BLAIR v HUTZEL HOSPITAL
Docket No. 173709
Michigan Court of Appeals
July 9, 1996
217 Mich App 502
Submitted February 6, 1996, at Detroit. Decided July 9, 1996, at 9:10 A.M. Leave to appeal sought.
The Court of Appeals held:
1. Wrongful birth, as an action brought by a parent of a child born with severe defects against a physician or other responsible party who negligently failed to inform the parent in a timely fashion of the risk that the mother would give birth to such a child, effectively precluding an informed decision regarding whether the pregnancy should have been avoided or terminated, remains a viable cause of action in this state. In denying the hospital‘s first motion for summary disposition, the trial court did not err in rejecting the hospital‘s argument that wrongful birth actions are contrary to public policy.
2. A claim for the loss of a substantial opportunity to achieve a better result may be raised in any medical malpractice action, including an action for wrongful birth. In this case, where there was expert testimony concerning a twenty-five percent to thirty percent chance that MSAFP screening would have indicated Down‘s
Reversed and remanded for trial.
O‘CONNELL, P.J., dissenting, stated that there exists no reasonable justification for applying the lost opportunity doctrine in this case inasmuch as the doctrine has been applied only in situations involving death or physical harm and the doctrine has been superseded by
1. NEGLIGENCE — MEDICAL MALPRACTICE — WRONGFUL BIRTH.
Wrongful birth, as an action brought by a parent of a child born with severe defects against a physician or other responsible party who negligently failed to inform the parent in a timely fashion of the risk that the mother would give birth to such a child, effectively precluding an informed decision regarding whether the pregnancy should have been avoided or terminated, remains a viable cause of action in the State of Michigan.
2. NEGLIGENCE — MEDICAL MALPRACTICE — WRONGFUL BIRTH — LOST OPPORTUNITY.
A claim for the loss of a substantial opportunity to achieve a better result is raised in an action for wrongful birth where it is alleged that the defendant‘s failure to provide prenatal screening for the birth defect deprived the mother of an opportunity to consider the termination of the pregnancy by abortion.
Gittleman, Paskel, Tashman & Walker, P.C. (by Clifford Paskel and Evan Shaw), for the plaintiff.
Before: O‘CONNELL, P.J., and REILLY and D. E. SHELTON,* JJ.
*D. E. SHELTON, J. Plaintiff Raquel Blair was a twenty-two-year-old pregnant woman who was treated at defendant Hutzel Hospital. She filed this action against the hospital, alleging that the defendant negligently failed to offer her maternal serum alpha-fetoprotein (MSAFP) screening during the second trimester of her pregnancy. She alleges that the screening test would have provided a substantial opportunity to discover that her fetus had Down‘s syndrome and that by failing to administer the test the hospital thereby negligently deprived her of the ability to make an informed decision to terminate her pregnancy, causing her to deliver Delano Blair, a child born with Down‘s syndrome, on May 10, 1992.1
Defendant filed its first motion for summary disposition, pursuant to MCR 2.116(C)(8) and (10), arguing that plaintiff‘s wrongful birth2 action was contrary to
the public policy of the State of Michigan. The trial court denied the motion.
Defendant filed a second motion for summary disposition, pursuant to MCR 2.116(C)(10), arguing that plaintiff could not prove proximate causation beyond mere conjecture. Although there was evidence that there was a twenty-five percent to thirty percent chance that MSAFP would have identified the fetus as suffering from Down‘s syndrome, the trial court nevertheless granted defendant‘s motion. Plaintiff has appealed and defendant has cross appealed from the trial court rulings.
Two issues are presented for appeal. First, defendant asks this Court to hold that the tort of wrongful birth is no longer valid in Michigan. Second, defendant maintains that the doctrine that the loss of a substantial opportunity to avoid physical harm should not be applied to a wrongful birth cause of action.
