## Facts

- Margaret Kawaauhau was treated by Dr. Paul W. Geiger for a foot injury and was hospitalized due to infection concerns.
- Geiger prescribed oral penicillin despite knowing intravenous penicillin would have been more effective; he testified he understood Kawaauhau wanted to reduce treatment costs.
- Geiger left on a business trip while other physicians sought transfer to an infectious disease specialist; upon returning, Geiger canceled the transfer and discontinued antibiotics believing the infection had subsided.
- Kawaauhau’s condition worsened, resulting in amputation of her right leg below the knee.
- A jury found Geiger liable for malpractice and awarded the Kawaauhaus about $355,000; Geiger lacked malpractice insurance, later moved, and faced wage garnishment.
- Geiger filed for bankruptcy; the Kawaauhaus sought a declaration that the malpractice judgment was nondischargeable under 11 U.S.C. § 523(a)(6) as a debt for “willful and malicious injury.”

## Issues

1. Whether a malpractice debt attributable to negligent or reckless conduct qualifies as a debt for “willful and malicious injury” under 11 U.S.C. § 523(a)(6) and is therefore nondischargeable.
2. Whether § 523(a)(6) requires intent to cause the injury itself, as opposed to intent to commit the act that resulted in injury.

## Decision

- The Supreme Court affirmed the Eighth Circuit.
- The Court held that § 523(a)(6) excepts from discharge only debts for injuries the debtor actually intended to cause.
- Because medical malpractice liability premised on negligent or reckless conduct does not establish intent to injure, the debt was dischargeable.
- The Court rejected a reading that would treat a deliberate act leading to injury as sufficient; the statute requires a deliberate or intentional injury.

## Legal Principles

- For nondischargeability under 11 U.S.C. § 523(a)(6), the debtor must have acted with actual intent to cause injury, not merely with intent to perform an act that results in injury.
- “Willful” modifies “injury”; therefore, the exception covers deliberate or intentional injuries rather than negligently or recklessly inflicted harm.
- The statutory phrase “willful and malicious injury” is aligned with intentional tort concepts, which generally require intent as to consequences, not only intent as to the act.
- Debts from recklessly or negligently inflicted injuries, including malpractice judgments lacking proof of intent to injure, fall outside § 523(a)(6) and are generally dischargeable.

## Conclusion

The Court construed § 523(a)(6) narrowly, holding that bankruptcy nondischargeability for “willful and malicious injury” requires proof that the debtor intended the injury itself; malpractice debts based on negligent or reckless treatment decisions do not satisfy that standard and may be discharged.


Kawaauhau v. Geiger, 523 U.S. 57 (1998)