Horton v. Oregon Health & Science UniversityHorton v. Oregon Health & Science University
Plaintiffs are the parents of a very young child whose liver was severely damaged during surgery performed by defendants, who—at least for purposes of this
The pleading pertinent to this appeal is the amended complaint, which included four claims for relief: (1) a claim by plaintiff mother, acting in her capacity as guardian ad litem and conservator for her child, against defendants for negligently harming the child in the initial surgery; (2) a claim by plaintiff mother for her own injuries associated with the subsequent liver-transplant surgery; (3) plaintiff father’s claim for loss of consortium with plaintiff mother; and (4) plaintiffs’ past and future economic damages associated with caring for their child.
In the second claim for relief, plaintiff mother alleged that her infant child was diagnosed with hepato-blastoma and that defendant OHSU recommended that he have surgery to remove one lobe of his liver. During that surgery, performed when the child was about eight months old, defendants severed blood vessels leading to and from the child’s liver, necessitating further procedures, which plaintiffs alleged caused additional damage. Plaintiffs alleged that defendants were negligent in several respects, including utilizing inexperienced surgeons, performing the initial surgery without coordinating with a transplant team, failing to properly identify the vessels upon which they operated, and failing to stop the child’s bleeding.
Soon after the child’s surgery at OHSU, plaintiff mother alleged, she:
“was advised by physicians attending to her son * * *, including those at OHSU, that because of the injuries he suffered in the * * * surgery at OHSU he would not survive without an emergency liver transplant. She thereafter learned that her body tissues ‘matched’ those of her son and that she was, therefore, an eligible liver donor for her son. Plaintiff [mother], therefore, took the reasonably foreseeable step of donating a portion of her liver to save the life of her son.”
Plaintiff mother also alleged that she suffered a complication from the transplant surgery, which required an additional surgery. Plaintiff mother claimed economic damages associated with the physical injuries from those surgeries, lost income, and severe emotional distress, both from her own surgeries and from learning of the complications associated with her child’s surgery at OHSU.
The trial court granted defendants’ motion to dismiss the second and third claims for relief. The court did not agree with defendants that the lack of a physician-patient relationship was fatal to plaintiffs’ claims. Rather, it dismissed the claims on the ground that, because plaintiff mother had “voluntarily [made] a decision to engage in a surgery to donate an organ,” her claims against defendants were “too far attenuated to have [the] sort of either foreseeability or causal link that * * * is currently required under Oregon law.” Accordingly, the court entered a limited judgment in favor of defendants on the second and third claims for relief. It is that limited judgment from which plaintiffs appeal.
In this court, plaintiffs argue, as they did below, that the amended complaint adequately stated a negligence claim by plaintiff mother against defendants for harm she suffered as a result of defendants’ negligent surgery on the child. To adequately plead a negligence claim, a complaint
“must allege facts from which a factfinder could determine (1) that defendant’s conduct caused a foreseeable risk of harm, (2) that the risk is to an interest of a kind that the law protects against negligent invasion, (3) that defendant’s conduct was unreasonable in light of the risk, (4) that the conduct was a cause of plaintiff’s harm, and (5) that plaintiff was within the class of persons and plaintiff’s injury was within the general type of potential incidents and injuries that made defendant’s conduct negligent.”
In response, defendants defend the trial court’s reasoning that—given plaintiff mother’s choice to donate a portion of her liver to the child—plaintiffs’ complaint did not adequately plead the first and fourth elements of a negligence claim, that is, foreseeability and causation. The structure of defendants’ argument reflects the oft-quoted holding from Fazzolari v. Portland School Dist. No. 1J,
“[U]nless the parties invoke a status, a relationship, or a particular standard of conduct that creates, defines, or limits the defendant’s duty, the issue of liability for harm actually resulting from defendant’s conduct properly depends on whether that conduct unreasonably created a foreseeable risk to a protected interest of the kind of harm that befell the plaintiff.”
Defendants assert that plaintiff mother’s injuries “did not ‘actually result’ from defendants’ conduct” and that “nothing ‘befell’” plaintiff mother, because “she chose to undergo” the liver-transplant surgery. In their view, no allegations in the complaint could support an opposite determination.
