Tyler LOUGH, a minor, by Carolyn LOUGH, his Guardian & Conservator, Appellant, v. ROLLA WOMEN‘S CLINIC, INC., et al., Respondents.
No. 75749.
Supreme Court of Missouri, En Banc.
Nov. 23, 1993.
Rehearing Denied Dec. 21, 1993.
860 S.W.2d 306
Robert A. Wulff, Robert G. Brody, Patricia A. Manhart, St. Louis, Ronald R. McMillin, Kent L. Brown, Jefferson City, J. William Turley, Dan L. Birdsong, Charles Bennett, Rolla, for respondents.
HOLSTEIN, Judge.
Tyler Lough was born with multiple, irreversible, profound disabilities. According to a petition filed on his behalf, his condition is traceable to an error in reporting an Rh factor blood test performed on his mother in connection with a previous pregnancy in 1984. Concluding that no cause of action for preconception tort exists in this state, the trial court sustained motions for summary judgment. Following opinion by the Missouri Court of Appeals, Southern District, this Court granted transfer.
I.
On appeal from a summary judgment, the record is viewed in a light most favorable to the nonmoving party, and that party is granted the benefit of all favorable inferences. ITT Commercial Finance Corp. v. Mid-America Marine Supply Corp., 854 S.W.2d 371, 376 (Mo. banc 1993). However, if the judgment of the trial court is sustainable on any grounds, it will not be overturned on appeal. Swink v. Swink, 367 S.W.2d 575, 578 (Mo.1963). The record is viewed with these principles in mind.
Tyler‘s mother has Rh negative blood. Tyler‘s older brother, Justin, born in 1984, has Rh positive blood. During delivery of Justin, some of his Rh positive blood entered his mother‘s bloodstream. The reaction of his mother‘s body was that her immune system became sensitized to Rh positive blood. Mrs. Lough‘s immune system dealt with the Rh positive blood as an invading substance and, following the delivery of Justin, her system developed antibodies to attack Rh positive blood in the future in a manner like the body‘s response to a vaccine. Tyler has Rh positive blood. Mrs. Lough learned of this problem in the fifth month of her pregnancy with Tyler, during November of 1986. During that pregnancy, antibodies in her system attacked Tyler‘s Rh positive blood. This condition is diagnosed as erythroblastosis fetalis, or EBF. Because Tyler‘s system was constantly under attack from a time commencing shortly after his conception until he was delivered, he sustained devastating pulmonary, cardiovascular and neurological damage.
The drug RhoGAM is designed specifically to prevent what occurred to Tyler. Administered within 72 hours of a woman giving birth to a child with an Rh factor different from hers, RhoGAM suppresses the mother‘s immune system response, preventing the sensitization that harmed Tyler.
The mother in this case was given prenatal treatment by Drs. Fortin and White at the Rolla Women‘s Clinic during both pregnancies. Blood was drawn at the clinic and sent to the Phelps Regional Medical Center for analysis during the earlier pregnancy. Kathy Jadwin, a lab technician, did the blood analysis. She claims to have correctly identified the blood as Rh negative but misrecorded it as Rh positive. This report was returned to the clinic. As a result, RhoGAM was not administered after Justin was born.
In the context of this case, “preconception tort” refers to negligent conduct which occurred prior to the plaintiff‘s conception.1 The conduct in this case was that of Kathy Jadwin misrecording Mrs. Lough‘s blood type.
II.
No Missouri court has addressed the question of whether preconception torts are actionable. Most jurisdictions that have addressed the question have permitted preconception tort actions. Among those permitting preconception tort actions are Jorgensen v. Meade Johnson Laboratories, Inc., 483 F.2d 237 (10th Cir.1973) (construing Oklahoma law); Bergstreser v. Mitchell, 577 F.2d 22 (8th Cir.1978) (construing Missouri law); Renslow v. Mennonite Hospital, 67 Ill.2d 348, 10 Ill.Dec. 484, 367 N.E.2d 1250 (1977); Monuska v. Postle, 175 Mich.App. 269, 437 N.W.2d 367 (1989); Hegyes v. Unjian Entp., Inc., 234 Cal.App.3d 1103, 286 Cal.Rptr. 85 (2nd Dist.1991); and Walker v. Rinck, 604 N.E.2d 591 (Ind.1992). Cases in which a claim for preconception tort was denied include Albala v. City of New York, 54 N.Y.2d 269, 445 N.Y.S.2d 108, 429 N.E.2d 786 (1981); Grover v. Eli Lilly & Co., 63 Ohio St.3d 756, 591 N.E.2d 696 (1992); and McAuley v. Wills, 251 Ga. 3, 303 S.E.2d 258 (1983).
