Judy Komlodi v. Anne Picciano, M.D. (071301), 217 N.J. 387

Background

Michelle Komlodi, a patient with chronic back pain and known drug/alcohol addiction, was prescribed ten 75-microgram Duragesic (fentanyl) patches by Dr. Anne Picciano; Michelle later ingested a patch and suffered permanent anoxic brain injury.
Plaintiff (Michelle’s mother as guardian) sued for medical malpractice, alleging Dr. Picciano breached the standard of care by prescribing powerful fentanyl patches to a known addict and failing to take steps to prevent access/abuse.
At trial plaintiff proved deviation from the standard of care and that the deviation increased risk from Michelle’s preexisting condition, but the jury found the increased risk was not a substantial factor in producing the injury and returned a no-cause verdict.
The trial court instructed the jury on preexisting-condition (Scafidi), avoidable consequences, and superseding/intervening causation, but did not give a comparative negligence charge; the court inadvertently referenced “but for” causation alongside a substantial-factor instruction.
The Appellate Division (split) reversed and remanded for a new trial, finding errors in the jury charge; defendants appealed as of right on issues raised in the dissent.
The New Jersey Supreme Court held the Scafidi preexisting-condition charge was improperly applied (and, even if appropriate, was defectively given), affirmed that avoidable-consequences and superseding/intervening charges were proper but needed tailoring to the facts, and required the substantial-factor standard (not a "but for" charge) on remand.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Appropriateness of Scafidi (preexisting-condition/lost-chance) charge	Scafidi inapplicable: Dr. Picciano treated back pain, not the addiction; defendant’s fault caused injury	Scafidi applies because Michelle’s addiction was a preexisting condition that combined with the prescription to produce foreseeable harm	Court: Scafidi was misapplied here and, even if applicable, the charge was defective and confusing; required new trial
Superseding/intervening-cause and foreseeability instructions	Should not be given because foreseeability (general proximate-cause charge) suffices	Proper to give both; jury must decide foreseeability and whether Michelle’s act broke the causal chain	Court: Both concepts are distinct but related; superseding/intervening instruction was appropriate but must be tailored to the facts
Avoidable-consequences vs. comparative negligence	Plaintiff: comparative negligence inapplicable; avoidable consequences inapposite to blame	Defendants: plaintiff’s post-prescription conduct could limit or bar recovery	Court: Comparative negligence properly excluded; avoidable-consequences instruction appropriate but must account for plaintiff’s impairment and capacity to mitigate
Proximate cause standard used ("but for" vs. substantial-factor)	"But for" instruction was improper where concurrent/alternative causes existed	Defendants considered the error harmless	Court: "But for" is inappropriate here; substantial-factor test must be used on retrial; inclusion of "but for" was error (parties did not object)

Key Cases Cited

Scafidi v. Seiler, 119 N.J. 93 (preexisting-condition/lost-chance instruction)
Ostrowski v. Azzara, 111 N.J. 429 (distinguishing comparative negligence and avoidable consequences)
Cowan v. Doering, 111 N.J. 451 (duty to prevent self-harm; intervening/superseding cause analysis)
Verdicchio v. Ricca, 179 N.J. 1 (scope of preexisting-condition charge)
Evers v. Dollinger, 95 N.J. 399 (preexisting condition and aggravation of harm)
Conklin v. Hannoch Weisman, P.C., 145 N.J. 395 (distinction between "but for" and substantial-factor causation)
Reynolds v. Gonzalez, 172 N.J. 266 (need to tailor jury instructions to facts and theories)
Fosgate v. Corona, 66 N.J. 268 (identifying preexisting disease and its normal consequences)
Brown v. United States Stove Co., 98 N.J. 155 (substantial-factor test for proximate causation)