The question presented by the motion to strike filed by the defendant, Yale-New Haven Hospital, is one of first impression. Essentially, the issue is whether the facts alleged by the plaintiffs, Carolyn Witt and Thomas Witt, which detail their lost opportunity to potentially conceive a child together, support claims of either negligent or intentional infliction of emotional distress. More specifically, the plaintiffs allege that the Yale Fertility Center at the defendant hospital discarded Carolyn Witt’s ovarian tissue, which had been cryogenically frozen and stored for the purpose of using the tissue to allow the Witts to
I
FACTS
The operative complaint alleges the following facts. In 1997, Carolyn Witt was diagnosed with breast cancer, which was to be treated with chemotherapy. Because infertility was a likely side effect of the chemotherapy, the plaintiffs, who are married with no children, were referred to the Yale Fertility Center. On the recommendation of the defendant, and anticipating medical advances that would make a future pregnancy possible, the Witts agreed to allow the defendant to remove ovarian tissue from Carolyn Witt and to store it in the defendant’s cryopreservation facility in December, 1997.
In May, 2004, the Witts became aware of a woman in New York who had given birth to a child after having had her ovarian tissue removed and frozen. Upon learning of this woman’s successful pregnancy, the plaintiffs contacted the defendant to discuss the procedure for using Carolyn Witt’s frozen ovarian tissue to conceive a child. On June 16, 2004, the plaintiffs next spoke with an employee of the defendant, who told them that Carolyn Witt’s ovarian tissue had been discarded. The import of this news had a devastating effect on the plaintiffs’ respective emotional states, as, according to the revised amended complaint, Carolyn Witt suffered sleep disturbances, nightmares, headaches, inability to concentrate, depression, post-traumatic stress disorder, severe and extreme emotional distress, a diminished capacity or loss to engage in and enjoy many of life’s activities, and Thomas Witt suffered severe and extreme emotional distress.
This action was subsequently commenced by summons served on the defendant on June 19, 2006, and the complaint was last revised on December 24, 2007. The defendant filed its motion to strike on March 6, 2008, which was supported by a memorandum of law. The plaintiffs were granted an extension of time to reply and filed their objection on June 5, 2008, which was also supported by a memorandum of law. During argument at short calendar on June 10, 2008, the court offered the parties an opportunity to submit additional briefs due to the novelty of the issues presented and the corresponding dearth of relevant case law; both parties filed supplemental briefs on July 10, 2008.
II
DISCUSSION
Before addressing the merits of the defendant’s motion, the court sets forth the applicable standard of review.
1
As noted previously, this is a case of first impression, and, consequently, there is a dearth of case law examining the issues raised by this particular fact pattern.
Thus, before assessing whether the requisite facts have been pleaded to support the alleged causes of action, the court is first obliged to resolve several questions of law that have not previously been considered by Connecticut courts. See
Gordon
v.
Bridgeport Housing
Authority,
A
Counts One and Three: Negligent Infliction of Emotional Distress
Mindful of these legal considerations, the court now considers in turn whether Carolyn Witt and Thomas Witt have respectively pleaded the facts necessary to support a claim of negligent infliction of emotional distress. In connection with these two counts, the defendant argues that the plaintiffs cannot make out negligent infliction of emotional distress claims because the emotional injury alleged was not foreseeable. In this respect, the defendant argues that because the plaintiffs knew that there was only a possibility that technology would develop enough to offer the potential to conceive a child together, it was not foreseeable that losing that possibility would cause emotional injury. Additionally, the defendant argues that the cases relied on by the plaintiffs to support a holding that such injury is foreseeable are not relevant because they involve the loss of fertilized eggs rather than ovarian tissue alone. The defendant’s final argument is limited to Thomas Witt’s claim of negligent infliction of emotional distress: the defendant posits that it does not owe a duty of care to Thomas Witt because he was not a patient and has not pleaded the facts necessary to support a claim of bystander negligent infliction of emotional distress.
The plaintiffs argue that the emotional injury alleged was foreseeable because the defendant created and fostered the very hope that it dashed by discarding Carolyn Witt’s ovarian tissue. Moreover, the plaintiffs contend that the case law they offer to support their foreseeability argument is directly on point, as those cases involve the same lost opportunity to conceive a child that is at issue in this case. Finally, the plaintiffs argue that the court should recognize a duty of care owed to Thomas Witt by the defendant due to the unique emotional investment that both parents commonly make in ART procedures. In view of these arguments, the court now turns to the guideposts informing negligent infliction of emotional distress claims and their foreseeability requirement.