Renslow v. Mennonite Hospital recognized a cause of action in a case similar to this one. There an improper Rh blood transfusion was given to a mother by the defendant several years prior to the plaintiff‘s birth. The court in Renslow questioned whether there could be areas of foreseeable harm in which no duty arises. The court concluded there may be situations in which a duty for a particular preconception tort might not be imposed. The example given there was, “Successive generations of plaintiffs complaining against a single defendant for a harm caused by genetic damage done an ancestor in a nuclear accident.” 10 Ill.Dec. at 489, 367 N.E.2d at 1255. However, the court concluded that such situation is clearly distinguishable and that the damage in a case involving EBF was, by its nature, not self-perpetuating nor is the plaintiff remote. Indeed, the very reason for the RhoGAM treatment is to benefit later conceived children of the mother, while injury to those children in the absence of proper treatment is highly predictable. 10 Ill.Dec. at 487, 367 N.E.2d at 1253.
In addition to Renslow, every court addressing the specific issue presented here has consistently allowed an action for recovery by a child born with EBF following a defendant‘s failure to administer RhoGAM to an Rh negative woman who has given birth to an Rh positive child. Empire Casualty v. St. Paul Fire and Marine Ins. Co., 764 P.2d 1191 (Co.1988), and Walker v. Rinck, supra.
The most draconian of rules among those cases denying a claim for a preconception tort is found in New York. Albala v. City of New York, supra. Based on a perceived inability to judicially establish perimeters on a duty owed to unconceived children and the fear that doctors will face a choice between the best treatment for the patient mother and protecting future offspring of the patient, New York has adopted a rule criticized by Prosser as a “blanket no-duty rule.” Prosser and Keeton on Torts, § 55 at 369 (5th ed. 1984). This position was reaffirmed most recently in Enright v. Eli Lilly & Co., 77 N.Y.2d 377, 568 N.Y.S.2d 550, 570 N.E.2d 198 (1991). The courts of no other state have adopted that extreme view.
The other two preconception tort cases noted above denying the claims based their decisions on familiar principles of foreseeability. In Grover v. Eli Lilly & Co. the Ohio Supreme Court held that an injury to a child
The reason for not adopting a rule that would absolutely bar claims for preconception torts is demonstrated by the following hypothetical: Assume a balcony is negligently constructed. Two years later, a mother and her one-year-old child step onto the balcony and it gives way, causing serious injuries to both the mother and the child. It would be ludicrous to suggest that only the mother would have a cause of action against the builder but, because the infant was not conceived at the time of the negligent conduct, no duty of care existed toward the child. It is unjust and arbitrary to deny recovery to Tyler simply because he had not been conceived at the time of Kathy Jadwin‘s negligence.
The concern expressed in Albala, that liability will not be confined to manageable boundaries if preconception torts are permitted, is speculation. The respondents have not directed this Court to any indication that the states permitting preconception torts have been swallowed by the kind of apocalypse of liability actions envisioned by the Albala court. In addition, the concern that a physician might be called upon to make a treatment choice less favorable to his patient in an effort to avoid doing harm to future offspring of the patient does not exist in this case. As previously noted, Rh factor testing and RhoGAM treatment are done exclusively for the benefit of the children and benefit the mother only by removing the risk that sensitization poses to those children. There is no beneficial treatment to the mother that might be foregone if recovery is allowed in this case. See Walker v. Rinck, 604 N.E.2d at 595.
