Paula Kingman (“Paula”) brought this diversity action against Dillard’s, Inc. (“Dillard’s”), seeking damages for the injuries she sustained to her right shoulder when a high-hanging rack of apparel fell on her at a Dillard’s store. Her husband, Calvin Kingman (“Calvin”), brought a claim for loss of consortium. Dillard’s does not challenge the district court’s liability finding with respect to Paula, but appeals the amount of the damages award. Dillard’s also appeals the district court’s judgment in favor of Calvin on his loss-of-consortium claim. For the reasons stated below, we affirm in part and reverse in part.
I. Background
On November 14, 2004, Paula was shopping at a Dillard’s store when a high-hanging rack of apparel came loose from the wall and struck her on the right shoulder (“the Dillard’s incident”). The district court found that she reached violently back to protect her face or avoid being buried in clothing, with the result that her right shoulder was twisted. Although no accident report was filed at Dillard’s, Paula subsequently developed pain and went to a clinic where she was prescribed medication and a sling. Two days later, her doctor diagnosed “shoulder sprain/strain” and muscle spasm and prescribed a variety of pain medications as well as physical therapy. In spite of these treatments, Paula continued to experience pain and a reduced range of motion in her right shoulder. She also developed sensations of “popping” and “catching.” On December 12, 2005, October 24, 2007, and February 29, 2008, Paula underwent three separate surgeries to cure her shoulder impingement, but postoperatively, her symptoms have persisted. Plaintiffs’ expert, Dr. Swaim, concluded that, as of July 2008, Paula had “reached maximal medical improvement,” that further surgeries would not improve the shoulder condition, and thаt going forward, Paula “will have ongoing right shoulder pain, popping, decreased motion, and weakness” and will require analgesics and anti-inflammatory medications indefinitely. Further, since May 17, 2007, three different doctors have advised that Paula’s shoulder cannot tolerate lifting, pushing, or pulling her husband, Calvin, who is a 300-pound quadriplegic. Prior to this time, Paula was Calvin’s primary care-giver, assisting him with bathing and dressing, feeding, urinary and bowel care, stretching to avoid contractures of joints, and, importantly, hoisting and turning him to prevent pressure ulcers.
Prior to the Dillard’s incident, Paula had been involved in several accidents. First, in 1982, Paula suffered minor injuries in a car wreck — the same one that left Calvin a quadriplegic. On June 22,1982, she saw a *611 doctor who opined that the car accident had aggravated previous muscle injuries to her neck and lower back, and predicted that her neck and back pain would evolve into a chronic problem. As a result of the accident, Paula and Calvin filed a products liability suit against the car manufacturer. Calvin sought $33 million to cover, among other things, lifetime medical expenses, including nursing care, and Paula asked for $50,000 to сover past and future medical expenses. The case ultimately settled, with Calvin receiving approximately $1.3 million and Paula receiving approximately $50,000.
Second, on June 8, 1990, while at work, Paula tripped on a crack in the sidewalk, and fell on her right arm. In follow-up visits to doctors, she complained of recurrent pain and stiffness in her right elbow and shoulder, as well as a limited range of motion and weakness in the right upper extremity. She was diagnosed with a “myofascial dysfunction” and treated with pain medications and physical therapy. Paula and her employer disputed the nature and extent of any permanent disability, but on October 1, 1992, she received a worker’s compensation award of $11,750, which reflected a settlement based on an approximate disability of fifteen percent permanent partial disability to the body as a whole, “referable to the neck and arm.”
Third, on May 11, 2002, Paula was rear-ended and suffered whiplash-related injuries, including vertigo problems and muscle stiffness in her neck and upper back. Her lawsuit against the other driver settled for $25,000. Between May 2002 and August 2004, Paula was in and out of doctors’ offices, сomplaining mainly of vertigo and dizziness, but also of stiffness and pain in her neck and upper back, for which she was prescribed physical therapy and pain medications. On August 9, 2004, she was taking between two and five tablets of Darvocet, a prescription pain medication, per day. A physical therapy report dated September 23, 2004, indicates that her pain was continuing and was aggravated by activities such as cleaning, vacuuming, grabbing, and lifting. Nevertheless, a social worker’s report dated November 8, 2004, indicates that at that time, she was continuing to act as Calvin’s primary caregiver.