In addition, defendants make an argument that focuses on their characterization of plaintiff mother’s claim as one for “medical malpractice.”
In considering the parties’ arguments, which all relate to the trial court’s dismissal of plaintiff mother’s claim for “failure to state ultimate facts sufficient to constitute a claim,” ORCP 21 A(8), we review “for legal error, taking as true all well-pleaded factual allegations, and giving plaintiff the benefit of all reasonable inferences that can be drawn from those facts.” Nationwide Ins. Co. of America v. TriMet,
We begin with, and quickly dispose of, defendants’ contention that a medical-malpractice claim must always be premised on the existence of a special status—that is, a physician-patient relationship—between the plaintiff and the defendant. We have repeatedly rejected that argument, most recently in Tomlinson v. Metropolitan Pediatrics, LLC,
We turn to defendants’ remaining arguments, which relate to whether plaintiff mother adequately pleaded a negligence claim. The parties’ arguments on that point focus on whether plaintiff mother adequately alleged foreseeability and causation. That is, the parties dispute whether the amended complaint alleged facts from which a factfinder could determine (1) that defendants’ negligent surgery on the child caused a foreseeable risk of harm to persons other than the child, of the type that plaintiff mother suffered and (2) that defendants’ negligence was, in fact, a cause of the harm that plaintiff mother suffered when she chose to donate part of her liver to save the child.
Although “foreseeability” and “causation” may sometimes seem to overlap, conceptually they “are separate elements.” Towe v. Sacagawea, Inc.,
“Foreseeability is a prediction of the risk that an act or omission will result in a particular kind of harm—it turns on what prospectively might happen. Causation is an assessment of whether a particular act or omission in fact resulted in the particular harm that a plaintiff suffered—it turnson what retrospectively did happen. Thus, apart from proving either that the defendant’s conduct created an unreasonable risk of the kind of harm that befell the plaintiff or that the defendant breached a special duty owed to the plaintiff, the plaintiff in a negligence action must also prove an actual causal link between the defendant’s conduct and the plaintiff’s harm—that is, the plaintiff must prove ‘cause in fact.’”
Id. (emphases in original; internal quotation marks and citations to Fazzolari omitted). Accordingly, we consider those elements separately, beginning with causation.
“Cause in fact” has a well-defined legal meaning in Oregon: “it generally requires evidence of a reasonable probability that, but for the defendant’s negligence, the plaintiff would not have been harmed.” Joshi v. Providence Health System,
On appeal, and as discussed above, we first rejected the defendants’ argument that the plaintiff parents’ claim against their child’s medical providers failed because the plaintiff parents had not alleged that they had a physician-patient relationship with the defendants. Id. at 671-75. We then considered whether the plaintiff parents had adequately alleged causation. In doing so, we asked whether their allegations “directly link[ed] defendants’ conduct—that is, their failure to diagnose Manny and inform the [plaintiff parents] of his condition and its implications for them—with the injury that the [plaintiff parents] suffered—that is, the infringement of their interest in making informed reproductive choices and avoiding conceiving or bearing Teddy.” Id. at 678. The pertinent allegation was the plaintiff parents’ assertion that, “but for defendants’ failure to diagnose Manny *** and inform them of his condition and their reproductive risks, they ‘would not have produced another child’” who suffered from that condition. Id. We held that the “but for” allegation adequately linked the defendants’ conduct to the plaintiff parents’ harm; “nothing more [was] necessary” for them “to sufficiently allege causation.” Id.
