Plaintiff appeals, challenging the entry of judgment on the pleadings, ORCP 21 G(3), against his claim for negligence. The dispositive issue is novel: Under Oregon law, can a victim of medical malpractice, who has not suffered physical injury, nevertheless recover damages for negligent infliction of emotional distress? We conclude that the relationship between plaintiff and defendant medical professionals, as framed by the pleadings, gave rise to a “legally protected interest” and that the alleged invasion of that interest was of the sort that would permit plaintiff to recover emotional distress damages without any showing of concurrent physical injury. Accordingly, we reverse and remand.
In reviewing a judgment on the pleadings, we accept all factual allegations in the complaint as true.
Withers v. State of Oregon,
Plaintiffs operative fourth amended complaint alleged the following facts: On November 9, 1992, plaintiff arranged through North Lincoln Hospital to undergo an MRI. 1 The test was performed in a mobile unit that was set up in the hospital’s parking lot. Defendants MRI Imaging Services II and ABCT, Inc., administered the test. 2
Before and during the MRI procedure, defendants “negligently” failed to:
“1. * * * properly explain the nature of the MRI procedure to the Plaintiff prior to instituting such procedure, particularly in failing to warn the Plaintiff of the possible claustrophobic effects of the MRI;
“2. * * * take an adequate medical and psychological history from the Plaintiff, including the history of pre-exist-ing asthmatic condition;
“3. * * * properly monitor the progress of the Plaintiff during the course of the MRI procedure; and
“4. * * * promptly terminate the MRI procedure when Plaintiff complained of difficulties with breathing, and indicated a desire for the procedure to end.”
As a result of that failure, plaintiff experienced severe emotional distress. More particularly,
“[he] became extremely distressed, a condition which was exacerbated by his pre-existing asthma. His emotional status worsened during the entire procedure, and has resulted in continued and permanent psychological damage, including post-traumatic stress disorder, adjustment disorder with anxious mood, major depression, generalized anxiety disorder and panic disorder with agoraphobia. These psychological conditions are severe, continuing, and permanent.”
Plaintiff sought damages of $75,000 to compensate him for his “extreme and severe emotional distress, sleeplessness, fear and anxiety, which have significantly interrupted his normal lifestyle and will continue to do so in the future.” 3
In their answer, defendants admitted that they had performed the MRI. As an “affirmative defense,” defendants asserted:
“The plaintiff has plead a claim for the negligent infliction of emotional distress unaccompanied by either any actual or threatened physical harm or injury to another legally protected interest. Such a claim is not recognized in Oregon. The plaintiff has failed to state ultimate facts constituting a claim.”
On the day of trial, defendants moved for judgment on the pleadings. ORCP 21 G(3). Invoking
Hammond v. Central Lane Communications Center,
Plaintiff responded with two arguments. First, the relationship between plaintiff and defendant medical professionals who administered the MRI gave rise to a distinct “legally protected interest” beyond liability grounded in general principles of foreseeability. Second, because he was a “direct,” rather than “indirect,” victim of defendants’ negligence, the bar to recovery in
Hammond, Saechao,
and related cases was inapposite. As support for the latter proposition, plaintiff relied on our observation in
Harris v. Kissling,
The trial court granted judgment on the pleadings:
“Oregon law at this time does not allow for recovery for negligent infliction of emotional distress where there is no physical injury. That is it. It is really that simple. That is the pleading. If I accept everything in the pleadings as true, we still don’t get the elemental requirements of the tort.
“I’ve got to tell you something, I don’t know what the facts are in this case, and believe me I don’t want you to take this wrong, but I can see a situation where there ought to be recovery for something like this. I’ll be darned if—you know, I can see how someone being left in an environment like that or not being handled expertly the entire time could create some psychic trauma for which there should be compensation, but Oregon law simply doesn’t allow it.”
On appeal, plaintiff and defendants reiterate their arguments. In their briefs and arguments, counsel posit contending—and equally forbidding—slippery slopes and parades of horribles. Plaintiff, for example, contends that defendants’ position, by principled extension, would preclude claims for psychological or psychiatric malpractice, where the only injury suffered as a result of a defendant’s negligence is,
On either side, the abyss beckons: “Hard cases make bad law.” Still, we will attempt to mark and tread a principled and practical middle ground.
