J.N., a Minor, by and through his Next Friend, Colleen Nentwig and Colleen Nentwig, Individually, Appellants, and Ryne Dobson, Plaintiff, v. Dr. Dale Anderson, Respondent.

• Court: Missouri Court of Appeals
• Decided: July 29, 2025
• Docket: ED113033
• Status: Published

Opinion

In the Missouri Court of Appeals Eastern District DIVISION ONE

J.N., a Minor, by and through his Next ) No. ED113033 Friend, COLLEEN NENTWIG, AND ) COLLEEN NENTWIG, INDIVIDUALLY, ) ) Appellants, ) Appeal from the Circuit Court of ) St. Louis County AND ) 22SL-CC01952 ) RYNE DOBSON, ) ) Plaintiff, ) ) v. ) ) DR. DALE ANDERSON, ) Honorable Richard M. Stewart ) Respondent. ) Filed: July 29, 2025 Before James M. Dowd, P.J., Angela T. Quigless, J., and Madeline O. Connolly, Sp. J.,

OPINION

The tragedy giving rise to this case occurred on April 25, 2020 in Webster Groves,

Missouri when Ryne Dobson killed 1 his stepfather Kevin Nentwig (Decedent). Dobson’s half-

brother J.N. and his mother Colleen Nentwig sued Dobson’s treating psychiatrist Dr. Dale

1 Dobson was charged with first-degree murder and armed criminal action, but the trial court found Dobson not guilty by reason of insanity – specifically, bipolar disorder with psychotic features – pursuant to section 552.030 (RSMo 2016) and committed him to the Missouri Department of Mental Health. Anderson for wrongful death based on medical negligence. Appellants claimed that Dr.

Anderson knew or should have known that Dobson presented a serious danger of future harm to

a readily identifiable victim – Decedent – and failed to notify Dobson’s family of that danger

which failure they claim caused Decedent’s death. The jury returned a verdict for Dr. Anderson.

Now in their single point on appeal, Appellants claim that the trial court erred in failing

to instruct the jury on an alternative theory of negligence, one that has not been recognized in

Missouri. Appellants’ Instruction A would have allowed the jury to find Dr. Anderson negligent

in prescribing to Dobson a certain anti-depressant medication or in failing to alert Dobson’s

mother and stepfather to monitor him, and that this negligence caused Decedent’s death.

Appellants’ proposed theory of duty was that healthcare providers owe a duty to third parties to

not prescribe medications that affirmatively cause patients to harm third parties.

We are not persuaded to recognize such a duty because the record here does not establish

that Decedent’s death was reasonably foreseeable. Thus, the trial court did not error in rejecting

Appellants’ proffered instruction and the court properly submitted Appellants’ failure to warn

verdict director, Instruction 8, which is the recognized theory of recovery in Missouri under the

circumstances of this case.

Background

In 2019, Dobson began experiencing depression symptoms such as the loss of motivation,

insomnia, guilt, indecision, and anxiety. That June, his primary care doctor prescribed Zoloft, an

antidepressant. Initially, Dobson attempted to resolve his depression without the medication.

Then, after beginning Zoloft in November, Dobson began to suffer hallucinations, severe

insomnia, and severe appetite loss which led to his hospitalization. Dobson was then prescribed

olanzapine, an antipsychotic and mood stabilizer medication used to stop hallucinations and

2 delusions that can also be used to treat bipolar disorder. The olanzapine stopped the

hallucinations and helped Dobson sleep better. Throughout his mental health struggles, Dobson

was a regular marijuana smoker. Specifically, he ingested “dabs” or “wax” which are highly

concentrated forms of THC 2 with strong potencies.

In late January 2020, Dobson began seeing Dr. Anderson for mental health treatment.

Dr. Anderson diagnosed him with major depressive disorder, panic disorder, generalized anxiety

disorder, and attention-deficit/hyperactivity disorder (ADHD). He did not believe Dobson had

bipolar disorder. 3 Based on his diagnoses, Dr. Anderson prescribed 12.5 milligrams of Paxil, a

psychotropic anti-depressant medication, Adderall for Dobson’s ADHD, and hydroxyzine to help

soothe his anxiety. He also referred Dobson to a clinical psychologist for cognitive therapy.