To apply that principle here, we pose the following question, which is analogous to the one we addressed in Tomlinson: Has plaintiff mother alleged a direct link between defendants’ negligently performed surgery on her child’s liver and the harm that she suffered during the subsequent liver-transplant surgery? We conclude that she has. Although the words “but for” do not appear in the amended complaint, the allegations in that pleading reflect the pertinent link, as explained in plaintiffs’ opening brief:
“As to causation, but for the defendants’ surgical errors that destroyed her son’s liver, [plaintiff mother] would not have suffered the loss of a portion of her own liver. [Plaintiff mother] alleged, ‘[a]s a direct result of the negligence of defendants, plaintiff [mother] was required to undergo surgery to save the life of her son * *
In arguing to the contrary, defendants do not contend that their negligence cannot be
As a bare proposition, defendants’ argument cannot withstand Tomlinson, in which we held that the plaintiff parents had adequately pleaded that the defendants’ negligence in failing to diagnose their older son’s genetic condition was a “cause in fact” of the damages they suffered from conceiving and bearing another child who suffers from that condition, despite the fact that the plaintiff parents made a choice—to have a second child—without which the harm would not have occurred. The important point is that here, as in Tomlinson, plaintiff mother’s choice itself was allegedly driven by defendants’ negligence. In Tomlinson, the plaintiff parents alleged that they would not have chosen to have the second child if they had known of the associated reproductive risks (i.e., if not for the defendants’ alleged negligence in failing to recognize that risk and advise the plaintiffs of it). Here, plaintiff mother alleges that she would not have chosen to donate part of her liver to her child—she would not have had to make that choice—if not for the failed liver surgery at OHSU (i.e., if not for defendants’ negligence in performing that operation).
Our conclusion that plaintiffs have adequately pleaded causation is supported by the few Oregon cases that address situations in which a plaintiff was injured in the course of responding to the defendant’s negligent conduct, rather than being more directly affected by that negligence. In Gillilan v. Portland Cremation Ass’n,
The next question, then, is whether plaintiffs adequately pleaded foreseeability. Again, defendants focus on the fact that, as they put it, plaintiff mother “chose to undergo a surgery” and, therefore, “elected” to have the procedure that directly caused her harm. Under those circumstances, defendants contend, her surgery cannot be deemed “the foreseeable consequence of defendants’ actions” because “nothing ‘befell’ her.”
Again, “foreseeability” is forward-looking: it “involves a prospective factual
In Chapman, the Supreme Court considered how, over the past five decades, it had attempted “to give informed meaning to” those general principles. Id. at 206-07. In particular, the court addressed how it had conceived of— and how courts should conceive of—the harm a plaintiff suffered, when considering whether a defendant reasonably could have foreseen that type of harm. See id. at 208 (“[A]ny conception of foreseeability necessarily depends on how the type of harm is described.”). The court began with Stewart— the case involving the negligently caused sawmill fire and the plaintiff who was injured when he fell through the skylight of an adjacent building while helping to fight the fire— observing that it had described the type of harm the plaintiff suffered “more generally—injuries that may occur while fighting a fire—rather than specifically—injuries incurred from falling through a concealed skylight while fighting a fire.” Id. at 207.
In discussing cases that followed Stewart, the Supreme Court showed how its focus remained on the importance of describing the risks of harm associated with particular kinds of negligent conduct in a way that fairly captures the scope of possible injuries, to certain classes of plaintiffs, for which a negligent defendant may reasonably be deemed responsible. See generally id. at 208-15 (discussing cases). For example, the court explained, it had
“in Fazzolari reiterated that an assessment of foreseeability does not involve the precise, mechanical prediction of events for which a defendant would be expected to argue; on the other hand, the court observed, it does not adopt a paranoid view of the world that encompasses all sources of potential injury that a plaintiff might propose.”
Id. at 209. The court concluded in Fazzolari that a school district could be held liable in negligence to a student who was sexually assaulted near the entry to her high school because “a trier of fact could find that the type of harm that the plaintiff suffered was reasonably foreseeable to the district in light of the known risk of harm,” particularly given evidence that the district knew that another sexual assault had occurred on school grounds only 15 days earlier. Id. (discussing Fazzolari).
After summarizing more of its negligence decisions, including those that involved intervening acts by third parties,
Significantly, “rescuers” may fall within the class of “foreseeable plaintiffs” in at least some circumstances. That is, an
We do not view cases like Stewart, Fuhrer, and Gillilan as establishing some sort of “rescue doctrine” distinct from the principles that ordinarily apply in negligence cases. Rather, they help define when a rescuer may be deemed a “foreseeable plaintiff’ to whom a defendant may be liable in negligence. Those cases provide assistance here, as we consider whether plaintiff mother has adequately alleged “foreseeability.”