For at least 60 years, Oregon courts have assumed, albeit implicitly, that emotional distress damages can only be recovered in cases involving physical injury—and then have proceeded to carve out exceptions to that general proposition. 4 The cases have fallen generally, though inexactly, into three categories: (1) claims for emotional distress resulting from the defendant’s tortious conduct directed against persons other than the plaintiff; (2) claims for emotional distress resulting from the defendant’s tortious conduct directed against the plaintiff; and (3) “hybrid” claims for emotional distress resulting from tortious conduct directed against both the plaintiff and third persons.
Saechao
and
Norwest v. Presbyterian Intercommunity
Hosp.,
Most reported decisions fall into the second, “direct injury’ group.
See, e.g., Nearing v. Weaver,
The third, “hybrid” category is somewhat more amorphous. However, the Supreme Court’s most recent discussion in this area,
Hammond,
appears to fall into that group. In
Hammond,
the plaintiff sought emotional distress damages based on the defendants’ mishandling of a 9-1-1 call that the plaintiff had made concerning her husband. The
In Hammond, the court summarized and organized the exceptions to the general assumption, under Oregon law, that psychic distress is not compensable unless accompanied by physical injury:
“This court has recognized common law liability for psychic injury alone in three situations. First, where the defendant intended to inflict severe emotional distress. Second, where the defendant intended to do the painful act with knowledge that it will cause grave distress, when the defendant’s position in relation to the plaintiff involves some responsibility aside from the tort itself. Third, where the defendant’s conduct infringed on some legally protected interest apart from causing the claimed distress, even when that conduct was only negligent.” 7312 Or at 22-23 (citations omitted).
Here, plaintiff does not allege that defendants either engaged in intentional misconduct or intended to inflict emotional distress; consequently, the only arguably applicable trigger for liability is the third, “legally protected interest” exception. Further, plaintiffs claim here is unambiguously one of direct injury; consequently, we need not be concerned with the special constraints of “indirect injury” or “hybrid”
We begin, perhaps pedantically, with the meaning of ‘legally protected interest.” The genesis of that term appears to lie in
Macca v. Gen. Telephone Co. of N.
W.,
“resulted in an invasion of plaintiffs right to enjoy her property without unreasonable interference. As such it is governed by the law relating to a private nuisance, and plaintiff is entitled to recover for mental distress resulting from defendant’s negligent act.” Id. at 418.
In so holding, the court observed:
“Allowing recovery for mental suffering and anguish unaccompanied by physical injuries under the circumstances of the present case is in accord with previous decisions of this court. Where an independent basis of liability exists, irrespective of whether there existed physical injuries, recovery has been uniformly allowed for mental suffering and anguish.” Id. at 420 n 1 (citing cases; emphasis supplied).
Thus, in
Macea,
the “independent basis of liability,” which was later denominated “legally protected interest,” was the plaintiffs property-law based right of use and enjoyment.
See also Edwards v. Talent Irrigation District,
“Under the terms of the divorce decree, as attached to the complaint, plaintiff had a legal right to the custody of his child and it is the infringement of that right which is the subject of this action. It follows, in our opinion, that conduct by defendant which resulted in an infringement of that legal right, if established by evidence on trial, would entitle plaintiff to recover damages for ‘anguish and mental [suffering] due to the loss of his minor child,’ as alleged in the complaint.” Id. at 789.
The term ‘legally protected interest” first appeared in this context in Norwest, an “indirect injury” case. In rejecting the plaintiffs “parental consortium” claim, the court observed:
“If there are few causes of action for psychic or emotional harm as such, the reason is not found in objections to monetary damages for harm of that nature. The reason may be found by focusing, not on the nature of the plaintiffs loss, but on the source and scope of the defendant’s liability. This court has recognized common law liability for psychic injury alone when defendant’s conduct was either intentional or equivalently reckless of another’s feelings in a responsible relationship, or when it infringed some legally protected interest apart from causing the claimed distress, even when only negligently. * * * But we have not yet extended liability for ordinary negligence to solely psychic or emotional injury not accompanying any actual or threatened physical harm or any injury to another legally protected interest.”293 Or 558 -59 (footnotes omitted).