In
Montinieri
v.
Southern New England Telephone Co.,
In considering these elements, it bears emphasis that the primary focus for a court is on the question of foreseeability and not on the physical manifestation of the emotional injury. See
Perodeau
v.
Hartford,
In this case, the plaintiffs allege that the defendant was providing reproductive technology services to them with the full knowledge that the frozen ovarian tissue it had harvested and stored was their only hope of one day conceiving a child together. Although the plaintiffs acknowledge that their chances of a future pregnancy depended on the development of anticipated new technologies, they nevertheless claim that they experienced severe emotional distress as a result of the anxiety created by the lost opportunity to ever utilize such technology in the future. Thus, as a threshold matter, the court must now resolve the question as to whether the anxiety or fear attendant upon the loss of an opportunity to use anticipated future technology to potentially conceive a child is sufficiently foreseeable to support a claim of negligent infliction of emotional distress.
Not only has this issue not yet been decided by a Connecticut court, but there is little case law nationwide to provide meaningful guidance. Those courts that
have evaluated claims in analogous situations have held that the emotional harm attending the deprivation of the “opportunity of experiencing pregnancy, prenatal bonding, and the birth of a child” is foreseeable. See, e.g.,
Perry-Rogers
v.
Obasaju,
282 App. Div. 2d 231, 231-32,
These cases are also significant because New York, like Connecticut, does not require a physical injury as an element for negligent infliction of emotional distress, which other jurisdictions do. Compare
Montinieri
v.
Southern New England Telephone Co.,
supra,
Moreover, the legal academy has also documented the significant emotional stress that routinely accompanies ART procedures, further buttressing the viewpoint that reasonable health care professionals are aware of the heightened potential for emotional distress that negligence can cause in these cases. See, e.g., T. Feliciano,
“Davis
v.
Davis:
What about Future Disputes?” 26 Conn. L. Rev. 305, 308-309 (1993) (ART experience “emotionally draining for both prospective parents. Clinics report that couples attempting [in vitro fertilization] often show an abnormal attachment to the embryos, sometimes even naming them, and experience deep depression if successful implantation does not occur”); I. Heide, “Negligence in the Creation of Healthy Babies: Negligent Infliction of Emotional Distress in Cases of Alternative Reproductive Technology Malpractice Without Physical Injury,” 9 J. Med. & L. 55, 70-72 (2005) (noting that because “[t]he ART treatment process makes patients very vulnerable, in many ways more so than patients of traditional medical interventions . . . many doctors have begun to include mental health counseling and personnel as part of the regular services provided to ART patients”). Thus, these articles further support the position that it was reasonable for
the defendant in this case to appreciate that the plaintiffs’ lost opportunity to use developing technologies to conceive a child together
The plaintiffs’ very actions, as pleaded in their complaint, also manifest a clear emotional investment in the procedures recommended to them by the defendant, which would be reasonably apparent to any ART provider. Indeed, in view of the Witts’ decision in this case to bear the emotional, physical and financial expense of harvesting and freezing the ovarian tissue—a decision based on the defendant’s very own recommendation—it should have been reasonably apparent to the defendant that the plaintiffs harbored a significant emotional investment in the potential for a future pregnancy. Moreover, the scholarly articles from the legal academy referenced previously further suggest that an ART practitioner would reasonably be aware of both the heightened emotional distress that commonly attends these procedures and the special attachment that parents typically maintain for this type of unique genetic material. 3 See, e.g., T. Feliciano, supra, 26 Conn. L. Rev. 308-309; I. Heide, supra, 9 J. Med. & L. 70-72.
It is additionally noteworthy that the plaintiffs’ hope in this case that medical technology would eventually develop to support a realistic chance for future pregnancy was also reasonable. Indeed, the Witts’ hope was created by the defendant, which, “anticipating medical advances,” recommended that the plaintiffs harvest and freeze Carolyn Witt’s ovarian tissue in this first instance. It is logical to infer, after all, that the defendant would not recommend an invasive procedure, such as harvesting ovarian tissue, if there was not a reasonable likelihood that such a procedure might well serve as the first step in conceiving a child.