Finally, he told Dobson to stop using marijuana because it was still illegal and could interfere

with his medications.

From February to March, Dobson’s depression improved. So, in February, Dr. Anderson

increased the Paxil dosage to 37.5 milligrams and instructed Dobson to stop taking the

olanzapine. By April 1, Dobson experienced severe insomnia. Dr. Anderson recommended that

Dobson increase the hydroxyzine up to 100 milligrams if needed. Several days later, they spoke

on the phone and Dobson reported that he had exceeded the dosage by 25 milligrams and still

2 Tetrahydrocannabinol (THC) is the main psychoactive ingredient in marijuana. Department of Justice/Drug Enforcement Administration (April 2020), https://www.dea.gov/sites/default/files/2020-06/Marijuana-Cannabis-2020_0.pdf. THC “has intoxicating effects, meaning it can temporarily alter a person’s mood, thoughts, and perceptions.” National Institute on Drug Abuse, Cannabis (Marijuana) (September 2024) https://nida.nih.gov/research-topics/cannabis-marijuana#what-is-cannabis. 3 After his arrest, the psychiatrist treating Dobson while he was in the St. Louis County jail diagnosed him with “bipolar disorder, manic.”

3 could not sleep. Dr. Anderson told Dobson to discontinue the hydroxyzine and to start taking

Lunesta for the insomnia.

On April 20, during their final office visit together before Dobson killed his stepfather,

Dr. Anderson observed Dobson to be very depressed. Dobson told Dr. Anderson that he

believed that his “father” had molested him as a child. 4 Although Dobson told Dr. Anderson he

was having suicidal thoughts, the doctor did not believe that Dobson intended to act on those

thoughts, and he did not observe any other symptoms such as confusion, psychosis,

aggressiveness, agitation, elevated mood, hyperactivity, or impaired judgment. Dr. Anderson

upped the Paxil dosage to 50 milligrams, prescribed a different anti-anxiety medication, and

prescribed trazodone to help Dobson sleep since the Lunesta was not working. Five days later,

Dobson, in a purported manic state, stabbed Decedent to death. Dobson later stated he believed

Decedent had raped him.

In March 2022, Appellants 5 filed this wrongful death suit based on medical negligence

against Dr. Anderson. The case proceeded to trial in July 2024. During the instruction

conference, the court agreed to submit Appellants’ verdict director, which the court later

numbered Instruction 8. That instruction submitted a failure to warn theory which provided that

the verdict must be for the plaintiffs if the jury believed that Dr. Anderson knew or should have

known that Dobson presented a serious danger of future harm to Decedent, a readily identifiable

victim, and that he failed to notify Appellants of the danger. The court then rejected Appellants’

proposed Instruction A, another verdict director which allowed the jury to find in favor of

4 During the time he was on Zoloft, Dobson had previously claimed that either his stepfather or his biological father had molested or raped him and during their first visit, Dobson told Dr. Anderson that he believed his biological father, not the victim here, had molested him. 5 Dobson was also a plaintiff in the underlying lawsuit, but he is not a party to this appeal.

4 Appellants if it believed that by either prescribing an SSRI antidepressant medication to Dobson

or by failing to advise Appellants and Decedent to monitor Dobson, that Dr. Anderson was

negligent which directly caused or contributed to cause Decedent’s death. The jury returned a

verdict for Dr. Anderson on Instruction 8 and this appeal follows.

Standard of Review

“Whether a jury was instructed properly is a question of law that this Court reviews de

novo.” Templemire v. W & M Welding, Inc., 433 S.W.3d 371, 376 (Mo. banc 2014). Similarly,

“[t]he trial court’s refusal to give a party’s proffered instruction is reviewed de novo, evaluating

whether the instructions were supported by the evidence and the law.” Miller v. Norfolk

Southern Railway Company, 591 S.W.3d 29, 38 (Mo. App. W.D. 2019). “This Court views the

evidence in the light most favorable to submission of the instruction.” Stevens v. Markirk

Constr., Inc., 454 S.W.3d 875, 880 (Mo. banc 2015). Thus, we disregard contrary evidence.