In addressing that question, we must properly describe “the type of harm at risk and the class of plaintiffs at risk with reference to the particular factual circumstances of the case,” which we take from the pleadings. Chapman,
The more difficult question is whether plaintiffs have adequately alleged that plaintiff mother—the liver donor—was a “foreseeable plaintiff’ in these circumstances. That is, we must decide whether plaintiff mother, in acting essentially as a rescuer of her child, fell within “the class of plaintiffs at risk.” Id. We conclude that she did. Plaintiff mother alleged that, after she was told of the need for an emergency transplant, she “learned that her body tissues 'matched’ those of her son and that she was, therefore, an eligible liver donor.” Viewing the allegations in the light most favorable to plaintiffs, we conclude that a factfinder could reasonably infer that plaintiff mother’s decision to undergo liver-transplant surgery (1) was prompted by her child’s need for a transplant (the amended complaint includes no allegation that mother would have donated her liver under other circumstances) and (2) was made possible by the tissue match—a match that is more common between family members
To recap: Plaintiff mother’s negligence claim against defendants is not foreclosed by the absence of a physician-patient relationship between plaintiff mother and defendants. In addition, plaintiff mother has adequately pleaded both causation and foreseeability. The trial court erred in ruling otherwise and in dismissing plaintiff mother’s claim for failing to state a claim for relief. It follows that the trial court also erred in dismissing plaintiff father’s derivative claim for loss of consortium. Accordingly, we reverse the trial court’s dismissal of both of those claims and remand for further proceedings.
We must address one more argument that defendants make on appeal. They contend that, at least, we should hold that mother is not entitled to the damages for emotional distress that she seeks in paragraphs 20, 21, and 22 of the amended complaint; defendants assert, for several reasons, that those damages are not recoverable under Oregon law. A similar argument was the subject of another ORCP 21 motion that defendants made to the trial court, which did not rule on the motion because it had dismissed plaintiffs’ claims on other grounds. Under the circumstances, we decline to reach that argument on appeal, as we believe that it is more appropriately addressed by the trial court in the first instance on remand.
Reversed and remanded as to plaintiff parents’ claims for relief; otherwise affirmed.
Notes
The amended complaint named four defendants: OHSU, Pediatric Surgical Associates, P.C., Marvin Harrison, M.D., and Audrey Durrant, M.D. The trial court subsequently granted an unopposed summary judgment motion filed by Pediatric Surgical Associates, P.C., and entered a limited judgment in its favor. Plaintiffs later voluntarily dismissed claims against Durrant. Accordingly, this opinion’s references to “defendants” generally are to OHSU and Harrison, except where context may require otherwise.
Defendants pointed to ORS 677.095(1), which provides:
“A physician licensed to practice medicine or podiatry by the Oregon Medical Board has the duty to use that degree of care, skill and diligence that is used by ordinarily careful physicians in the same or similar circumstances in the community of the physician or a similar community.”
We quote the current version of the statute. Although the statute was amended in 2013, after the trial court’s decisions in this case, those amendments are not pertinent to the parties’ arguments and do not affect our analysis. See Or Laws 2013, ch 129, § 8.
The limited judgment also reflects dismissal of claims against Durrant. We do not disturb that aspect of the judgment.
Following additional pretrial proceedings, see
After hearing post-trial motions, the trial court ruled that a “$3 million aggregate damage limit applies to OHSU in this case,” but that the “damages verdict should not be reduced as to defendant Dr. Harrison” because such a reduction would violate various provisions of the Oregon Constitution. The trial court entered a limited judgment to that effect. Defendant Harrison has appealed that limited judgment directly to the Supreme Court pursuant to ORS 30.274; the case number is S061992.
Plaintiffs, instead, use the term “medical negligence.”
E.g., Buckler v. Oregon Corrections Div.,
On that point, it is reasonable to “expect juries to bring to their task” a general understanding that biologically related individuals are more likely to “match” for organ-donation purposes than are unrelated individuals. See Chapman,