Opinion
Catherine Jenae Tussy-Garber (Tussy-Garber) allegedly pricked her finger on a hypodermic needle in the pocket of a jacket that had been returned to Macy’s California, Inc. (Macy’s), by another customer. Tussy-Garber is now suing Macy’s for negligence, asserting a right to emotional distress damages because she fears contracting acquired immune deficiency syndrome (AIDS) 1 or another serious or lethal disease. Macy’s challenges availability of emotional distress damages for fear of disease *747 where no physical harm has been shown. We conclude that the superior court erred in concluding that a needle stick, without more, entitled Tussy-Garber to seek emotional distress damages.
Facts and Procedures
According to her declaration, on February 10, 1993, while trying on a “jean jacket” at a Macy’s store in Fairfield, Tussy-Garber placed her hand in one of the pockets and pricked her finger on a hypodermic needle. The pocket contained two hypodermic needles, a knife and a metal pipe possibly used for ingesting cocaine. Tussy-Garber promptly sought hepatitis treatment and testing for the HIV. She admits that she has nevef tested positive for HIV and would stand only a 1 in 200,000 chance of contracting the virus from the needle if it was contaminated. She concedes that she has had no contact with hepatitis A or hepatitis C and, as of May 1995, had no infection related to hepatitis B. According to Tussy-Garber, Macy’s refused to help her find the person who returned the jacket so that she could find out if the person had AIDS and refused to assist her in having the needle tested. She claims also that Macy’s refused to pay for treatment required because of the incident.
In response to interrogatories, Tussy-Garber described her emotional injuries: “I can’t sleep at night. I have panic attacks. I cry all of the time. I am very sharp with my family. I worry constantly about putting my family through a terrible ordeal and what they may experience by being related to a victim of HIV. I experience nightsweats and nightmares concerning my future and the future of my family. If I dwell on the situation, I throw up. I get very angry about being victimized. I focus on this situation so often that I am unable to give adequate attention to my children. I feel helpless. I went through a period of deep mourning.” She also described physical injuries, including aches and pains, diarrhea, uncontrolled weight loss and weight gain, tiredness, rapid aging and tumors on her liver.
On February 8, 1994, Tussy-Garber and her husband filed an action against Macy’s for negligence, negligent infliction of emotional distress and loss of consortium. Macy’s moved for summary adjudication to bar recovery for emotional distress arising out of Tussy-Garber’s fear of contracting AIDS or another infectious disease. For purposes of summary adjudication, *748 Macy’s stipulated that Tussy-Garber was actually pricked by a hypodermic syringe as alleged in the complaint. After hearing, the court denied summary adjudication, finding that because Tussy-Garber was “within the area of physical risk and . . . actually sustained a physical impact” she could recover for any proven psychological reactions which “as a matter of reasonable foreseeability, result from the episode as a whole.” This petition followed.
Emotional Distress Damages
Although Tussy-Garber has stated two “causes of action” for negligent infliction of emotional distress, negligently causing emotional distress “ ‘. . . is not an independent tort but the tort of
negligence
. . . .’ [Citation.] ‘The traditional elements of duty, breach of duty, causation, and damages apply. [H Whether a defendant owes a duty of care is a question of law. Its existence depends upon the foreseeability of the risk and upon a weighing of policy considerations for and against imposition of liability.’ [Citation.]”
(Marlene F.
v.
Affiliated Psychiatric Medical Clinic, Inc.
(1989)
“Damages for serious mental suffering may now be recovered in the absence of either physical injury or impact. [Citation.] This was the holding in
Molien
v.
Kaiser Foundation Hospitals
(1980)
*749
“To determine liability for negligent infliction of emotional distress in any given case . . . several factors should be considered to ascertain whether the defendant has breached a duty of care. Whether a defendant owes a duty of care is a question of law. [Citations.]” (
The Potter Decision
In
Potter
v.
Firestone Tire & Rubber Co.
