A Missouri spine surgeon must stand trial against claims that medical negligence led to a patient's suicide, the state supreme court has ruled.

While a county circuit court had dismissed the patient's widow's wrongful death allegations and excluded an expert witness slated to connect the suicide to the patient's failed surgery, Judge Michael A. Wolff is allowing a jury to hear these matters and decide the case.

The case originates from a January 2005 procedure Gerald Kivland underwent to correct the curvature of his spine. According to Judge Wolff's ruling, the surgery paralyzed him from the waist down and left him in "intense and continuous pain in the paralyzed region."

Mr. Kivland sued Robert Gaines, MD, who performed the surgery, and his practice, the Columbia (Mo.) Orthopaedic Group, for medical negligence, seeking damages for injury, disability and suffering. In the meantime, medication treatment and even the use of a morphine pump failed to relieve Mr. Kivland's pain. In March 2006, he took his own life.

After his death, Jana Kivland and the couple's daughter, Kristin Bold, amended the lawsuit, which had not yet reached trial, to include wrongful death claims, arguing that Mr. Kivland's suicide was a direct result of the negligence the lawsuit was alleging. They planned to present an expert witness at trial who reasoned that the suicide, resulting as it did from extreme pain, was not a rational choice and was therefore not a voluntary act.

Attorneys for Dr. Gaines requested the exclusion of the expert witness. They argued that the suicide was an independent act and that the law could not hold the surgeon responsible for it. They also asked for the dismissal of the wrongful death claim on grounds that it did not fit the court's jurisdiction. The circuit court granted both requests.

On appeal, however, the supreme court decided that these matters were suitable for a jury to decide and returned them to the lawsuit. "Because Gerald Kivland, now deceased, cannot provide direct evidence as to why he acted as he did, an expert witness may be used to interpret the facts and data relating to his injury and suffering to supply the causal link from the injury to his death," wrote Judge Wolff in his Jan. 25 ruling. "Whether Dr. Jarvis's opinion is to be believed or accepted is for the jury, not the court."

Regarding the suicide's connection to the family's allegation of negligence, "the burden, as usual, is still on the plaintiff to prove causation to the jury," wrote Judge Wolff.

An attorney representing the Kivland family declined to comment on the lawsuit as it is still awaiting disposition. An attorney for Dr. Gaines did not return a call seeking comment. A trial date has not yet been set.

David Bernard