From “Suicide Rule” to “Foreseeability Test”: Nevada Affirms Potential Liability of Health-Care Providers for a Patient’s Post-Treatment Suicide

1. Introduction

In Bourne v. Valdes, 141 Nev., Advance Opinion 30 (2025), the Nevada Supreme Court confronted a question of first impression: Does a patient’s suicide automatically sever a medical provider’s liability for malpractice when the patient was not under the provider’s custody or control at the time of death? Rejecting what many jurisdictions term the “suicide rule,” the Court held that suicide is not a per se bar to recovery. Instead, ordinary principles of medical malpractice—duty, breach, causation, foreseeability, and damages—continue to govern. The ruling reverses a district court’s grant of summary judgment for the defendant physician, Dr. Zidrieck Valdes, and remands the case for trial.

Parties: Katy Bourne, individually and as guardian for her minor son, appealed the dismissal of their wrongful-death/medical-malpractice claims against Dr. Valdes and his professional corporation. David Bourne, Katy’s husband, committed suicide in November 2019 after medication changes allegedly mishandled by Dr. Valdes.

2. Summary of the Judgment

• Holding. A patient’s suicide does not categorically relieve a health-care provider from liability for professional negligence. Liability turns on the traditional elements of malpractice, particularly whether the suicide was a foreseeable consequence of any breach of the applicable standard of care.
• Disposition. Reversed and remanded. The district court erred by applying the “suicide rule” and granting summary judgment. A jury must resolve factual disputes concerning breach, foreseeability, and proximate causation.
• Vote. Majority opinion by Justice Lee, joined by Chief Justice Hardesty and Justices Herndon and Cadish; dissent by Justice Stiglich with Justice Pickering concurring in the dissent.

3. Analysis

3.1 Precedents Cited

1. Wood v. Safeway, Inc., 121 Nev. 724 (2005) – Standard for summary judgment (view evidence in the light most favorable to the non-moving party).
2. White v. Lawrence, 975 S.W.2d 525 (Tenn. 1998) – Suicide foreseeable where provider’s negligence leads to that outcome.
3. Edwards v. Tardif, 692 A.2d 1266 (Conn. 1997) – A physician may be liable if suicide was foreseeable and proximately caused by negligent treatment.
4. Truddle v. Baptist Memorial Hosp.—DeSoto, 150 So. 3d 692 (Miss. 2014) – Requires showing of an irresistible impulse caused by provider’s wrongful act.
5. Runyon v. Reid, 510 P.2d 943 (Okla. 1973) – Psychiatrist may be liable; summary judgment inappropriate if reasonable minds could differ.
6. Secondary Sources: 81 A.L.R.5th 167; 11 A.L.R.2d 751 (historic survey of suicide rule).

The majority distinguished the traditional “suicide rule” cases—largely outside the medical-malpractice context and rooted in early 20th-century tort law—from modern health-care negligence claims where foreseeability is the touchstone.

3.2 Legal Reasoning

• Statutory Framework. Nevada’s malpractice scheme (NRS Chapter 41A) defines duty as the reasonable care, skill or knowledge ordinarily used by similarly situated providers. Nothing in the statute immunizes providers from liability when the injury manifests as suicide.
• Duty & Breach. Through expert testimony, appellants created a triable issue that Dr. Valdes deviated from the standard of care by (a) concurrently prescribing an opioid and a benzodiazepine, and (b) discontinuing Klonopin without tapering—a practice known to trigger withdrawal and heightened suicidality.
• Causation. The Court reframed suicide not as an automatic superseding cause but as a potential foreseeable consequence. If foreseeability is present, suicide will not break the chain of causation; if unforeseeable, it will.
• Foreseeability Test. Borrowing language from White v. Lawrence, the majority announced the operative question: Did the defendant’s negligent conduct make it reasonably foreseeable that the patient would commit suicide?
• Dissent’s Position. Justice Stiglich argued for adoption of the traditional suicide rule with recognized narrow exceptions (custody/control, irresistible impulse, intentional torts), emphasizing common-law continuity (NRS 1.030) and policy concerns over attenuated causation.

3.3 Impact of the Decision

1. End of Per-Se Bar. Health-care defendants in Nevada can no longer obtain summary judgment merely by pointing to a patient’s out-of-custody suicide.
2. Expanded Litigation. Plaintiffs may frame post-treatment suicides as foreseeable consequences, spurring expert-driven disputes over pharmacology, psychiatric care, and risk-assessment procedures.
3. Clinical Risk Management. Providers will likely adopt stricter documentation, informed-consent discussions, tapering protocols, and suicide-risk screenings when altering psychotropic or pain-management regimens.
4. Jury Instructions & Pattern Law. Nevada’s civil-jury-instruction committees will need to draft new language clarifying that suicide may or may not be a superseding cause depending on foreseeability.
5. Persuasive Authority Elsewhere. The ruling may influence jurisdictions reconsidering the rigidity of the suicide rule, contributing to a modern trend aligning tort law with contemporary understandings of mental health.

4. Complex Concepts Simplified

• Suicide Rule. A common-law doctrine stating that a person’s voluntary, intentional suicide is an independent intervening act that cuts off liability for antecedent negligence. Courts carved out narrow exceptions over time (custody, irresistible impulse, intentional torts).
• Superseding Intervening Cause. An event occurring after the defendant’s conduct that breaks the causal chain because it was not reasonably foreseeable.
• Foreseeability. In tort law, the idea that a consequence is one a reasonable person (or professional) could predict might result from their conduct.
• Standard of Care. The level of skill, knowledge, and care ordinarily possessed and exercised by members of the profession in similar circumstances.
• Summary Judgment. A procedural device where the court decides a claim without trial because no genuine factual dispute exists and the movant is entitled to judgment as a matter of law.
• Tapering Medication. Gradually lowering dosage to avoid withdrawal; abrupt cessation of benzodiazepines is known to induce severe anxiety, agitation, and suicidal ideation.

5. Conclusion

Bourne v. Valdes charts a new course in Nevada tort jurisprudence by substituting the traditional, categorical “suicide rule” with a nuanced foreseeability analysis. The majority’s approach harmonizes medical-malpractice doctrine with modern psychiatric insights, prioritizing factual inquiry over blanket immunity. For practitioners, it underscores the critical need for diligent risk assessment and documentation whenever treatment decisions could plausibly elevate a patient’s suicide risk. For litigants and courts, it signals that questions surrounding post-treatment suicide will now routinely reach juries unless the evidence unmistakably negates foreseeability.

In the broader legal landscape, the decision nudges Nevada into the progressive minority of states permitting malpractice liability for suicides occurring outside custodial settings. Whether other jurisdictions will follow remains to be seen, but Bourne stands as a significant precedent re-defining proximate-cause analysis in the context of mental-health-related wrongful-death claims.