“The obstacle to plaintiffs action is that ordinarily negligence as a legal source of liability gives rise only to an obligation to compensate the person immediately injured, not anyone who predictably suffers loss in consequence of that injury, unless liability for that person’s consequential loss has a legal source besides its foreseeability.” Id. at 569 (emphasis supplied).
A year later, in Nearing, the court amplified the “legally protected interest” concept and explicitly stated that that “interest” must be distinct from liability grounded in the generic common-law duty to avoid foreseeable harm:
“Plaintiffs [assert] that Oregon law does allow recovery of damages for psychic or emotional harm when defendant’s conduct infringes some legal right of the plaintiff independent of an ordinary tort claim for negligence. Plaintiffs are right. * * *
* * * *
“The question, therefore, is whether plaintiffs pleaded an infringement by defendants of a legal right arising independently of the ordinary tort elements of a negligence action. It is clear that plaintiffs did so.
“The complaint alleges facts that, if proved, obliged the St. Helens police officers to respond to plaintiffs’ call for protection against the exact kind of harassment * * * that is said to have occurred, and it alleges that the officers refused to enforce the restraining order in the manner prescribed by law. The duty defendants are alleged to have neglected therefore is not an ordinary common law duty of due care to avoid predictable harm to another. It is a specific duty imposed by statute for the benefit of individuals previously identified by a judicial order.
‡ ‡ Hi *
“In explaining their claim to the trial court as well as on appeal, plaintiffs described it as a type of action for defendants’ negligent failure to perform their duty, * * * though the words ‘negligent’ or ‘negligence’ neither were nor had to be used in the complaint. This invited possible confusion insofar as there is no cause of action for negligent infliction of purely psychic or emotional injury as such, unsupportedby a violation of some more specific duty toward the plaintiff. * * *
«* * * [PJlaintiffs reference to ‘negligence’ in this case was immaterial to the alleged liability, if ‘negligence’ is used in the sense of‘carelessness’ or ‘failure to use due care’ rather than merely as a conventional legal totem, because the result would not be different if defendants had acted, or failed to act, willfully or intentionally or with some other state of mind. It must be recalled what role the allegation of ‘negligence’ plays in an ordinary common law case. In general terms that role is to invoke a duty to take reasonable care not to cause a risk of a foreseeable type of harm to a foreseeable class of plaintiffs.”295 Or at 706-08 (emphasis supplied).
As we understand “legally protected interest,” as described in
Norwest
and
Nearing,
that term refers to a sort of “duty’ that is distinct from
Fazzolari
9
-like
foreseeability.
See Norwest,
We conclude that the relationship between plaintiff and defendant medical professionals, as alleged in the complaint, does give rise to such an actionable “legally protected interest.” Obviously, an action for malpractice and, particularly, failure to obtain informed consent, sounds, at least in part, in negligence. Just as obviously, a medical professional’s standard of care toward his or her patients—and liability for breach of that standard—transcends mere
Fazzolari
foreseeability. That is, the relationship between medical professionals and their patients, of the sort alleged in this case, imposes a duty on the care providers that goes beyond the general common-law duty to exercise reasonable care to prevent foreseeable harm.
See, eg., Dowell v. Mossberg,
“[W]e first examine the types of relationships in which one party owes the other a duty to exercise reasonable care beyond the common-law duty to prevent foreseeable harm.
“Oregon law imposes such a duty of care upon certain professionals in actions toward their clients. For example, lawyers owe their clients a duty to exercise reasonable care, as do physicians toward their patients. * * *
«‡ ‡ jfc * *
“* * * Another way to characterize the types of relationships in which a heightened duty of care exists is that the party who owes the duty has a special responsibility toward the other party. This is so because the party who is owed the duty effectively has authorized the party who owes the duty to exercise independent judgment in the former party’s behalf and in the former party’s interests. In doing so, the party who is owed the duty is placed in a position of reliance upon the party who owes the duty; that is, because the former has given responsibility and control over the situation at issue to the latter, the former has a right to rely upon the latter to achieve a desired outcome or resolution.
