Facts
- David Fritts was seriously injured when a pickup truck (driven either by Fritts or a friend) hit a tree and overturned; both men had been drinking before the crash.
- Fritts suffered extensive facial fractures, including a LeFort II fracture, and was hospitalized for surgical repair.
- Five days after the accident, surgeons scheduled a procedure to repair the facial fractures; Dr. Richard McKinne, an otorhinolaryngologist, was asked to assist by performing a tracheostomy to manage Fritts’s airway and to address any sinus damage.
- During the tracheostomy attempt, Fritts began bleeding profusely due to a cut or rupture of the innominate artery; the tracheostomy was not completed and the planned facial surgery was delayed.
- Fritts lost a major amount of blood, did not regain consciousness, and died about three days later.
- Fritts’s estate (through his surviving spouse) sued Dr. McKinne for wrongful death/medical negligence, alleging that McKinne failed to properly identify and isolate the innominate artery and failed to timely and properly control the bleeding.
- Dr. McKinne denied negligence, asserting that Fritts had an unusually positioned (anomalous) innominate artery and that the complications were attributable to anatomy and trauma rather than substandard care.
- McKinne also asserted comparative negligence, arguing that Fritts’s injuries resulted from drunk driving or from riding with a drunk driver; he further argued that evidence of Fritts’s drug and alcohol use was relevant to damages because it reduced life expectancy.
- Over the estate’s objection, the trial court admitted evidence of intoxication at the time of the accident and evidence of prior drug/alcohol use, and it instructed the jury on comparative negligence (including an instruction on a driver’s duty to use ordinary care to prevent injury).
- The jury returned a verdict for Dr. McKinne, and the estate appealed.
Issues
- May a defendant physician assert comparative negligence in a malpractice action based on the patient’s pre-treatment conduct that caused the accident and created the need for medical care?
- Did the trial court err by admitting evidence of the patient’s intoxication at the time of the accident and history of drug/alcohol use to support comparative negligence and/or damages (life expectancy)?
- If error occurred, was it prejudicial such that a new trial was required?
Decision
- The Court of Civil Appeals of Oklahoma reversed the judgment for Dr. McKinne and remanded for a new trial.
- The court held that comparative negligence is not available when the patient’s alleged negligence merely caused the initial injury that led to treatment; it is not compared against alleged negligence in rendering medical care.
- The court held that evidence of intoxication at the time of the crash and prior drug/alcohol use was not relevant to whether Dr. McKinne met the standard of care in performing the tracheostomy and responding to bleeding, and it created a substantial risk of unfair prejudice.
- Because the comparative-negligence theory was presented to the jury through both evidence and instructions, the errors were not harmless and warranted a new trial.
Legal Principles
- Comparative negligence in medical malpractice requires patient negligence that contributes to the injury attributed to the medical provider’s negligence; conduct that only explains why treatment was needed is not compared to later treatment decisions.
- A health-care provider’s duty to use reasonable care in treatment is independent of a patient’s fault in causing the condition that required care.
- Evidence must be tied to a fact of consequence in the malpractice claims (standard of care, causation, or properly limited damages); otherwise it is inadmissible.
- Evidence of intoxication and substance use may carry strong unfair-prejudice risk and may be excluded when it chiefly invites a character-based verdict rather than helping the jury decide whether the provider met the standard of care.
- Even when substance-use evidence is offered on damages (such as life expectancy), the trial court must weigh probative value against unfair prejudice and limit the use to the damages issue where appropriate.
Conclusion
Fritts v. McKinne holds that a patient’s pre-treatment negligence that caused the accident and made medical care necessary is not comparative negligence in a later malpractice action over that care. Because the trial court allowed the defense to present intoxication and drug/alcohol-history evidence and instructed the jury on comparative negligence based on the antecedent accident, the appellate court reversed the defense verdict and ordered a new trial focused on whether the physician’s conduct during the tracheostomy and bleeding event met the applicable standard of care.