I. WRONGFUL BIRTH
This Court first expressly recognized the wrongful birth cause of action in Eisbrenner v Stanley, 106 Mich App 357; 308 NW2d 209 (1981), a case involving rubella-caused birth defects. In Proffitt v Bartolo, 162 Mich App 35, 40-41; 412 NW2d 232 (1987), this Court
The term “wrongful birth” is a shorthand name given to actions brought by the parents of a child born with severe defects against a physician (or other responsible party) who negligently fails to inform them in a timely fashion of the risk that the mother will give birth to such a child, effectively precluding an informed decision as to whether the pregnancy should have been avoided or terminated. A “wrongful life” claim, on the other hand, is brought on behalf of a child with birth defects who claims that, but for the negligent advice to the parents, the child would not have been born.
In rejecting that earlier challenge to the wrongful birth concept, we noted at p 42:
The jurisdictions considering the issue have now almost uniformly adopted the wrongful birth cause of action. See generally James G v Caserta, 332 SE2d 872, 875, n 6 (W Va, 1985), and Anno: Tort liability for wrongfully causing one to be born, 83 ALR3d 15.
And concluded at pp 46-47:
Against this backdrop, we conclude that the Eisbrenner holding with regard to wrongful birth remains the law in Michigan until changed by the Legislature or the Supreme Court. The issue of whether abortion should be allowed and all the related moral, religious, and policy arguments are not before us following the line of privacy cases culminating in Roe v Wade, [410 US 113; 93 S Ct 705; 35 L Ed 2d 147 (1973)]. The issue is instead whether physicians have a duty to ascertain and advise parents of information necessary for the parents to exercise the options provided by Roe, whatever the physician personally believes. If a physician breaches the appropriate duty under the facts of a case, and it can be established that the parents would have avoided or terminated the pregnancy, the necessary causal connec-
tion is established. The parents should recover for their extraordinary medical expenses and the extraordinary costs of raising the child, as well as the emotional harm they have suffered.
As long as abortion remains an option allowed by law, the physician owes a duty to furnish patients with adequate information for them to be able to decide whether to choose that course of action. Those who would eliminate such a right of recovery must first abolish the right to have an abortion — a matter not germane to this appeal.
We have continued to recognize the wrongful birth cause of action in subsequent cases, and neither the Supreme Court nor the Legislature has acted to change our holdings. See Rinard v Biczak, 177 Mich App 287; 441 NW2d 441 (1989),3 and Rouse v Wesley, 196 Mich App 624; 494 NW2d 7 (1992).4
The trial court properly denied summary disposition of the wrongful birth claim because that is still a viable cause of action in this state.
II. THE SUBSTANTIAL OPPORTUNITY RULE
In Falcon v Memorial Hosp, 436 Mich 443; 462 NW2d 44 (1990), the Supreme Court held that the family of a decedent could maintain an action for malpractice where the malpractice had denied the
In Michigan, causes of action are recognized for what has been labeled wrongful birth and wrongful pregnancy, but there exists no cause of action for wrongful life. Wrongful birth is a tort action brought by parents of a child with a birth defect against a doctor or other person whose negligent failure to inform the parents of the risk of the birth defect deprived the parents of the opportunity to make an informed decision to avoid or terminate the pregnancy. Rinard, supra at 290-291; Proffitt v Bartolo, 162 Mich App 35, 40; 412 NW2d 232 (1987). The cause of action for wrongful birth is available to parents to recover the extraordinary medical expenses and costs of raising the child, as well as emotional harm. Rinard, supra at 296.
Defendant here maintains that this substantial opportunity rule should be limited to wrongful death actions. There is no merit to that position. Although Falcon involved a claim of wrongful death, Justice LEVIN stated in a footnote that
[t]he accrual of a cause of action for loss of an opportunity of achieving a better result does not . . . depend on whether death ensues as a result. The cause of action accrues when harm and damages result from the loss of a substantial opportunity for a better result. The plaintiff has the burden of establishing through expert testimony the difference between the course of the disease and treatment had there been a correct diagnosis, and the course of the disease and treatment as a result of failure to diagnose or misdiagnosis. [Id. at 470, n 43.]
Moreover, this Court has very recently held that the substantial opportunity rule applies to all medical malpractice actions. In Weymers v Khera, 210 Mich App 231; 533 NW2d 334 (1995), lv gtd 451 Mich 898 (1996), the plaintiff claimed that her physician‘s negli-
We hold that the loss of a substantial opportunity to avoid physical harm is harm distinct from the underlying injury for which tort law should allow recovery in proportion to the extent of the lost opportunity, provided that the negligence of the defendant, more probably than not, caused the loss of opportunity.
