## Facts

- Agatha M. Edwards had a long history of serious depression and alcohol abuse treated by Dr. Daniel Tardif, including a 1987 hospitalization for severe depression during which she expressed suicidal thoughts.
- In late 1987, Tardif discontinued Edwards’ antidepressant medication and instructed her to contact his office if depression recurred.
- About ten months later, Edwards called Tardif’s office reporting she felt depressed; Tardif was unavailable, and Dr. Jeffrey Ettinger (an internist practicing with Tardif) returned the call.
- Ettinger had no prior relationship with Edwards and did not review her medical chart before calling back.
- During the telephone consultation, Ettinger did not meaningfully investigate precipitating events, Edwards’ history of depression, or suicide risk; he did not arrange an in-person evaluation or psychiatric assessment.
- Ettinger prescribed a large quantity of medication without follow-up safeguards.
- Approximately one week later, Edwards died by suicide after overdosing on the prescribed medication.
- The estate sued for medical malpractice, alleging Ettinger’s negligent assessment and prescribing proximately caused the death.

## Issues

1. Whether Edwards’ suicide was unforeseeable as a matter of law and therefore an independent, intervening cause that relieved Ettinger and the medical practice of liability.
2. Whether the evidence was sufficient to support the jury’s findings that Ettinger breached the standard of care and that the breach was a substantial factor in causing the suicide.

## Decision

- The Connecticut Supreme Court affirmed the judgment for the plaintiff against Ettinger and the professional corporation.
- The court held that, on the evidence presented, suicide was not an independent, unforeseeable intervening cause as a matter of law.
- The court held the evidence permitted the jury to find that Ettinger knew or reasonably should have known of suicide risk in depressed patients and failed to provide adequate care.
- The court held the evidence permitted the jury to find Ettinger’s inadequate assessment, lack of safeguards, and prescribing were a proximate cause of the suicide.

## Legal Principles

- In malpractice actions involving treatment of depression, a patient’s suicide is not automatically treated as an independent intervening act; foreseeability depends on the clinical context and what the physician knew or should have known.
- A physician may be liable where negligent evaluation and management of a depressed patient, including failure to assess suicide risk and failure to implement appropriate follow-up measures, is found to be a substantial factor in a subsequent suicide.
- Appellate review of a jury verdict in malpractice focuses on whether sufficient evidence supports findings on standard of care and proximate cause; where competing inferences are reasonable, the jury’s determinations control.

## Conclusion

The court upheld a malpractice verdict against an internist who, during a telephone consultation, failed to review a depressed patient’s history, assess suicide risk, or arrange appropriate evaluation and follow-up before prescribing substantial medication; the patient’s suicide by overdose was not an unforeseeable intervening cause, and the jury could find negligence and proximate cause.


Edwards v. Tardif, 692 A.2d 1266 (Conn. 1997)