Paula filed this tort action against Dillard’s in state court on August 24, 2005. After removal to the Western District of Missouri, the district court conducted a nine-day bench trial. The district court found Dillard’s negligent and liable for any damages suffered as a result of its negligence. The court awarded Paula $186,388 in damages, comprised of $116,388 to cover the past and future costs of medication and medical services incurred in treating Paula’s right shoulder since the Dillard’s incident, and $70,000 for the disability itself, including pain and loss of use of the shoulder. Additionally, the court found in favor of Calvin on his loss-оf-consortium claim and awarded him $1 million in damages to cover the cost of professional care-giver services for fifteen years — that is, until Paula reaches the age of sixty-two. Beyond that age, the court reasoned, Paula could no longer be expected to continue moving Calvin, even absent the Dillard’s incident.
II. Discussion
“After a bench trial, this court reviews the district court’s findings of fact for clear error, and its legal conclusions de novo.”
Lisdahl v. Mayo Found.,
A. Paula’s Damages
Dillard’s contends that the district court erred in calculating Paula’s damages because Paula’s right shoulder was already damaged when the Dillard’s incident occurred. According to Dillard’s, the clothing rack caused no further harm for which Dillard’s is responsible. Alternatively, Dillard’s maintains thаt even if a portion of Paula’s current shoulder injuries are attributable to the Dillard’s incident, Dillard’s is liable only for that portion of the total damages that were directly caused by the Dillard’s incident, as opposed to preexisting injuries. Further, Dillard’s believes that it was Paula’s burden to demonstrate what proportion of her current injuries are attributable to the Dillard’s incident, and that because she has not met that burden, her recovery is limited to nominal damages.
The district court rejected the theory that Paula’s current shoulder problems are attributable to injuries that prеdated the Dillard’s incident. According to Dr. Swaim and the district court, the Dillard’s incident caused shoulder joint and muscle problems, which constituted a new injury. The district court credited Dr. Swaim’s opinion that the 2002 accident caused nerve problems rather than structural damage to the shoulder muscles. Additionally, the district court rejected the hypothesis that Paula’s long-term care-giving activities contributed to her current shoulder problems. With respect to the 1990 accident, the district court found that, although Paula sustained a shoulder injury in 1990, it healed and caused no further problems for more than a decade before the Dillard’s incident. At most, according to the district court, Paula was left with a “predisposition” toward the kind of serious injury that resulted from the Dillard’s incident. Thus, the district court found that Paula’s shoulder muscle problems began in November 2004 and constituted a new injury wholly caused by the Dillard’s incident. The district court concluded that “[e]ven if Paula Kingman was predisposed to injury in her right shoulder, ... Missouri law ... requires the tortfeasor to compensate her for resulting injury.”
Kingman v. Dillard’s, Inc.,
No. 06-0907,
The district court did not err as a matter of law in concluding that even if Paula was predisposed to injury in her right shouldеr, Dillard’s is required to compensate her for the injuries she sustained on November 14, 2004. Under Missouri law, the plaintiff in a personal injury action “is not entitled to recover damages for conditions that are due entirely and wholly to previous disease or injuries,” but “may recover for the aggravation of existing ailments caused by the negligent acts of [the] defendant.”
Schide v. Gottschick,
In
Miller v. Gulf, Mobile & Ohio R.R. Co.,
Applying Miller to the facts of our case, because the district court found that Paula’s post-November 2004 shoulder problems were a direct result of the Dillard’s incident, Paula was entitled to recover for those injuries. Even if Paula’s 1990 shoulder injury left her right shoulder weaker than an ordinary person’s, and thus more susceptible to serious injury, Dillard’s is liable for the full measure of damages that resulted when the clothing rack struck her shoulder and, thereby, aggravated a condition that had been dormant for over a decade.
Regarding the attribution of Paula’s present condition to the Dillard’s incident, the district court’s factual findings are supported by the evidence. In particular, the testimony of two orthopaedic surgeons who examined Paula support the district court’s findings. Dr. Reardon, who performed the first two of Paula’s three shoulder surgeries, explained that shoulder problems like Paula’s could be caused by a blunt trauma. He was unable to determine whether the Dillard’s incident was the sole cause of Paula’s shoulder pain because he had not reviewed Paula’s complete medical history. In his view, though, the Dillard’s incident at least “significantly contributed” to that pain. Thus, Dr. Rear-don’s testimony is consistent with the district court’s finding, based on its review of Paula’s complete medical history, that the Dillard’s incident was “the cause of [Paula’s] generally constant shoulder muscle problems from 2004.”