We believe that the arguments for allowing a cause of action for the loss of an opportunity to survive apply equally to allowing a cause of action for the loss of an opportunity to avoid lesser physical harm. In recognizing such harm, the traditional rule that the plaintiff must prove that the defendant‘s negligent conduct, more likely than not, caused the harm is not contradicted. Falcon, supra at 462-463 (LEVIN, J.), 472-473 (BOYLE, J.); Harris v Kissling, 80 Or App 5; 721 P2d 838 (1986); but see Falcon, supra at 473-495 (RILEY, C.J., dissenting).
Allowing recovery for the loss of a substantial opportunity to avoid physical harm is an equitable approach. DeBurkarte v Louvar, 393 NW2d 131, 137 (Iowa, 1986). In this case, defendants undertook to protect plaintiff from the type of harm that occurred. Falcon, supra at 461 (LEVIN, J.). As Justice LEVIN stated in Falcon, an actor‘s negligent omission in cases like this prevents the plaintiff from being able to prove the defendant‘s liability, and destroys the ability to allow fate to run its course. Id. at 456-457, ns 20, 21. Here, assuming for the purpose of argument only that defendants should have diagnosed and treated plaintiff for Goodpasture‘s Syndrome upon her admission to the hospital, plaintiff might still have lost kidney function, but she would know that it was because of “fate,” i.e., the natural progression of the disease, and not because of any failure by defendants.
If the lost opportunity doctrine is limited to cases only involving death, potentially flagrant examples of malpractice could go uncompensated in cases in which the same negligent failure to diagnose or treat results in a lost oppor-
tunity to avoid egregious harm, i.e., paralysis or coma. Thus, the deterrent and loss-allocation functions of tort law would be undermined if defendants could escape liability for the effects of negligent conduct that cause demonstrable losses. DeBurkarte, supra at 137 (citing King, Causation, valuation, and chance in personal injury torts involving preexisting conditions and future consequences, 90 Yale L J 1353, 1377-1378 [1981]); but see Falcon, supra at 494-495 (RILEY, C.J., dissenting).
Defendant nevertheless contends that the wrongful birth tort should somehow be carved out as an exception to the substantial opportunity rule. The only authority cited for this unusual proposition is the 1989 California case of Simmons v West Covina Medical Clinic, 212 Cal App 3d 696; 260 Cal Rptr 772 (1989). The rationale of Simmons is inapplicable in this state, however, because California is one of the minority of states that does not recognize the substantial opportunity rule in any type of tort. See Dumas v Coone, 235 Cal App 3d 1593, 1600-1601; 1 Cal Rptr 2d 584 (1991).
The substantial opportunity rule is the law of Michigan that applies to this case. A patient goes to a physician in order to improve opportunities of avoiding, ameliorating, or reducing physical harm, as well as pain and suffering. A pregnant patient goes to a physician in order to obtain the best possible care during her pregnancy and the best possible outcome of the pregnancy. We have consistently held, as we did in Proffitt, that a physician has a duty to ensure that a woman makes informed decisions regarding her procreative options, including the option of abortion. The failure to so inform a woman is a breach of that duty. The element of causation is satisfied if a plaintiff can show that the defendant‘s negligence in providing that
In Falcon, a 37.5 percent chance of survival was held to be substantial as a matter of law. In Weymers, a thirty percent to forty percent chance was held to be substantial. In this case, plaintiff‘s expert testified that there was a twenty-five percent to thirty percent chance that MSAFP screening would have identified plaintiff‘s fetus as being affected by Down‘s syndrome. Plaintiff testified that she would have undergone an abortion had she been provided with the information. Under these circumstances, we hold that plaintiff‘s claim that she was deprived of a substantial opportunity to learn of the defective condition of her fetus when her physician negligently failed to provide MSAFP screening stated a cause of action. Further, such evidence created a question of fact. The defendant denies that the failure to provide the screening was a breach of the standard of care and denies that such screening would have provided a substantial opportunity to achieve a better result. We hold that both of those issues are questions of fact for a jury to resolve.