(1993)
Addressing the “negligence: fear of cancer” issue,
Potter
first considered whether parasitic damages were available for emotional distress. “[I]t is settled in California that in ordinary negligence actions for physical injury, recovery for emotional distress caused by that injury is available as an item of parasitic damages. [Citations.] Where a plaintiff can demonstrate a physical injury caused by the defendant’s negligence, anxiety specifically due to a reasonable fear of a future harm attributable to the injury may also constitute a proper element of damages. [Citation.]” (
Potter
next addressed the question of whether the absence of a present physical injury would preclude recovery for emotional distress engendered by fear of cancer. The court reaffirmed the general principle that there is “no duty to avoid negligently causing emotional distress to another, and that damages for emotional distress are recoverable only if the defendant has breached some other duty to the plaintiff.” (
Extension of Potter to AIDS/HIV
Two California Court of Appeal opinions have applied to fear of AIDS/ HIV infection
Potter's
“more likely than not” requirement, which was developed in the fear of cancer context. In
Herbert
v.
Regents of University of California
(1994)
The plaintiff in
Kerins
v.
Hartley
(1994)
Kerins examined the Potter court’s articulated policy concerns: (1) nearly everyone could reasonably fear cancer from exposure to or ingestion of carcinogenic substances. Claims would proliferate absent meaningful restrictions, compromising the availability or insurance for toxic liability risks; (2) unrestricted liability for fear of cancer would diminish availability of new, beneficial prescription drugs or increase their price beyond the reach of those who need them most; (3) recovery by those who fear disease would shift available funds of the defendants and insurers away from those who actually suffer from the diseases; (4) imposing a more likely than not requirement would establish a definite and predictable threshold, leading to more consistent results and early resolution or settlement of claims. Kerins concluded that all these concerns applied with equal force in the fear of AIDS context. Applying the more likely than not standard, Kerins sustained summary judgment for the defendants. (27 Cal.App.4th at pp. 1073-1074.)
Contentions
Macy’s contends that in order to qualify as a “physical injury” and avoid the more likely than not requirement of Potter, the injury must be more than a mere needle stick. In a fear of AIDS/HIV case, plaintiff must either test positive for HIV or exhibit symptoms of the actual onset of the disease. Macy’s contends that Herbert and Kerins recognized this when they applied Potter where a boy was scraped by a hypodermic needle and where surgery was performed on a plaintiff. These two courts impliedly found that neither physical invasion constituted the kind of physical injury necessary to bypass the Potter requirements.
Macy’s also argues that, as a matter of law, Tussy-Garber’s fear of AIDS/HIV was unreasonable.
*752 Tussy-Garber insists that neither Potter, Herbert nor Kerins applies because her needle stick was a direct physical injury. She contends that under well-established negligence law she is entitled to recover for the emotional distress and mental suffering accompanying her physical injury. Neither the Potter plaintiffs nor Kerins alleged a physical injury and in Herbert plaintiff was the mother, not the boy stuck by the needle. Tussy-Garber seeks to distinguish AIDS/HIV from cancer by asserting that we are all exposed to carcinogens every day, whereas AIDS can be avoided “without great effort.” She also notes that AIDS is inevitably fatal, while cancer is sometimes curable. She examines the policy considerations noted by the Potter court and reaches the opposite conclusion from Kerins.
Tussy-Garber contends that the jury should decide whether her fears were reasonable.
Parasitic Recovery
The issue left open by Potter and not specifically addressed by Herbert or Kerins is what degree of physical injury is required for parasitic recovery of emotional distress damages for fear of disease without plaintiff meeting the strict requirements of Potter. Is a mere needle stick enough, as claimed by Tussy-Garber? Is some level of bodily harm, such as symptoms of disease or a positive test for HIV required, as Macy’s asserts?
“At the common law the duty to avoid the negligent infliction of mental or emotional distress on others was not generally actionable unless it was accompanied by a physical injury or was parasitic to a recognized cause of action.”
(Andalon
v.
Superior Court
(1984)
Crisci
v.
