This case arises from a wrongful death action brought by the plaintiffs/appellants, the parents of a deceased minor child. The suit alleges that the defendant/appellee, Dr. Klein, was guilty of medical malprac
The child was born on August 19, 1968, with a congenital heart defect later diagnosed as ventricular septal defect. In 1978 the parents were first advised that the child should undergo surgery to cоrrect the problem. The parents decided not to go forward at that time with the recommended surgery but to wait until the child was older. One of the secondary benefits of such surgery would have been a significant decrease in the risk of contracting serious internal infeсtions including bacterial endocarditis, the infection from which the child suffered at the time of her death.
It is alleged that the defendant was guilty of medical malpractice during the period of time immediately prior to the child’s death, from June 27, 1983, through June 29, 1983, the day before hеr death. On June 21, 1983, the child developed a fever which prompted appellants to seek medical attention. On June 23, 1983, she was examined by Dr. Klein’s partner, Dr. Stewart, since Dr. Klein was away from the office that week. Dr. Stewart found that the child had an inflamed ear and prescribed penicillin. The next morning, she complained that her ear still hurt, and Mrs. Shively called the doctors’ office for ear drops.
Although the fever lessened on June 25, it increased again on the evening of June 26. The following morning Mrs. Shively called Dr. Klein and informed him that the сhild still had a fever and her condition had not improved. Dr. Klein ordered a blood count, in the hope of detecting an infection. He did not, however, order a blood culture.
On June 28, Mrs. Shively brought the child to see Dr. Klein. Dr. Klein felt there still was a problem with the child’s ear and sent her to the lab for lab work and an x-ray. On June 29, Mrs. Shively brought the child in for another examination. Dr. Klein determined that her condition had deteriorated, and he now suspected she had pneumonia and a urinary tract infection. He informed Mrs. Shively that the child should go to the hospitаl. The child was then admitted to the hospital, where it was soon determined she was critically ill. On June 30, she died from a rare condition known as bacterial endocarditis. Appellants allege that the failure of the defendant during the period immediately preceding hеr hospitalization to diagnose and treat the bacterial endocarditis with massive quantities of antibiotics led to the grave illness and death of their child.
After the trial the jury returned a verdict for the defendant. Appellants then submitted a motion for judgment notwithstanding the verdict аnd a motion for a new trial, both of which were denied by the Superior Court.
In this appeal, the appellants contend that: (1) evidence which might be construed as indicating “contributory negligence” on their part was erroneously admitted and resulted in reversible errоr; (2) a “loss of chance” instruction should have been included in the jury charge; (3) an improper statement of the law made by defendant’s counsel constituted prejudicial conduct and reversible error; (4) the verdict was against the great weight of the evidence; and (5) the denial of judgment notwithstanding the verdict was error since accepting evidence in the light most favorable to the defendant, reasonable minds could only find in favor of the plaintiffs. All of appellants’ arguments were addressed by the Superior Court in its opinion denying judgmеnt notwithstanding the verdict and a new trial.
Shively v. Klein,
Super.Ct., No. 84C-JL-112, Poppiti, J. (Aug. 28,1987) (Order) [available on WEST-LAW,
I.
Appellants’ first contention, that evidence of their “contributory negligence”
II.
Appellants’ second contention is that the Superior Court erred in failing to give a specific “loss of chance” instruction as part of the charge to the jury. Under the usual negligence rule, a plaintiff must prove that the doctor’s inadequate treatment was the proximate cause of the patient’s injury or death. 10
Del.C.
§ 3722(a); 18
Del.C.
§ 6853;
Laskowski v. Wallis,
Del.Supr.,
Recently, however, in the limited area of medical malpractice, when the failure of a doctor to provide the required standard of care is shown to have increased the risk of harm to a patient, a principle sometimes referred to as the “loss of a chаnce doctrine” has been adopted in some states. This loss of a chance doctrine, based on the standard articulated in Restatement (Second) of Torts § 323 (1965), 2 has developed in part because of the difficulty in the medical malpractice area of proving precise degrees of causation, and in part because of the perceived unfairness in denying recovery when a doctor’s negligence, although not shown to be the probable cause of the patient’s malady or death, significantly decreased the patiеnt’s chance of recovery.