The basic question in this case is whether a duty exists. Any question of duty depends upon a calculus of policy considerations. These include “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; considerations of cost and ability to spread the risk of loss; the economic burden upon the actor and the community.” Hyde v. City of Columbia, 637 S.W.2d 251, 257 (Mo.App.1982). Foreseeability is the paramount factor in determining existence of a duty, but a relationship between the parties where one is acting for the benefit of another also plays a role. Hoover‘s Dairy, Inc., v. Mid-America Dairymen, Inc., 700 S.W.2d 426, 432 (Mo. banc 1985); Prosser and Keeton on Torts, § 42, p. 274 (5th ed. 1984). Each of the factors listed in Hyde and Hoover‘s Dairy militate in favor of the existence of a duty in this case.
Individual cases involving “preconception torts” can be sensibly analyzed under existing principles of tort law to determine if a duty exists in a particular case. Just as there is not a duty in every case when a plaintiff is alive at the time of some allegedly negligent conduct, there will not be a duty in every case where allegedly negligent conduct harms a plaintiff not yet conceived. It is sufficient to say that in this case, a duty exists.
The respondents make a series of other arguments in support of their claim that there is no duty. The first is that
Respondents claim that because Missouri does not allow a cause of action for wrongful life, see Miller v. Duhart, 637 S.W.2d 183 (Mo.App.1982), Tyler‘s claim is invalidated. Wrongful life was rejected because wrongful life would require finding a right to have never been born and it would require the courts to measure how the plaintiff might have benefitted by having never existed. Respondents further argue that this Court‘s decision in Sullivan v. Carlisle, 851 S.W.2d 510 (Mo. banc 1993), weighs against preconception tort. That case denied a plaintiff ad litem the right to pursue a wrongful death action because a plaintiff ad litem was not a “person” entitled to recover under the wrongful death statute, nor was anyone else living who was qualified to sue. In Sullivan it was not an absence of duty but an absence of a person entitled to recover damages occasioned by the death. In addition, respondents cite Rambo v. Lawson, 799 S.W.2d 62 (Mo. banc 1990), holding no wrongful death cause of action may be maintained for a nonviable fetus. Whether a nonviable fetus is a “person” in the context of
III.
Respondents argue that even if a preconception tort exists, this one is barred by the statute of limitations found in
All actions against physicians, hospitals, ... and any other entity providing health care services and all employees of any of the foregoing acting in the course and scope of their employment, for damages for malpractice, negligence, error or mistake related to health care shall be brought within two years from the date of the occurrence of the act of neglect complained of, except that a minor under the full age of ten years shall have until his twelfth birthday to bring such action....
Respondents argue that a minor must have been in existence at the time of the act of neglect to take advantage of the exception. While it is true that
In Walker v. Rinck, supra, a statute of limitations under consideration provided that actions against health care providers must be brought within two years of the alleged misconduct. However, the statute further provided that “a minor child under the full age of six (6) years shall have until his eighth birthday in which to file.”
The defendants essentially make two arguments as to why the exception for minors is inapplicable. The first argument is that the exception is a tolling of the statute of limitations only during the minority of the child. The provision for children under ten years of age found in
The defendants’ second argument is that the exception in
IV.
There were other issues raised by some of the defendants in the motion for summary judgment, including the question of the agency of Jadwin for other defendants. Inasmuch as those issues were specifically not decided by the trial court, they need not be decided here.
The judgment is reversed and the cause remanded to the trial court for further proceedings consistent with this opinion.
BENTON, THOMAS and PRICE, JJ., concur.
GERALD M. SMITH, Special Judge, dissents in separate opinion filed.
COVINGTON, C.J., and LIMBAUGH, J., concur in opinion of GERALD M. SMITH, Special Judge.
ROBERTSON, J., not sitting.
GERALD M. SMITH, Special Judge, dissenting.
I respectfully dissent.
I do not disagree with the majority‘s conclusion that within the narrow parameters of the facts before us recognition of the existence of a pre-conception tort committed against this plaintiff is warranted and proper. The medical test involved is conducted for the benefit of subsequently born children of the mother in order to treat the mother so as to prevent the very conditions that afflicted plaintiff here. The medical procedure is for the direct benefit of the as yet unconceived child, and its negligent performance will directly injure that child. The procedure is not one that is primarily for the benefit of the mother and incidentally causes injury to the unconceived child. Within those narrow confines, I believe recognition of liability by the tortfeasor to the child is justified.
