Houston, Texas (May 16, 2022) - On Friday, May 13, 2022, the Texas Supreme Court issued an important opinion addressing but-for causation in Pediatrics Cool Care v. Ginger Thompson (o/b/o A.W.). In this case, tragically, the minor plaintiff A.W. committed suicide after seeing her pediatric healthcare provider and complaining of feelings of depression. A.W. was brought to Pediatrics Cool Care in 2012 by her parents and described feeling sad and not being able to control her feelings. The defendant healthcare provider diagnosed A.W. with depression and prescribed her Celexa. On April 17, 2012, A.W. returned to the office and complained of a headache but reported that she had a positive mood change. In August 2012, approximately four months later, A.W. committed suicide by overdosing on Benadryl.

The plaintiff presented two medical experts: Dr. Lessin, who opined on the failures of the defendant in practice, protocols, and record keeping, and Dr. Moss, who opined that Celexa was not the cause of death and instead it was the defendant's failure to question A.W. about her depression in depth and away from the presence of her parents. Dr. Moss stated that "based on questions that were not asked" there could have been "pathways" towards better treatment options. The Texas Supreme Court was critical of Dr. Moss' opinion because he could not list one specific path that would have prevented A.W.'s suicide.

The court distinguished this case from its prior holding in which the court had rejected a "stringent but for causation test" for multiple healthcare defendants and instead applied a "substantial factor test." In this case, the Texas Supreme Court clearly indicated it did not eliminate the but-for causation analysis in its prior holdings and stated that the acts of the individual defendants - when they could be isolated from each other - would still be analyzed by the but-for test when assessing each individual defendant's acts.

Further, the court found Dr. Moss' opinion on causation assumed too much in reliance on the substantial factor test. Dr. Moss assumed A.W. had suicidal thoughts at the time of her encounter with Pediatrics Cool Care and that A.W. would have consented to more potentially restrictive treatment. The court also found that Dr. Moss could not prove that had A.W. received psychiatric care, she would not have committed suicide as required by the but-for causation test. The Texas Supreme Court emphasized Pediatrics Cool Care's expert's opinion that some patients who do receive psychiatric care still commit suicide and that suicide is often an impulsive act. The court held that Dr. Moss' theory on causation did not meet the but-for test because, unlike the treatment for a health-related issue that may have a 75% to 90% success rate, the success of psychiatric care with regard to suicide prevention is not so easily quantifiable.

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