Medical Causation in an Automobile Accident

Earlier this month, the North Carolina Court of Appeals issued an unpublished opinion in an automobile accident case involving the issue of medical causation. Fields v. Fields involved a plaintiff who sued on her own behalf and as administrator of the estate of her deceased husband. The husband was injured in an automobile accident which resulted from the negligence of the defendant. The court of appeals affirmed the trial court’s award of defendant’s partial summary judgment on the issue of causation but remanded the case for a partial new trial on the issue of damages.

The accident in Fields occurred when the defendant rear-ended the husband’s truck. Just prior to the accident, the defendant was traveling at 60 miles per hour. As a result of the impact of the accident, the windows and seat in the truck broke and the cab partially separated from the body of the truck. The husband was taken to the hospital following the accident and complained of pain in his head, neck, back and left knee. At the hospital, the husband was diagnosed with degenerative arthritis in his left knee, as well as a lumbar sprain or strain and hypertension.

Following the husband’s discharge from the hospital, he returned to work. However, friends and family noticed that he was weaker and less energetic and that his feet and hands were unsteady. Although the husband was known as energetic and active, he had a 20-year history of untreated hypertension prior to the date of the accident. About three weeks after the accident, the husband visited his doctor who noted that the husband’s pain and swelling in his knee and shoulder were worse. The doctor also made note of the husband’s hypertension.

Approximately one month after the accident, the husband suffered a massive ischemic stroke which affected the husband’s motor movement on his right side. After the stroke, the husband was unable to walk or speak. The husband went through physical therapy. However, because his left knee was unable to bear weight, he had a difficult time making progress. After three years of therapy, the husband was still unable to use a walker and was mainly confined to a wheelchair.

Eventually, the plaintiff filed a suit against the defendant alleging that the defendant was liable for the husband’s disabling injuries and the loss of the value of his life, as well as medical expenses and lost wages. A little more than one year after the suit was filed, the husband passed away from colon cancer, which was unrelated to his injuries.

Prior to the trial, two doctors were deposed. One opined that the accident had nothing to do with the husband’s stroke, while the other was unsure as to the cause. However, the doctor unsure as to the cause had previously written a letter noting his professional opinion that the accident was a cause of the stroke. The defendant moved for summary judgment on the issue of causation of the stroke, and the trial court ruled in favor of the defendant  At trial, the judge instructed that the only damages the jury could consider with respect to the husband’s injuries were medical expenses and pain and suffering. The jury awarded the plaintiff a little over $1,500, and the plaintiff appealed.

On appeal, the plaintiff argued that the trial court erred in granting the defendant’s motion for partial summary judgment. For the plaintiff to be successful on the issue of causation, the accident must be a proximate cause of the stroke. The court noted that “proximate cause” has been defined as “a cause which in natural and continuous sequence, unbroken by any new and independent cause, produced the plaintiff’s injuries, and without which the injuries would not have occurred.” In addition, the defendant’s actions must be “a substantial factor . . . of the particular injuries for which plaintiff seeks recovery.” Prior caselaw has established that “where the exact nature and probable genesis of a particular type of injury involves complicated medical questions far removed from the ordinary experience and knowledge of laymen, only an expert can give competent opinion evidence as to the cause of the injury.”

The plaintiff deposed a doctor who had opined in a letter that the accident was a cause of the stroke. However, the doctor’s deposition testimony included only statements that the accident “could have contributed” to the stroke and there was a “possibility” that the accident was a cause but that the doctor didn’t know. The doctor also explained that the letter was meant only to mean that the accident might have contributed to the stroke but that he couldn’t say that the accident caused the stroke.

In rejecting the plaintiff’s argument that the trial court erred in granting the defendant’s motion for partial summary judgment, the court noted that the North Carolina Supreme Court has held that “could” or “might” testimony is not sufficient to prove causation. The court concluded that “while plaintiff presented admissible evidence of causation,… that evidence was not sufficient to give rise to a genuine issue of material fact regarding whether the accident was a proximate cause of [the husband’s] stroke.” Therefore, the trial court did not err in granting the defendant’s motion for partial summary judgment on the issue of causation.

The plaintiff also argued on appeal that the trial court erred in refusing to instruct the jury on damages from husband’s loss of the use of his left knee. The court quoted prior caselaw as holding that

[A] tortfeasor is responsible for all damages directly caused by his misconduct, and for all indirect or consequential damages which are the natural and probable effect of the wrong, under the facts as they exist at the time the same is committed and which can be ascertained with a reasonable degree of certainty. However, [d]amages which are uncertain and speculative . . . are too remote to be recoverable.

The court pointed to evidence showing that the husband’s left knee was impacted in the accident, the husband was limping after being discharged from the hospital following the accident, and the husband suffered numerous falls after his stroke which the plaintiff perceived as being related to his weakened left knee. The court then held “that plaintiff’s evidence was sufficient to allow the jury to find that [the husband] suffered at least a partial loss of use of his left leg or knee as a result of the accident.” Therefore, the court vacated the award of damages and remanded for a new trial on the issue of damages.

If you have been injured in an automobile accident, contact an attorney at Rosensteel Fleishman, PLLC (704) 714-1450 to discuss your options.