o w het herD r . Thot a d i d ordi d notpl ac e t he nee dl e a nd
ca t het eri n t he w r ong l oca t i on, t he j ur y c oul d r ea so nab l y hav e re s o l ved t he
c re d i b i l i tyi s s u e s b yd i s b e l i e v i n g D r. D o h e r t y ’ s o p i n i o n s a n d b yb e l i e v i n g D r. Th ot a’ s and coul d r easonabl y have f oun d t hatA ppel l a n t fa il e d t o car r y her b u rd e n o f p ro o f o n e s ta b l i s h i n g th e n e g l i g e n c e o f D r. T h o ta . O n c e th e j u ry a n s w e re d “ n o ” th a t a n yn e g l i g e n c e o f D r. T h o ta p ro x i m a te l yc a u s e d R o n n i e ’s i nj u r y, hew asex one r at ed, an d ne i t hera “y es ” nora “n o” an sw erast o t he
c o n tri b u to ryn e g l i g e n c e o f R o n n i e c o u l d h a v e a l te re d th e v e rd i c t. See Alvar ado, 897 S . W . 2d a t752– 53. M or eover , not hi ng i n t he r ecor d “cl ear l y i ndi cat es” t hatt he j ur y r el i ed
u p o n the n e w a n d i n d e p e n d e n t ca u se i n stru c ti o n . T h e j u ry w a s free to23

di sb el i evet he exp ert t es t i m ony of D r . D ohe rt y, t o ac ce ptt hatofD r . Thot a, an d t o c onc l ude t hatD r . Tho ta di d noti nco r r ec t l y pl ac e t he punc t ur e s i t e f ort he
c a th e teri za ti o n . W e p res u m e th a t th e j u ry d e c i d e d a l l q u e sti o n s o f c r e d i b i l i ty
a n d c o n f lic t s in t h e e v id e n c e in f a v o ro ft h e v e r d ic tifre a s o n a b le ju r o r s c o u ld h a v e d o n e s o . To r

res , 231 S. W . 3d at63–6 4 ( ci t i ng City of Kel ler v. W i l so n , 1 6 8 S .W .3 d 8 0 2 , 8 1 9 (T e x . 2 0 0 5 )). T h e j u ryc o u l d re a s o n a b l yh a v e fo u n d D r. Th ot a notnegl i gent w i t hou tr eachi ng t h e is sue ofpr oxi m at e cause, i n w hi ch eventt he ju ry w o u ld nothave r el i ed on t he new and i ndep enden tcause i n s tru c ti o n b e c a u s e th a t i n s t r u c t i o n re l a te s o n l yto p ro x i m a te c a u s e . S ee A r guel lesv. Ke l

lo ggBrown & Root , I nc . , 222 S . W . 3d 714, 727 ( Tex. A pp. — H ous t on [ 14t h Di st . ] 2007 , no p et . ) ( not i ng “ new an d i n d e p end ent
c a u s e ” i s c o mp o n e n t o f p r o x i ma t e c a u s e ) . Ad d i t i o n a l l y , t h e j u r y ’ s a n s werof “y es ” as t o Ronni e’ s con t r i but or y ne gl i gen ceasa pr oxi m at e c aus e n ega t esan y re l i a n c e b yth e j u ryo n th e i n s tru c ti o n . S e eEo ff, 811 S. W . 2d at193 ( hol di ng new and i ndep enden t cause i nst r uct i on contem pl at es i ndep enden t f or ce r at her th a n n e g l i g e n c e o f p a rti e s w a s re s p o n s i b l e fo r i n j u ri e s ). F i n a l l y , c o u n s e l fo r D r. T h o t a n e v e re v e n m e n t io n e d t h e in s t r u c t io n in h is c lo s in g a r g u m e n t . I w o u ld hol d t her e i s no i ndi cat i on, m uch l ess any “cl eari ndi cat i on, ” t hatt he j ur y r el i ed
o n th a t i n s tru c ti o n i n re a c h i n g i ts v e rd i c t. S e eUri sta , 211 S. W . 3d a t758– 59.24

T h u s , e v e n ift h e r e w a s c h a r g e e r r o r , u n d e rt h e p r o p e rh a r m a n a l y s is I w o u ld h o ld t h a tt h e re c o r d f a ils t o e s t a b lis h t h a ta n ys u c h e r r o rp r o b a b lyre s u lt e d in
a n i m p ro p e r ju d g m e n t. S eeTex. R. A pp. P. 44. 1( a) . I w oul d a f f i r m t he j u d g m e n t of th e tr i a l co u rt .

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DEL I VERE D: Nov e m be r20, 2008