Douglas v. St. Louis Cold Drawn, Inc., 439 S.W.3d 775, 779 (Mo. App. 2014).

“An instruction must be given when there is substantial evidence to support the issue

submitted.” Meyer ex rel. Meyer v. Astrazeneca Pharmaceuticals, L.P., 224 S.W.3d 106, 108

(Mo. App. E.D. 2007). A party is entitled to submit an instruction upon any theory supported by

the evidence. Bach v. Winfield-Foley Fire Prot. Dist., 257 S.W.3d 605, 608 (Mo. banc 2008);

but see Blanks v. Fluor Corp., 450 S.W.3d 308, 393 (Mo. App. E.D. 2014) (where this Court

rejected a legal theory and therefore did not address the party’s allegation of error regarding the

trial court’s rejecting of an instruction that sought to submit that theory).

Discussion

Appellants claim that the trial court erred in failing to instruct the jury on their theory,

which is a matter of first impression in Missouri, that Dr. Anderson had a duty to third parties

5 like Appellants to not prescribe medications that cause or contribute to cause their patients to

harm third parties. We disagree and find under the public policy factors used to determine

whether a new duty should be recognized in Missouri, as outlined by our Supreme Court in

Hoover’s Dairy, Inc. v. Mid-America Dairymen, Inc., 700 S.W.2d 426 (Mo. banc 1985), and

under the specific facts of this case, that Dr. Anderson did not have a duty to Decedent because

Dobson’s violent conduct was not reasonably foreseeable.

Preservation. It appears that Appellants have preserved this point. During the instruction

conference, Appellants proposed Instruction A as an additional verdict director along with

Instruction 8, their failure to warn verdict director. The court had already rejected Instruction A

in an off-the-record discussion. Then back on the record, Appellants told the court that in lieu of

spreading their arguments upon the transcript, they would simply adopt the written arguments

they had made months earlier in their summary judgment response addressing the same issue,

i.e., the legal viability of their theory that physicians have a duty to not prescribe medicine that

may cause the patient to harm third parties. In their motion for new trial, Appellants asserted the

same issue and included their same written arguments.

We do not sanction Appellants’ resort to and incorporation of a previous written

argument instead of stating their arguments on the record during an instruction conference as

required by Rules 70.02(e) 6 and 70.03. But, under the circumstances of this case, we conclude

that Appellants preserved the issue by a hair. See Rhoden v. Missouri Delta Medical Center, 621

S.W.3d 469, 480 (Mo. banc 2021) (where the Court found that MDMC’s point was preserved

even though counsel made only a vague objection during the instructions conference and did not

make a more specific objection until its new trial motion because the trial court was “fully

6 All rule references are to the Missouri Supreme Court Rules (2024) unless otherwise stated.

6 apprised of MDMC’s argument ….”). Nevertheless, we discourage litigants from adopting this

approach to preserving instructional error and we do not endorse it.

“In any action for negligence, a plaintiff must establish the defendant owed a duty of care

to the plaintiff, the defendant breached that duty, and the defendant’s breach proximately caused

the plaintiff’s injury.” Wieland v. Owner-Operator Servs., Inc., 540 S.W.3d 845, 848 (Mo. banc

2018) (internal quotations omitted). “The touchstone for the creation of a duty is foreseeability.”

Id. “Whether a duty exists is purely a question of law.” Hoffman v. Union Elec. Co., 176

S.W.3d 706, 708 (Mo. banc 2005) (internal citation omitted).

“A duty of care arises out of circumstances in which there is a foreseeable likelihood that

particular acts or omissions will cause harm or injury.” Bradley v. Ray, 904 S.W.2d 302, 311

(Mo. App. 1995) (internal quotations omitted). “In such cases, the duty does not arise out of

‘any special relationship’ between the parties, but rather arises ‘out of the defendant’s knowledge

of a dangerous condition, which imperils the plaintiff, as well as time and ability to prevent the

attack.’” Id. (quoting Reed v. Hercules Constr. Co., 693 S.W.2d 280, 282 (Mo. App. 1985).