4
As noted by the court in
Del Zio,
“if the experiment indisputably
The court believes it was reasonable for the defendant to appreciate that the level of fear or anxiety created by the loss of the only opportunity to potentially conceive a child with one’s spouse could likely result in emotional distress severe enough that it might result in illness or bodily harm. Regardless of the likelihood of success, the lost opportunity to even attempt utilization of anticipated technologies at all can lead to understandable fear or anxiety, which is especially so in this case in which the recommendation and plan—indeed, the hope—was created by the defendant, and the consequence of the defendant’s alleged action is to foreclose the potential for the plaintiffs to ever conceive a child together. Accordingly, the court concludes that it was reasonably foreseeable for the defendant to appreciate that its discarding the ovarian tissue could result in the type of overwhelming anxiety sufficient to cause illness or bodily harm.
In view of the foregoing, the court concludes that Carolyn Witt has pleaded facts sufficient to state a claim of negligent infliction of emotional distress in count one of the plaintiffs’ complaint. The defendant created an unreasonable risk of causing emotional distress when it foreclosed the plaintiffs’ only opportunity to potentially conceive a child together by discarding Carolyn Witt’s ovarian tissue. This risk was foreseeable both because the defendant created the hope that the successful harvesting and freezing of ovarian tissue could one day allow for a pregnancy to occur and because it is reasonable for ART practitioners to be aware of the heightened emotional stress that ART patients are under. Indeed, the anxiety the plaintiffs experienced as a result of the lost ovarian tissue was so predictably severe that the defendant should have known that it could reasonably lead to illness or physical injury. Finally, the plaintiffs have alleged that the defendant’s conduct caused this anxiety, and, in the case of Carolyn Witt, that anxiety led to the physical manifestations of emotional illness, including sleep disturbances, nightmares, headaches, inability to concentrate and depression. Consequently, the court denies the defendant’s motion to strike count one of the plaintiffs’ complaint, alleging negligent infliction of emotional distress against Carolyn Witt.
Having already decided that it was reasonably foreseeable for the defendant to appreciate that the loss of ovarian tissue could result in the type of overwhelming anxiety sufficient to cause illness or bodily harm,
5
the court now turns its attention to the relevant public policy considerations implicated in this case as it relates
to Thomas Witt. Our Supreme Court has previously articulated “four factors to be considered in determining the extent of a legal duty as a matter of policy: (1) the normal expectations of the participants in the activity under review; (2) the public policy of encouraging continued vigorous participation in the activity, while protecting the safety of the participants; (3) the avoidance of increased litigation; and (4) the decisions of other jurisdictions.”
Perodeau
v.
Hartford,
supra,
Turning to the first guidepost, the normal expectations of the participants in the activity under review, the court views the relationship between parents and ART
It is therefore significant that in Connecticut, morticians appear to owe a duty of care to the immediate family members of a decedent. See
Del Core
v.
Mohican Historic Housing Associates,
Accordingly, the court concludes that the parties in this case entered into a similar relationship—one predicated on the special relationship forged between a professional and emotionally vulnerable clients who rely on the practitioner’s care to navigate emotionally charged human experiences. In such a relationship, both parties reasonably expect that the practitioner will exercise care in mitigating the potential for conduct that would foreseeably result in an even greater emotional injury than the circumstances that brought them to the practitioner’s office in the first place. To this end, it would be reasonable for the aspiring parents to be notified of developments impacting their reproductive tissue and to be consulted before their ART provider took affirmative steps affecting the potential for the couple to conceive a child together in the future. 8 Thus, the court concludes that the first inquiry of the duty guideposts is satisfied.
In connection with the public policy considerations of encouraging continued vigorous participation in the activity, while contemporaneously protecting the safety of the participants, the court believes that recognition of an ART practitioner’s duty to both participating parents strikes the appropriate balance. As wall be further explained, because there is a limited number of potential litigants, i.e., the parents seeking ART treatment, it is unlikely that recognition of this duty will significantly increase litigation in this area or increase the potential for double recovery. At the same time, ensuring that ART practitioners are accountable to the couples they assist for the emotional injury that would foreseeably result from their negligence is likely to ensure greater diligence and further increase patients’ confidence in their ART provider. Greater practitioner accountability, coupled with increased patient confidence, is likely to help ensure robust participation in ART clinics. Thus, recognition of this duty raises little fear that such a duty wall “impose an added economic burden upon society”; (internal quotation marks omitted)
Mendillo
v.
