A driver who suffers a sudden medical emergency and crashes into another vehicle may be held liable for the accident even if never diagnosed with the condition or never advised not to drive.

If the driver knew or should have known about the medical risk, liability could still follow, the Massachusetts Appeals Court has found in overturning a lower court summary judgment that let a driver who lost consciousness due to sleep apnea off the hook.

The appeals court returned the case to the lower court to determine whether Edward Laidley’s loss of consciousness was reasonably foreseeable and, thus, whether Laidley was negligent in driving on the day he crashed into a bus driven by Shauntoo Cottrell.

Although there was no dispute that Laidley’s untreated sleep apnea caused him to lose consciousness, the court concluded there was a genuine fact question as to whether Laidley was aware of prior onsets of sleepiness or had experienced drowsiness in the hours leading up to the accident and thus was negligent in deciding to drive.

At the same time, the court upheld the part of the lower court summary judgment that relieved Laidley’s employer from vicarious or direct liability for the accident.

Laidley, 55 years old, drove a parts truck for Colonial, a car dealer. On a Jan. 3, 2018, the plaintiff Cottrell was driving his usual bus route for the Massachusetts Bay Transportation Authority (MBTA) when Laidley, who was traveling behind the plaintiff, rear-ended the bus. Cotrell alleged that he sustained “serious injuries to his neck, back, legs, head, shoulders, and other parts of his body.”

The bus driver sued for medical expenses and pain and suffering, alleging that Laidley negligently rear-ended him, and that Colonial was vicariously liable for Laidley’s negligence and directly liable for negligent hiring and negligent supervision.

The defense asserted that the accident was the result of a sudden medical emergency and therefore Laidley and Colonial were not liable.

The case required the courts to examine the doctrine of a sudden medical emergency negating negligence. To prevail on a negligence claim, a plaintiff must prove that the defendant owed the plaintiff a duty of reasonable care, that the defendant committed a breach of this duty, that damage resulted, and that there was a causal relation between the breach of the duty and the damage. Under the sudden medical emergency doctrine, however, “a sudden and unforeseeable physical seizure rendering an operator unable to control his motor vehicle cannot be termed negligence.”

No one observed Laidley’s physical appearance in the moments before the accident. After the accident, Laidley was placed in a medically induced coma for approximately one month. When Laidley woke up, he had no recollection of the accident and no recollection of the two to three weeks leading up to the accident. After the accident, Laidley was diagnosed with severe obstructive sleep apnea, high blood pressure, high cholesterol, and diabetes.

Laidley testified that he was never informed by a doctor that the conditions that he was diagnosed with after the accident were a result of longstanding medical issues. In addition, he attested that prior to the accident he was never told by a doctor that it was unsafe to drive and he had never experienced a loss of consciousness. Laidley further attested that before the accident he “had never experienced any medical issues while he was driving that led him to believe that driving was unsafe.”

Laidley did not dispute that sleep apnea was the cause of the accident but his medical expert testified that there were no pre-accident medical records where Laidley was told not to drive nor was Laidley experiencing any symptoms that would have indicated that he should not have been driving. Similarly, she said that, although Laidley had a history of snoring, “snoring, without symptoms of excessive fatigue, is not an indication that one should not be driving.” She also recounted that Laidley did not recall “daytime somnolence,” nor was that noted in any of his records. Ultimately, this doctor concluded that “there was nothing to indicate to Laidley that he should not have been driving.”

A doctor put forth by Cottrell agreed with the evidence that Laidley’s untreated sleep apnea “ultimately caused the accident.” But unlike the defendants’ experts, this doctor opined that Laidley “knew or should have known that his excessive sleepiness made it dangerous for him to operate a vehicle.” That’s because Laidley had experienced prior sudden onsets of sleepiness and because his symptomology (obesity and snoring) was significant. He explained that untreated sleep apnea is associated with “excessive daytime sleepiness.” He determined that “to a reasonable degree of medical probability, Laidley would have felt very drowsy while driving the vehicle on the date of the subject incident” and that “the drowsiness should have compelled him not to drive further.”

After testimony, the district court judge allowed Laidley’s motion for summary judgment and dismissed the plaintiff’s complaint. The judge found that there was no genuine dispute of material fact that Laidley suffered a sudden, unforeseeable medical emergency when he rear-ended the plaintiff and that, because Laidley was not liable, Colonial could not be held vicariously liable. As to the plaintiff’s direct liability claims against Colonial, the judge determined that the summary judgment record did not raise a triable issue of negligent hiring or negligent supervision on the part of Colonial

But the Massachusetts Appeals Court said the lower court overlooked issues of fact surrounding whether Laidley knew or should have known about his condition, issues a jury needs to resolve in order to determine if Laidley was negligent.

The appeals court acknowledged that Laidley’s defense presented considerable evidence that his loss of consciousness was not foreseeable including Laidley’s testimony that prior to the accident he never had difficulty breathing, shortness of breath, chest pains, or trouble sleeping, and he had never been told by a doctor that it was unsafe to drive.

However, the court noted, Laidley’s medical expert did not review the treatment records of the sleep specialist who testified or Laidley’s other treatment records after the initial hospitalization. Indeed, she seemed to be unaware that Laidley suffered from severe sleep apnea. Moreover, she ignored the fact that Laidley had no recall of his symptomology or, indeed, anything in the weeks leading up to the accident.

The court also noted that Laidley’s expert’s opinion was contested by a doctor who testified that Laidley had the “main symptoms of sleep apnea” — obesity, and snoring — for decades prior to the crash.

The court said that a competent medical expert can determine from a post-accident diagnosis what symptoms a patient must have been experiencing prior to the accident. The court said that the contrary medical report, if credited by a jury, suggests that it was not possible or at least highly unlikely that Laidley was not lethargic before the accident, as untreated sleep apnea is associated with “excessive daytime sleepiness.” This opinion was supported by the post-accident medical records that were not reviewed by Laidley’s doctor.

Although Laidley was not diagnosed with sleep apnea until after the accident, the defense medical testimony indicates that, on the day of the accident, “Laidley would have felt very drowsy while driving the vehicle” and that Laidley “knew or should have known that his excessive sleepiness made it dangerous for him to operate a vehicle.”

As Laidley had no memory of the weeks leading up to the accident and the defendants presented no medical expert testimony to the contrary, the high court said a jury could credit this opinion. Even if Laidley did not know why he was experiencing excessive sleepiness, a jury could determine that he was negligent in driving. Accordingly, the court concluded, a genuine issue of material fact exists as to whether Laidley’s loss of consciousness was reasonably foreseeable and, thus, whether Laidley was negligent in driving that day.

As for the liability of the employer, Colonial, the court agreed with the district court that it could not be held liable. While Colonial required only that each parts driver have “a clean driving record,” there is no evidence to suggest that a more thorough employment screening process would have revealed that Laidley was unfit to drive.

This article was originally published by Insurance Journal