I reluctantly conclude, however, that the plaintiff‘s cause of action here is barred by the provisions of
The significance of this legislative history, particularly that beginning with the year 1921, is that it shows clearly a legislative intent to treat particularly with medical malpractice actions and fix a specific date when the statute of limitation shall begin to run against those actions, a date different from the date and time when the statute begins to run against other actions covered by what is now
§ 516.140 . Prior to 1921 the limitation period for malpractice actions was five years and prior to 1919, when the General Assembly amended§ 1887, RSMo 1909 , the limitation peri-od commenced to run on the date the cause of action accrued. When the proviso was added by amendment of § 1887 by the Fiftieth General Assembly in 1919 the statute of limitation (the five-year statute) in malpractice actions commenced to run on the same date as actions for libel, slander, assault, etc., that is, not “... when the wrong is done ... but when the damage resulting therefrom is sustained and is capable of ascertainment ...” However, significantly, two years later, in 1921, the next General Assembly, the Fifty-first, with knowledge fresh in its mind of what had been done at the previous session to define by the proviso specifically when a cause of action shall be deemed to accrue and the meaningful effect of that proviso upon malpractice actions, amended§ 1319 by adding§ 1319a to provide that such actions “... shall be brought within two years from the date of the act of neglect complained of....” The result was that beginning with the revision of 1929, when§§ 1319 and1319a (RSMo 1919) were combined and became§ 864, RSMo 1929 , we had two types of action in one section, one of which (libel, assault, etc.) did not have attached to it its own specific date from which the limitation period commenced to run and one (malpractice) which did.... Again, significantly, and indicative of its intent to treat malpractice actions differently from other actions so far as the date of commencement of the running of the statute is concerned, the General Assembly, in 1945, repealed and reenacted§ 1016 by adding another type of action, those by employees for the payment of unpaid minimum wages, etc., and provided that such actions shall be brought within two years after the cause accrued, but left intact and unchanged the provision that malpractice actions shall be brought within two years from the date of the act of neglect.
Id. at 312-13 (emphasis in original) (footnotes omitted).
Based upon this analysis, the Court concluded that the exceptions dealing with accrual of the cause of action premised upon sustaining damage and ascertainment of that damage (the discovery provision), found in what is now
In 1976, the General Assembly enacted Senate Bill 470, part of which became
In the case before us, more than two years elapsed between “the date of occurrence of the act of neglect complained of” and plaintiff‘s conception. The question before us then is whether, in that situation, the provision of
Exceptions to the time constraints of statutes of limitation fall into basically two categories, which for convenience I will delineate as “disabilities” and “impracticalities“. Disabilities exceptions are directed to those persons who because of their legal status are not authorized by law to pursue on their own behalf their legal remedies. Usually, that group is comprised of minors, the mentally incompetent, and, frequently, imprisoned felons. See Black‘s Law Dictionary 461 (6th ed. 1990). The “impracticalities” exceptions deal with factual situations in which the injured party is prevented, for reasons beyond his control, from pursuing his remedy. These include lack of knowledge or non-discovery of the injury or the damage (
The exception in
Section 516.105 is something of an anomaly. In many respects it more closely resembles a statute of repose than a true statute of limitations. See Francis E. McGovern, The Variety, Policy and Constitutionality of Product Liability Statutes of Repose, 30 Am.U.L.Rev. 579 (1981) [l.c. 587, 1st para.].2
It is apparent that the General Assembly, dating back to at least 1921, has found it important to limit narrowly the time constraints in medical malpractice cases. The 1976 revision of
Neither Walker v. Rinck, 604 N.E.2d 591 (Ind.1992), nor Bergstreser v. Mitchell, 577 F.2d 22 (8 Cir.1978), upon which the majority rely, discusses the statutes involved in terms of the history of their enactment. Both assume that regardless of the time elapsing between the act of neglect and the conception of the plaintiff the statutory exception applies. What they assume is, in fact, the issue before us. I find neither case instructive nor persuasive on that issue.
During the two year period after the occurrence plaintiff had not been conceived and therefore could sustain no damage, and no cause of action existed. He was not under any legal disability for disability connotes existence, which plaintiff did not have. Black‘s, supra, at 461; Webster‘s Third International Dictionary at 642 (14th ed. 1961). He incurred no legal disability until after the time established in
I would affirm the judgment of the trial court.