Kingman,
Moreover, Dillard’s is incorrect regarding the burden of proof. As the Supreme Court of Missouri explained in
Miller,
Paula was required to demonstrate only “substantial evidence of aggravation.” 386
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S.W.2d at 102 (“The line between an aggravation and the normal progress of a chronic pathological condition may be a hazy one, but under our practice a jury is entitled to make the finding if there is substantial evidence of aggravation.”). Once Paula satisfied the elements of her claim, the burden was on Dillard’s to challenge the extent to which her injuries were directly attributable to its own negligence.
Carlton v. Phillips,
Finally, the district court’s holding is consistent with Missouri’s conception of proximate causation. In Missouri, the plaintiffs “injury must be a reasonable and probable consequence of the act or omission of the defendant.”
Callahan v. Cardinal Glennon Hosp.,
B. Calvin’s Damages
Dillard’s makes several arguments in support of its contention that the district court erred in awarding $1 million to Calvin on his consortium claim. First, Dillard’s argues that Calvin’s damages were not foreseeable and, therefore, not proximately caused by the Dillard’s incident. Second, Dillard’s contends that full-time nursing care is not the type of “service” that is encompassed by the notion of consоrtium. Third, Dillard’s asserts that, as a matter of Missouri law, a consortium award cannot be larger than the damages recovered by the injured party.
“Proximate cause requires something in addition to a ‘but for’ causation test to exclude causes upon which it would be unreasonable to base liability ... because they are too far removed from the ultimate injury or damage.”
Alcorn v. Union Pac. R.R. Co.,
Nevertheless, we agree with Dillard’s that current Missouri law does not contemplate an unlimited consortium claim of the sort awarded to Calvin by the district court. “As a federal court, our role in diversity cases is to interpret state law, not to fashion it.”
Orion Fin. Corp. of S.D. v. Am. Foods Grp., Inc.,
“When a married person is injured, two causes of action arise: one accrues to the injured person for the injuries suffered directly by him or her, and the other accrues to the injured person’s spouse for damages suffered as a result of the loss of the injured person’s services, society, companionship, and sexual rеlations (loss of consortium).”
Thompson v. Brown & Williamson Tobacco Corp.,
Additionally, the uninjured spouse may recover on a consortium claim when the injury to the injured spouse requires the uninjured spouse to take on “varied and sundry duties” above and beyond the norm.
Helming,
Further, the Kingmans have not cited any Missouri authority for the proposition that a consortium award may exceed by a factor of five the damages awarded to the injured spouse. In
Hodges v. Johnson,
the Missouri Court of Appeals observed that “[tjhere should be some reasonable relationship between the size of a verdict awarded in a consortium action and that given the injured spouse,” and that “[i]n the usual case, ... the damages to the uninjured spouse are necessarily considerably less than those suffered by the one injured.”
Finally, the Supreme Court of Missouri has previously recognized some limits on the concept of cоnsortium.
See Powell v. Am. Motors Corp.,
We remand Calvin’s loss-of-consortium claim for reconsideration by the district court. While professional nursing services are not encompassed by the notion of consortium under Missouri law, Calvin’s invalid status and Paula’s former role as his primary care-giver are not entirely irrelevant to Calvin’s loss-of-consortium claim. A consortium award seeks to compensate for the domestic servicеs that have been lost. Thus, an invalid spouse might be entitled to a greater recovery than a healthy spouse if his injured wife had previously been undertaking a greater share of the household services that are encompassed by the notion of consortium.
See Gooch,
III. Conclusion
For the reasons stated above, we affirm in part, reverse in part, and remand for further proceedings not inconsistent with this opinion. We affirm as to the award of damages to Paula and reverse as to the award of damages to Calvin. We remand Calvin’s loss-of-consortium claim to the district court with instructions to reconsider its judgment.
Notes
. The only case we have encountered in which this theory was even advanced did not squarely address the issue. In
Nichols v. Montgomery Ward Co.,
. Dillard's argues further that the consortium award violated Missouri's rule that a party cannot be compensated twice for the same injury. According to Dillard’s, Calvin already recovered the cost of lifetime healthcare in the settlement of his 1982 litigation. Because
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the settlement agreement is not included in the record, it is impossible for this court to determine whether any part of the settlement amount was intended to compensate Calvin for future nursing costs, nor is it possible to know whether Calvin signed a full release of all his claims, including for lifetime medical care.
See Hails v. Sys. Constructors, Inc.,
