## Facts

- Peter R. Quirion suffered recurring chest pain from 1978 until his death in 1985 at age 33.
- He was treated over several years by physicians in the Newport, Vermont area, including his primary physician and other doctors involved in his care.
- Seeking another opinion, Quirion consulted Dr. R. Jackson Forcier, a cardiologist at the Hitchcock Clinic, who examined him for about an hour on October 3, 1985.
- Forcier sent letters to Quirion and his primary physician stating he did not believe the chest pain was related to coronary artery disease, suggested alternative causes (including reflux esophagitis and anxiety), and recommended diagnostic testing.
- There was no follow-up by Quirion’s primary physician on the recommendations.
- Slightly more than a month later, Quirion died of a heart attack; an autopsy showed coronary artery blockage.
- The estate sued multiple physicians and the Hitchcock Clinic for medical malpractice; the estate settled with the Newport-area physicians before trial, leaving Forcier and the clinic as the only trial defendants.
- At trial, the court admitted evidence of the prior settlements (excluding amounts) for limited purposes, allowed evidence and argument that the settled physicians were negligent, and admitted evidence that the plaintiff regularly used marijuana.

## Issues

1. Whether evidence that the plaintiff settled with other physicians was inadmissible under Vermont Rule of Evidence 408, or admissible for another purpose such as showing expert bias and explaining a change in testimony.
2. Whether the defendants could introduce evidence and argument that the settled, nonparty physicians were negligent to contest causation and liability.
3. Whether admitting evidence of the plaintiff’s marijuana use was an abuse of discretion due to unfair prejudice outweighing probative value.

## Decision

- The Vermont Supreme Court affirmed the judgment for Dr. Forcier and the Hitchcock Clinic.
- The court held settlement evidence was properly admitted for a limited, nonliability purpose: impeaching the credibility of the plaintiff’s key expert and explaining the timing and nature of his changed opinions.
- The court held evidence of alleged negligence by the settled physicians was admissible because defendants may argue alternative causes and rebut proximate-cause allegations, even when the alleged tortfeasors are no longer parties.
- The court held admission of marijuana-use evidence was within the trial court’s discretion under the probative-value versus unfair-prejudice balancing standard and did not warrant reversal.

## Legal Principles

- Under Rule 408, settlement evidence is inadmissible to prove liability or claim amount but may be admitted for another purpose, including demonstrating witness bias, interest, motive, or explaining a material change in testimony, especially with limiting instructions.
- A defendant in a negligence or malpractice action may introduce evidence that other actors’ negligence caused or contributed to the injury to challenge causation and the plaintiff’s theory of liability, even if those actors have settled and are not parties at trial.
- Evidentiary rulings involving potentially prejudicial material are reviewed for abuse of discretion; limiting instructions and the trial court’s balancing of probative value against unfair prejudice are given substantial deference on appeal.

## Conclusion

The court upheld a defense verdict in a medical malpractice case, concluding the trial court acted within its discretion by admitting settlement evidence for impeachment and bias, allowing proof of nonparty physicians’ negligence on causation, and permitting limited marijuana-use evidence despite potential prejudice.


Quirion v. Forcier, 632 A.2d 365 (Vt. 1993)