The trial court‘s granting of defendant‘s second motion for summary disposition was in error.
The grant of summary disposition for defendant is reversed, and this matter is remanded for trial on plaintiff‘s wrongful birth complaint.
REILLY, J. concurred.
O‘CONNELL, P.J. (dissenting). The majority concludes that the “lost opportunity to survive” rationale,
There exists no reasonable justification for applying the lost opportunity doctrine to the present case where, first, that doctrine has been applied only to situations involving death or physical harm, and, second, where the doctrine as a whole has been expressly superseded by statute. Because I do not believe that the lost opportunity doctrine should apply to the present case, I would find that plaintiff failed to meet her burden of proving that any malpractice on the part of defendant “more likely than not” caused her loss of opportunity to obtain an abortion. Accordingly, I would affirm the order granting summary disposition of the issue of proximate causation. In light of this, I would find it unnecessary to reach the issue whether Michigan continues to recognize a cause of action for wrongful birth where a child is born with birth defects.
I
On May 10, 1992, plaintiff gave birth to a son suffering from Down‘s syndrome (trisomy 21). On December 17, 1992, she filed suit against defendant, contending that defendant had been both directly and vicariously liable for the failure of her physician to perform a particular prenatal test that might have detected that her son would suffer from the chromosomal disorder. Had the test been performed and had the test
As relevant to the instant appeal, defendant moved for summary disposition, alleging that plaintiff had failed to present legally sufficient evidence with respect to proximate causation. The prenatal test in issue, maternal serum alpha-fetoprotein (MSAFP) screening, is an indirect method of detecting, among other things, the possibility that the fetus will suffer from Down‘s syndrome. While alpha-fetoprotein occurs normally in pregnant women, an abnormally low concentration of the serum during the second trimester of pregnancy is associated with Down‘s syndrome. Expert testimony on deposition established that MSAFP screening will detect Down‘s syndrome in approximately twenty-five percent to thirty percent of the cases in which the syndrome will ultimately be manifested. Defendant argued, in short, that, because the MSAFP screening failed to detect Down‘s syndrome more than fifty percent of the time, the chance of detection was legally insufficient to have caused plaintiff‘s lost opportunity to obtain an abortion. The circuit court granted defendant‘s motion, and plaintiff now appeals as of right.
II
In Falcon, supra, p 453, our Supreme Court ruled that a patient deprived of an opportunity to survive because of a physician‘s malpractice could recover pro rata in tort from that physician, even where the
The Falcon decision was, however, both a limited and short-lived holding. As clarified in Justice BOYLE‘S concurrence, p 473, the Falcon Court was
called upon to decide the viability of a claim for “lost opportunity” only where the ultimate harm to the victim is death. Thus any language in the lead opinion suggesting that a similar cause of action might lie for a lost opportunity of avoiding lesser physical harm is dicta. Whether the social and policy factors which justify compensation for a lost chance of survival would justify recovery for the loss of a chance to avoid some lesser harm is a question for another day.
We hold that the loss of a substantial opportunity to avoid physical harm is harm distinct from the underlying injury for which tort law should allow recovery in proportion to the extent of the lost opportunity, provided that the negligence of the defendant, more probably than not, caused the loss of opportunity. [210 Mich App 236.]
The Falcon holding was thereby extended beyond situations involving the loss of a substantial opportunity for survival to “the loss of a substantial opportunity to avoid physical harm.”2 This was done despite the fact that the Falcon decision declared itself to be a limited holding and the fact that the Legislature had repudiated the substantial opportunity doctrine.
III
Plaintiff asks that this Court further extend the reasoning of Falcon to situations involving the loss of an
At issue in the present case is proximate cause.3 The element of proximate cause encompasses two distinct aspects: cause in fact and so-called “legal cause.” Skinner v Square D Co, 445 Mich 153, 162-163; 516 NW2d 475 (1994). In general, to establish cause in fact, a plaintiff must demonstrate that “it is more likely than not that the conduct of the defendant was a cause in fact of the [injury].” Id., p 165, quoting Mulholland v DEC Int‘l Corp, 432 Mich 395, 416; 443 NW2d 340 (1989), in turn quoting Prosser & Keeton, Torts (5th ed), § 41, p 269. The phrase “more likely than not” is a precise term denoting a probability of greater than fifty percent. Falcon, supra, p 450.