Security Ins. Co.
(1967)
By the time of
Merenda, supra,
Merenda
involved emotional distress damages for attorney malpractice. The complaint there alleged that attorney malpractice had caused plaintiff’s sexual assault claim to be discharged in bankruptcy. (
Precedent runs against recovery for emotional distress in connection with actions alleging economic damage, such as attorney malpractice actions. Precedent favors recovery, however, in medical malpractice cases and other cases involving personal injuries. (See
Bro
v.
Glaser
(1994)
Duarte
v.
Zachariah
(1994)
We agree with Duarte’s analysis of the requirements for personal injury as the terminology is used in Civil Code section 1708. Actual damage in the *755 sense of harm or detrimental change to the body is required. Unlike Duarte, however, we have occasion also to decide whether this is the meaning Potter intended in its discussion of parasitic recovery. 5
Potter’s discussion of parasitic recovery case law conveniently divides into two parts: (1) cases from other jurisdictions involving serious physical injuries, and (2) differing conclusions from other jurisdictions over whether impairment of the immune system response and cellular damage constitute “physical injury.”
(1) Serious Physical Injuries
Potter
noted that other jurisdictions have allowed parasitic recovery for fear of cancer in connection with serious physical injuries.
Potter
cited three examples: (a) a plaintiff who feared cancer after being negligently burned during X-ray treatments
(Ferrara
v.
Galluchio
(1958)
Although Potter did not specifically approve or adopt the reasoning of these cited authorities, its citation to these three cases strongly suggests agreement with the principle that emotional distress damages may be recovered in connection with serious physical injury.
(2) Impairment of the Immune System and Cellular Damage
Potter’s views about less visible injuries are not as clear. Potter concluded that it lacked “an appropriate factual record for resolving whether impairment to the immune response system or cellular damage constitutes a physical injury for which parasitic damages for emotional distress ought to be available.” (Potter, supra, 6 Cal.4th at pp. 984, fn. omitted.) Potter referred, however, to a split of authority from other jurisdictions over whether exposure to substances causing such injuries could support emotional distress damages. (Potter, supra, at pp. 982-983.)
The
Potter
plaintiffs had cited three toxic chemical decisions permitting proof of emotional distress damages, one involving chromosomal breakage
*756
and damage to the cardiovascular and immune system
(Werlein
v.
United States
(D.Minn. 1990)
The
Potter
defendants had cited asbestos exposure decisions, one finding that the pleural thickening and pleural plaques caused by asbestos fibers in the lungs did not constitute physical injury for purposes of parasitic emotional distress damages
(In re Hawaii Federal Asbestos Cases
(D. Hawaii 1990)
Although
Potter
made no attempt to reconcile these two lines of cases,
Duarte
suggested that the
Potter
plaintiffs’ cited cases could be distinguished from the asbestos cases on the ground that each of plaintiffs’ cases involved proof or allegations of harm to the immune system or other body system, whereas the experts considered pleural changes caused by asbestos fibers to be harmless.
(Duarte
v.
Zachariah, supra,
We need not resolve the issues of whether and when subcellular damage constitutes “harm.” Both the asbestos decisions and the toxic chemical decisions cited by Potter agreed that physical injury for purposes of parasitic emotional distress damages required actual harm. The question before us is whether a routine needle stick constitutes harm for purposes of parasitic damages. We conclude it does not. In a routine needle stick, harm, if it occurs, takes place when a hazardous foreign substance, introduced to the body through the needle, causes detrimental change to the body. Only if the plaintiff proves detrimental change to the body may he or she recover parasitic emotional distress damages. Without such proof, the plaintiff must satisfy Potter's more likely than not test.
Tussy-Garber directs our attention to opinions from other jurisdictions permitting emotional distress damages for fear of AIDS and asks us to distinguish fear of AIDS from fear of cancer, making
Potter
inapplicable.
*757
We see no reason to retill the ground plowed by
Kerins.
