On March 7, 2023, the Mississippi Court of Appeals issued its Opinion in Smith v. Minier. In doing so, the Court sought to clarify the law on the issue of causation.

Facts of the Case

On April 2, 2013, Mr. Smith was driving a truck eastbound on Interstate 10 in Jackson County when he lost control of his truck. Before Mr. Smith and his passenger could get out of the truck, it was hit from behind another tractor-trailer.

An ambulance took Mr. Smith to Singing River Hospital in Pascagoula, where a doctor prescribed the pain medication Lortab (which contains Tylenol) and discharged him that same day.

There was a dispute as to the scheduled dosage of the prescription. The doctor testified that the medication was to be taken “every six hours, as needed.”

An expert witness later testified that Mr. Smith’s medical chart directed a schedule of “one to two tablets every four hours.”

Mr. Smith’s discharged summary directed “one tablet every six hours.” Mrs. Smith followed a schedule of “two tablets every six hours,” following “the prescription from the bottle.”

Within six days, Mr. Smith had taken 56 Lortab tablets and was suffering from adverse symptoms. An ambulance took him to Sacred Heart Hospital, where it was found that he was suffering from “acute fulminant liver failure secondary to Tylenol toxicity.”

The doctors stabilized him over the course of a week. Once Mr. Smith was discharged, Mrs. Smith retrieved a second quantity of Lortab.

Four days later, Mr. Smith returned to Sacred Heart, where a liver biopsy revealed “acute Tylenol toxicity with liver failure.” He was again stabilized and discharged.

A few months later, he went to the University of Alabama at Birmingham hospital. There, Mr. Smith developed acute respiratory failure but ultimately died from acute chronic liver failure.

Jackson County Circuit Court Proceedings

On September 8, 2015, Mrs. Smith filed “a complaint requesting damages for pain and suffering on the basis of negligence and personal injury.” The trial court granted the defendants’ motion for partial summary judgment on April 2016, 2018, and it dismissed Mrs. Smith’s claim for relief due to pain and suffering. Her personal injury claim was settled out of court.

Mrs. Smith petitioned for interlocutory review to the Mississippi Supreme Court but was denied on October 25, 2018.

Mrs. Smith then, on April 30, 2021, “moved for the trial court to reconsider its partial summary judgment order.” On May 24, 2021, the defendants requested that the trial court deny this motion.

On October 21, 2021, “the trial court entered its final judgment in favor of the Defendants,” which Mrs. Smith appealed.

Appellate Court Proceedings

On March 7, 2023, the Mississippi Court of Appeals reversed the trial court’s order granting partial summary judgment and remanded the order for further proceedings.

Central to the court’s decision to reverse and remand the trial court’s order is the distinction between causation in the context of fact and causation in the context of law.

Mrs. Smith argued that the “the trial court’s grant of partial summary judgment in favor of the Defendants should be reversed because (1) the trial court applied the incorrect foreseeability (legal clause) standard; (2) a genuine issue of material fact exists as to foreseeability; and (3) Mr. Smith's use of pain medication was not an intervening cause.”

According to Civil Procedure Rule 56(c), the trial court is to grant summary judgment if “the pleadings, depositions, answers to interrogatories and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact,” where “[a] fact is material if it tends to resolve any of the issues properly raised by the parties.”

To then “withstand summary judgment, the party opposing the motion must present sufficient proof to establish each element of each claim,” and “[t]he evidence must be viewed in the light most favorable to the party against whom the motion has been made.” 

The court noted that, “[t]o succeed on a negligence claim, a plaintiff must show the following five elements: (1) duty, (2) breach, (3) cause in fact, (4) legal cause, and (5) damages.” However, the court notes that “Mississippi courts have at times condensed these five elements to four by combining the cause in fact and legal cause elements” into the term ‘proximate cause’.

Two elements of causation.

To address this ambiguity, the court delineated “two separate elements” of causation: “(1) but-for causation (or cause in fact) and (2) proximate causation (or legal cause), which includes foreseeability.”

With respect to cause in fact, “the plaintiff must show that ‘but for the defendant’s negligence, the injury would not have occurred.’”

With respect to legal cause, “the plaintiff must show that the injury ‘is the type, or within the classification, of damage the negligent actor should reasonably expect (or foresee) to result from the negligent act.”). The court then notes that the “damage to the plaintiff must fall within the zone of foreseeability that the actor reasonably should have known would result from its conduct.”

The court concluded that, “in regard to foreseeability, whether an event is so unusual or improbably that it is unforeseeable by the negligent actor is a question of fact that should be left for the jury, as it turns on whether another person’s actions constitute a superseding intervening cause that breaks the chain of causation.”

The defendants argued that Mr. Smith’s “abuse of pain medication was unforeseeable,” as was his subsequent liver failure. However, considering three alleged prescriptions and conflicting dosage instructions therefrom, as well as the expert testimony as to “how common it is for patients to inadvertently take more pain medication than they should, resulting in unintentional liver failure,” the court concluded:

           1. That the foreseeability of Mr. Smith’s misuse of the prescribed medication “is a question of fact for the jury to determine.” Moreover, the court concluded that his use  and “whether this action was an intervening or superseding cause of a genuine  issue of material fact that should have been resolved in favor of Smith because it  was unclear whether he intentionally took more pills than prescribed.”

           2. Considering the aforementioned expert testimony, the court concluded that  “[l]iver failure caused by pain medication prescribed by a medical physician is not outside the zone of foreseeability of an automobile accident,” making Mr. Smith’s death a question of fact for the jury, as “a reasonable juror could determine that  the Defendants should have foreseen that an injury would require medication and that an adverse reaction to that medication could occur.

S. Craig Panter

Panter Law Firm, PLLC

601-607-3156

www.craigpanterlaw.com