Here, plaintiff has failed to present evidence that defendant‘s failure to perform MSAFP screening for plaintiff “more likely than not” deprived her of the opportunity to have an abortion. Plaintiff‘s expert stated that, at best, the procedure had roughly a thirty percent chance of detecting that plaintiff‘s son would suffer from Down‘s syndrome. The chance that the test would not have detected Down‘s syndrome was greater than two in three. Therefore, because this probability was less than fifty percent, plaintiff was unable to demonstrate that the lack of MSAFP screening “more likely than not” deprived her of the opportunity to have an abortion.
Thus, we must determine whether the rule of law established in Falcon — that recovery may be predicated on the “loss of a substantial opportunity” for survival, as extended to physical injury by Weymers, even where the opportunity lost is less than fifty percent — applies to the loss of the opportunity to obtain an abortion. As made clear in both Falcon, supra, pp 458-461, and Weymers, supra, pp 236-239, this is a question of policy; it invokes not the cause-in-fact aspect of proximate cause, but the “legal cause” component. Therefore, we must determine whether the policy justifications advanced in Falcon and Weymers apply with equal force in the present context.
IV
While plaintiff does not address the public policy aspects of extending Falcon to the present case,
The Supreme Court of the United States has declared that there is a constitutional right to privacy. Roe v Wade, 410 US 113; 93 S Ct 705; 35 L Ed 2d 147 (1973). This right to privacy “protects the woman from unduly burdensome interference with her freedom to decide whether to terminate her pregnancy.” Maher v Roe, 432 US 464, 473-474; 97 S Ct 2376; 53 L Ed 2d 484 (1977). However, this right to privacy “implies no limitation on the authority of a State to make a value judgment favoring childbirth over abortion.” Id., p 474. For example, “[f]or public policy reasons, the state may choose to eliminate benefits that it previously offered,” such as the public funding of abortion. Doe v Dep‘t of Social Services, 439 Mich 650, 678; 487 NW2d 166 (1992). Michigan refuses to publicly fund an abortion unless the abortion is necessary to save the life of the mother. Id.;
However, defendant‘s argument is not wholly transferable to the present context. While the reasoning of Falcon was somewhat elusive in that it failed to succinctly summarize the public policy upon which it was based and failed to address competing policy considerations, the gist of its holding appears in section VI, p 461. Falcon involved a pregnant woman who
[w]omen gave birth to children long before there were physicians or hospitals or even midwives. A woman who engages the services of a physician and enters a hospital to have a child does so to reduce pain and suffering and to increase the likelihood of her surviving and the child surviving childbirth in a good state of health even though the likelihood of the woman and child not surviving in good health without such services is far less than fifty percent. That is why women go to physicians. That is what physicians undertake to do. That is what they are paid for. They are, and should be, subject to liability if they fail to measure up to the standard of care. [Id., p 461.]
The Court concluded that recovery should be allowed, despite the fact that only a 37.5 percent chance existed that the decedent would have survived had malpractice not occurred. Id., p 470. Thus, the Falcon Court gave its approval to a lowered threshold of proof of causation in cases involving the loss of the opportunity to survive.
From this passage, one may deduce that the policy considerations advanced by the Falcon decision concerned a patient‘s reliance on a physician to undertake measures meant to prevent death or physical harm, or at least to lessen the possibility that these exigencies would come to pass. Even where one has less than a fifty percent chance of suffering death, in Falcon, or physical harm, in Weymers, one engages the services of a physician to lessen that chance still
Turning, then, to the present case, I fail to see how the policy considerations articulated in Falcon and extended in Weymers would be furthered by allowing plaintiff to proceed in the absence of evidence that defendant‘s inaction “more likely than not” deprived her of the opportunity to obtain an abortion. First, and most significantly, plaintiff did not suffer death or physical injury; she “suffered” the birth of a healthy child with Down‘s syndrome. The alleged injury before this Court differs in kind from those considered in Falcon and Weymers. To apply the reasoning of those cases to the present context would constitute not an extension, but a wholesale grafting, of this reasoning to a distinct area of tort law. Second, as stated by the United States Supreme Court in Harris v McRae, 448 US 297, 325; 100 S Ct 2671; 65 L Ed 2d 784 (1980), “[a]bortion is inherently different from other medical procedures, because no other procedure involves the purposeful termination of a potential life.”