“The judicial determination of the existence of a duty rests on sound public policy as

derived from a calculus of factors: among them, the social consensus that the interest is worthy

of protection; the foreseeability of harm and the degree of certainty that the protected person

suffered injury; moral blame society attaches to the conduct; the prevention of future harm;

consideration of cost and ability to spread the risk of loss; the economic burden upon the actor

and the community ….” Hoover’s Dairy, Inc., 700 S.W.2d at 432.

Thus, in determining whether public policy supports the recognition of a duty in this case,

we are guided by the Hoover’s Dairy factors, particularly the foreseeability of the harm to

Decedent here. “[F]oreseeability that some injury might result from the act complained of

7 normally serves as the paramount factor in determining the existence of a duty.” Id. at 431.

“Foreseeability, for purposes of determining if a duty exists, is defined as the presence of some

probability or likelihood of harm sufficiently serious that ordinary persons would take

precautions to avoid it. A mere possibility of harm is insufficient.” Reddick v. Spring Lake

Estates Homeowner’s Association, 648 S.W.3d 765, 781 (Mo. App. E.D. 2022) (internal

citations omitted).

Here, the tragedy that unfolded on April 25 was not reasonably foreseeable. First, the

record does not establish that Dobson intended to harm anyone. Rather, the record before this

jury evinced a psychiatrist treating a troubled young man. When Dr. Anderson learned that

Zoloft may have caused Dobson to suffer hallucinations, he prescribed him Paxil which absorbs

more slowly and tends to minimize the risk of side effects. And when Dr. Anderson met with

Dobson between January and April, Dobson did not show any signs of bipolar disorder – only

depression, anxiety, and ADHD. Also, Dr. Anderson did not know that Dobson had a family

history of bipolar disorder and schizophrenia. Hindsight may be 20/20, but this record does not

support that Dr. Anderson should have anticipated Dobson’s conduct that night.

The remaining Hoover’s Dairy factors. The health and safety of a foreseeable victim,

such as an immediate family member the patient makes explicit threats about, is certainly an

interest worthy of protection. But that must be balanced with the public’s interest in maintaining

the physician-patient privilege. Virgin v. Hopewell Center, 66 S.W.3d 21, 27 (Mo. App. E.D.

2001). And again, Appellants have failed to demonstrate on this record that Decedent here was a

“foreseeable” victim.

It is manifest that diagnosing and treating mental illness is among the most delicate and

nuanced tasks which is plagued with uncertainties. Adopting Appellants’ proposed duty under

8 the facts of this case could unnecessarily shackle a psychiatrist with deterrent caution to

prescribe medication, such as antidepressants, to help individuals with mental health struggles

who show no signs of violence on the undocumented chance that they may become violent.

With these principles in mind, we find no duty under these circumstances.

For their part, Appellants cite to several cases from other states in support of their urging

that we recognize this new duty to third persons. B.R. ex rel. Jeffs v. West, 275 P.3d 228, 233-34

(Utah 2012) (healthcare providers owe a duty of care to third parties not to prescribe medications

that affirmatively cause patients to harm third parties); Mower v. Baird, 422 P.3d 837, 841 (Utah

2018) (a treating therapist of a minor child owes a duty to a nonpatient parent to refrain from

creating false memories of sexual abuse by that parent); Cheeks v. Dorsey, 846 So.2d 1169, 1173

(Fla. Dist. Ct. App. 2003) (“When one administers a drug which, when combined with other

drugs or alcohol, may severely impair the patient, the doctor’s failure to take proper precautions

(i.e., verify whether the patient is already under the influence of another drug) is an affirmative

act which creates the risk that unidentifiable third parties might be injured”); Taylor v. Smith,

892 So.2d 887, 895 (Al. 2004) (same holding as Cheeks).

We are unpersuaded in light of our Hoover’s Dairy analysis. Moreover, Mower, Cheeks,

and Taylor are readily distinguishable because the injuries there were found to be foreseeable

under the circumstances of those cases.

Conclusion

We affirm for the foregoing reasons.

______________________________ James M. Dowd, Presiding Judge Angela T. Quigless, J., and Madeline O. Connolly, Sp. J., concur.