In its first incarnation, without benefit of
Potter, Kerins
rejected the approach of several other jurisdictions and followed
Faya
v.
Almaraz, supra,
Conclusion
The superior court denied summary adjudication because it found that Tussy-Garber was in the “area of physical risk” and it considered the needle stick a “physical impact” sufficient to allow recovery for foreseeable psychological reactions. As discussed above, the issue is not whether the plaintiff was in the area of physical risk or sustained a physical impact. For parasitic recovery of emotional distress damages, plaintiff must have sustained physical injury, meaning detrimental change to the body.
Macy’s had the burden of proof on its motion, which it satisfied by presenting evidence that Tussy-Garber never tested positive for HIV, had no contact with hepatitis A or C, and was not infected with hepatitis B, and that the chance of contracting HIV from a needle stick, assuming a contaminated needle, was 1 in approximately 200,000. Tussy-Garber disputed none of Macy’s evidence and presented no evidence of other physical harm caused by the needle stick. Based upon the evidence presented, Tussy-Garber could meet neither the Potter “more likely than not” test, nor the requirement of a physical injury for purposes of parasitic recovery of emotional distress damages. Only by applying the wrong legal standard could the court have denied Macy’s motion.
Let a peremptory writ of mandate issue directing the Solano County Superior Court to vacate its order denying summary adjudication and to *758 enter a new order granting Macy’s motion to bar recovery for emotional distress.
Corrigan, J., and Parrilli, J., concurred.
The petition of real parties in interest for review by the Supreme Court was denied April 18, 1996. Chin, J., did not participate therein. Mosk, J., was of the opinion that the petition should be granted.
Notes
We insert here an instructional footnote about AIDS and human immunodeficiency virus (HIV), one probably unnecessary for the contemporary reader. We optimistically anticipate a day when AIDS/HIV is nothing more than a historical footnote. “First isolated and identified by scientists in 1983, HIV is a retrovirus that attacks the human immune system. The virus invades host cells, notably certain lymphocytes, replicates itself, weakens the immune system, and ultimately destroys the body’s capacity to ward off disease. FU HIV’s presence is detected by a laboratory blood test for antibodies to the virus. The virus may reside latently in the body for periods as long as ten years or more, during which time the infected person will
*747
manifest no symptoms of illness and function normally. HIV typically spreads via genital fluids or blood transmitted from one person to another through sexual contact, the sharing of needles in intravenous drug use, blood transfusions, infiltration into wounds, or from mother to child during pregnancy or birth. [Citations.] [*]D AIDS, in turn, is the condition that eventually results from an immune system gravely impaired by HIV. . . . AIDS is invariably fatal.”
(Faya
v.
Almaraz
(1993)
Because negligent infliction of emotional distress is not an independent cause of action, a motion to strike or a motion
in limine
to exclude evidence pertaining to emotional distress damages
(Merenda
v.
Superior Court
(1992)
In its citations to precedents for recovery for emotional distress, the
Merenda
court mistakenly described
Crisci
as a case of “physical injuries and psychosis resulting from fall through opening.”
(Merenda, supra,
“Every person is bound, without contract, to abstain from injuring the person or property of another, or infringing upon any of his rights.” (Civ. Code, § 1708.)
Potter used the more restrictive term “physical injury” when discussing parasitic recovery. (Potter, supra, 6 Cal.4th at pp. 981-984.) If personal injury requires detrimental change to the body, it follows, a fortiori, that physical injury requires it too.
Tussy-Garber is correct that, as far as we know, AIDS is inevitably fatal, whereas cancer is not inevitably so and that HIV is less free in the environment than cancerous substances. However, Tussy-Garber’s suggestion that AIDS can be avoided without great effort is overly simplistic. If it means that one not infected in útero may effectively avoid negligent introduction of HIV by avoiding intimate contact, syringes and blood transfusions, it may be correct. If it implies that prophylactics never fail, sexual partners never dissemble and tainted blood never enters the blood supply, it is simply wrong.