“This special responsibility exists in situations in which one party has hired the other in a professional capacity, as well as in principal-agent and other similar relationships.” Conway v. Pacific University,324 Or 231 , 239-40,924 P2d 818 (1996) (emphasis in original).
The analogous issue addressed in
Conway
was the proper scope of liability for economic damages resulting from negligent misrepresentation. In
Conway,
as in
Onita Pacific Corp. v. Trustees of Bronson,
Plaintiff has, thus, pleaded facts demonstrating a separate “legally protected interest.” That does not quite end our inquiry, however. As we observed in
Collver,
“we have never said that the mere existence of a legally protected interest is sufficient to allow a plaintiff to recover emotional distress damages in the absence of a physical injury.”
Two brief illustrations of that concept should suffice. In
Hilt,
the plaintiff sued her former attorney for malpractice, alleging that the attorney’s negligence in counseling her during a divorce proceeding had resulted in the loss of her equity in her home, causing her mental distress. We did not resolve the issue of whether the attorney-client relationship gave rise to a legally protected interest.
12
Instead, we concluded that, because the plaintiffs underlying loss,
viz.,
the loss of her home, was “solely an economic one,” the invasion of any interest was not sufficient to warrant the recovery of emotional distress damages.
Hilt,
In
Collver,
we considered whether the plaintiff could recover emotional distress damages on a claim against an insurance broker and carriers for negligent failure to procure auto insurance coverage. The plaintiff contended that the loss of his driver’s license as a result of being an uninsured driver constituted an invasion of a separate “legally protected interest” sufficient to permit recovery of emotional distress damages. After canvassing the case law, we concluded that, “[assuming without deciding that an invasion of a legally protected interest has occurred * * *, the invasion is not of sufficient importance to warrant the award of damages for emotional distress * * *; the invaded interest is chiefly an economic one.”
The determination of whether an invasion of a protected interest is of a sufficient quality or magnitude to warrant recovery of emotional distress damages seems, almost inevitably, to be case-specific.
See, e.g., Meyer v. 4-D Insulation Co., Inc.,
The trial court erred in granting judgment on the pleadings.
Reversed and remanded.
Notes
MRI is a noninvasive diagnostic technique that uses the simultaneous application of a magnetic field and electromagnetic radiation to discover information about the molecular material in a patient’s body. MRI is used to diagnose brain tumors and disorders, spinal disorders, multiple sclerosis, and cardiovascular disease. The procedure is considered to be medically risk-free. The Concise Columbia Encyclopedia 521 (3d ed 1994).
“Defendants” herein refers only to MRI Imaging Services II and ABCT, Inc. North Lincoln Hospital was also a defendant but was dismissed by stipulation of the parties.
Plaintiff also sought economic damages, for past and anticipated future medical expenses, of approximately $13,500.
Plaintiff points out correctly that no
Oregon
decision has explicitly stated that “rule” in circumstances in which the plaintiff was the
direct
victim of the tortious conduct.
Compare Saechao v. Matsakoun, 78 Or
App 340, 345-48,
See also Heusser v. Jackson County Health Dept.,
One case that may defy categorization is
Hovis v. City of Burns,
In Meyer v. 4-D Insulation Co., Inc.,
“The cases can be grouped into four main categories, although they cannot be said to form a definite pattern: (1) certain intentional torts, including trespass to land * * *; (2) private nuisance; (3) invasion of privacy; and (4) miscellaneous cases!.]” (Citations omitted.)
One often-cited example of a case involving a separate “legally protected interest” is
Houis,
note 6 above, which antedated
Macea v. Gen. Telephone Co. of N.W.,
Fazzolari v. Portland School Dist. No. 1J,
Neither
Onita Pacific Corp. v. Trustees of Bronson,
Other jurisdictions have allowed recovery for negligent infliction of emotional distress, without physical injury, where a special relationship gave rise to a heightened duty of care.
See Oswald v. LeGrand,
In Hilt v. Bernstein,