Courts have applied the loss of chance principle in a variety of ways. Some courts have used the doctrine to relax the causation standard from probable cause to a substantial cause. These cоurts permit a plaintiff to recover full compensation for injury or death when, although the patient had a less than 50 percent chance of recovery from his illness, the doctor’s negligent treatment is found to be a substantial factor in his failure to recover.
See, e.g., Aasheim v. Humberger,
Mont.Supr.,
Although appellants’ pleading did not mention the loss of chance doctrine, at the conference on jury instructions which took place during the trial the appellants submitted a proposed instruction which applied the doctrinе. The proposed instruction stated that if the jury found that the defendant’s negligence “proximately caused a reduction in the [child’s] chance of survival” at any time prior to her death, the “loss of chance is, in and of itself, compensable.” The proposеd charge would have shifted the cause of action from a death action to a reduction in the chance to live action. The appellants’ instruction cited only the case of
Herskovits v. Group Health Cooperative of Puget Sound,
Dеlaware law requires that negligence be pleaded with particularity. Super.Ct. Civ.R. 9(b). The right to amend a pleading lies within the sound discretion of the trial judge, and this Court will reverse the ruling of the trial judge only if he has abused his discretion.
Laird v. Buckley,
Del. Supr.,
While we do not here rule out entirely the possible applicability of the doctrine in an appropriate case in Delaware, we note that it is important that any such innovative theory of negligence be pleaded with particularity and taken up at the pretrial conference so that the opposing side has the appropriate knowledge of the issue and the court has a chance to consider it before trial.
Chesapeake & Potomac Tel. v. Chesapeake Util.,
Del.Supr.,
In this instance the loss of chance doctrine was not mentioned in the original pleading. The appellants did not move to amend the pleading when the trial commenced. It was only at the jury instruction conference that the appellants asked to have this new doctrine put before the jury. The circumstances under which testimony was elicited by the appellants concerning the loss of chance of survival do not indicate that the issue was tried by implied consent.
See Laird v. Buckley,
III.
Appellants also contend that a statement made by the defense in closing arguments which suggested that the jurors сould rely on their own experience in the medical community with reference to the standard of care applicable in this case constituted reversible error. Appellants are required to show that the trial court abused its discretion in not granting a new trial or judgment notwithstanding the verdict due to this misstatement, and that such a misstatement was significantly prejudicial so as to deny them a fair trial.
Eustice v. Rupert,
Del.Supr.,
IV.
Finally, appellants contend that the Superior Court erred in refusing to grant either a new trial because the verdict was against the weight of the evidence or judgment notwithstanding the verdiсt because the verdict was not supported by the evidence. A motion for a new trial based on the weight of evidence is granted only when the verdict is manifestly and palpably against the weight of the evidence.
Id.
at 510. In this case, expert witnesses offered cоnflicting opinions. Both opinions were supported by substantial evidence; therefore, the jury was free to accept the testimony of either medical expert.
See DiSabatino v. Wortman,
Del.Supr.,
******
This Court rules that the decisions of the Superior Court are correct and its judgment is AFFIRMED.
Notes
. At the close of the plaintiffs’ case, the claim alleging malpractice on the part of Dr. Stewart was dismissed. The plaintiffs were permitted to amend their сomplaint to name Dr. Stewart as a defendant because he practices medicine in a partnership with Dr. Klein. It is in this capacity that Dr. Stewart is a party to this proceeding.
. Section 323 of the Restatement provides, in relevant part, that:
One who undertakes ... to render services to another which he should recognize as necessary for the protection of the other's person ... is subject to liability ... for physical harm resulting from his failure to exercise reasonable care to perform his undertaking, if
(a) his failure to exercise such are increases the risk of such harm....
Restatement (Second) of Torts § 323(a), at 135 (1965).