Therefore, I would conclude that the reasoning of Falcon and Weymers does not apply where a plaintiff has not suffered death or physical injury. Because plaintiff suffered neither of these, the “lost opportunity” doctrine does not apply. Thus, plaintiff had the burden of presenting evidence that defendant‘s alleged breach “more likely than not” caused her
V
On cross appeal, defendant contends that the circuit court erred in denying defendant‘s prior motion for summary disposition pursuant to MCR 2.116(C)(8). In that motion, defendant argued that Michigan recognizes no cause of action for “wrongful birth” where the alternative would have been abortion. The term “wrongful birth” “is a shorthand name given to actions brought by the parents of a child born with severe defects against a physician (or other responsible party) who negligently fails to inform them in a timely fashion of the risk that the mother will give birth to such a child, effectively precluding an informed decision as to whether the pregnancy should be avoided or terminated.” Proffitt v Bartolo, 162 Mich App 35, 40; 412 NW2d 232 (1987). Defendant submits that given the absence of binding precedent on the subject and Michigan‘s public policy disfavoring abortion, the circuit court should have granted its motion for summary disposition.
There are persuasive arguments to be made both in favor of and in opposition to defendant‘s position. In defendant‘s favor, this Court has recognized that “all human life is presumptively valuable.” Rouse v Wesley, 196 Mich App 624, 631; 494 NW2d 7 (1992). We are aware of no court decision applying Falcon-type reasoning in the present context. See, e.g., Simmons v West Covina Medical Clinic, 212 Cal App 3d 696; 260 Cal Rptr 772 (1989). Additionally, we have stated
However, I would defer deciding this issue because it is not necessary to the resolution of this case. Regardless of whether such a cause of action exists, the outcome of the present appeal would be the same.
I would affirm.
Notes
The term “wrongful birth” is a shorthand name given to actions brought by the parents of a child born with severe defects against a physician (or other responsible party) who negligently fails to
inform them in a timely fashion of the risk that the mother will give birth to such a child, effectively precluding an informed decision as to whether the pregnancy should have been avoided or terminated. A “wrongful life” claim, on the other hand, is brought on behalf of a child with birth defects who claims that, but for the negligent advice to the parents, the child would not have been born. See Smith v Cote, 128 NH 231; 513 A2d 341, 344 (1986); Procanik v Cillo, 97 NJ 339, 347-348; 478 A2d 755 (1984). Both causes of action involve claims of professional negligence.
A stipulation was filed in this case dismissing the wrongful life claim and that claim is not part of this appeal.
2 The legislation nullifying the Falcon holding also nullified the Weymers holding, except in those causes of action arising before the effective date of the legislation.3 We assume arguendo that defendant was under a duty to provide MSAFP screening and that defendant breached that duty by failing to offer the test. We are aware that at the time this cause of action arose there existed divergent views concerning the applicable standard of care.A cause of action can be maintained in Michigan for failure to diagnose pregnancy. In Proffitt v Bartolo, 162 Mich App 35, 46-47; 412 NW2d 232 (1987), lv den 430 Mich 860 (1988), this Court stated that as long as abortion remains an option allowed by law, physicians owe a duty to furnish patients with adequate information for them to be able to decide whether to choose that course of action. Proffitt was a wrongful birth case. The term “wrongful birth” is a shorthand name given to actions brought by the parents of a child born with severe defects against a physician, or other responsible party, who negligently fails to inform them in a timely fashion of the risk that the mother will give birth to such a child, effectively precluding an informed decision as to whether the pregnancy should have been avoided or terminated. 162 Mich App 40. The instant case does not involve a wrongful birth cause of action. However, the claim asserted in this case is more analogous to that cause of action than to other causes of action such as wrongful life or wrongful pregnancy which Michigan courts have addressed. See Proffitt, supra at 40-41.