Board of Education,
Moreover, in reflecting on the second and third guideposts of this duty analysis, the court notes the dual benefits realized by ensuring that the actual victims of ART
Turning to the third factor, ensuring that such a duty does not overly increase the potential for litigation, the court is satisfied that the potential is remote because the pool of potential litigants is inherently limited. It is noted at the outset that this cause of action is usefully distinguished from claims involving secondary victims of negligence. The aspiring parents are the primary victims in a case such as this, and the defendant’s reliance on third party liability precedent is, therefore, misplaced. Moreover, this situation also stands in contradistinction to cases in which a defendant’s liability is extended to a potentially unlimited number of third parties because there is a natural boundary of just two claims arising out of a tortious AET transaction, which is not true in most third party liability cases. 9 For this reason, the concerns regarding the restrictions placed on recovery in the bystander line of cases are not relevant both because this case does not involve a secondary victim and because there is a limited universe of potential claimants.
In this respect,
Janicki
v.
Hospital of St. Raphael,
The court next inquires whether the cases of other jurisdictions recognize a duty owed by an ART practitioner to both parents engaging their services. Although no jurisdiction has previously resolved this issue directly, New York has previously held that both parents advanced cognizable emotional distress claims. See, e.g.,
Del Zio
v.
The Presbyterian Hospital,
supra,
The only other cases seemingly on point are less helpful for a variety of reasons. Illustratively, the claims asserted in
Perry-Rogers
v.
Obasaju,
supra, 282 App. Div. 2d 231, appear to have been brought by the mother alone, thus obviating the need for that court to examine the ART provider’s duty to the father. Similarly, the court in
Frisina
v.
Women & Infants Hospital of Rhode Island,
supra,
In view of this analysis, the court concludes that the defendant in this case owed a duty of care directly to Thomas Witt because recognition of that duty conforms to the parties’ expectations, encourages future utilization of ART procedures by society without being likely to result in increased litigation or other societal costs and enjoys support from other jurisdictions to have considered this issue.
Consequently, the court denies the defendant’s motion to strike count three, alleging negligent infliction of emotional distress against Thomas Witt, as the allegations contained in the operative complaint give rise to a duty owed by the defendant to Thomas Witt. Moreover, for the reasons further elucidated previously, it was foreseeable that the defendant’s conduct in this regard would result in the type of severe anxiety that could result in physical injury or illness, and Thomas Witt alleges that this conduct was the cause of that anxiety. Thomas Witt has, therefore, alleged the elements necessary to set forth a claim of negligent infliction of emotional distress.
B
Counts Two and Four: Intentional Infliction of Emotional Distress
The court next addresses the defendant’s motion to strike count two, claiming intentional infliction of emotional distress by Carolyn Witt, and count four, claiming intentional infliction of emotional distress by Thomas Witt. In claims for intentional infliction of emotional distress, a plaintiff must establish four elements. “It must be shown: (1) that the actor intended to inflict emotional distress or that he knew or should have known that emotional distress was the likely result of his conduct; (2) that the conduct was extreme and outrageous; (3) that the defendant’s conduct was the cause of the plaintiffs distress; and (4) that the emotional distress sustained by the plaintiff was severe. . . . Whether a defendant’s conduct is sufficient to satisfy the requirement that it be extreme and outrageous is
initially a question for the court to determine.” (Citation omitted; internal quotation marks omitted.)
Appleton
v.
Board of Education,
In this case, the plaintiffs allege that the defendant knew or should have known that its having unilaterally discarded Carolyn Witt’s ovarian tissue was likely to cause the plaintiffs severe emotional distress, including destroying any hope they had of potentially conceiving a child together. For the reasons articulated in part II A, the court concludes that as a matter of law, the defendant’s conduct was foreseeable, and that, consequently, the defendant should have known that emotional distress was indeed the likely result of its actions. Accordingly, the plaintiffs have satisfied the first criterion for a claim for intentional infliction of emotional distress, namely, that the actor intended to inflict emotional distress or that it knew or should have known that emotional distress was the likely result of its conduct. See id.
Although no Connecticut case addresses this issue, the
Del Zio
court found that a jury could conclude that the disposal of pre-embryos, done without prior notice or an opportunity to consider other alternatives, could support the “kind of deliberate, shocking and reckless conduct” necessary to ground a claim for intentional infliction of emotional distress.
Del Zio
v.
The Presbyterian Hospital,
supra,
Turning to the third criterion, whether the defendant’s conduct was the cause of the plaintiffs’ distress, the court concludes that this requirement, too, has been satisfied. Both plaintiffs pleaded that their emotional distress began after learning that Carolyn Witt’s ovarian tissue had been discarded, which supports their assertion that the defendant’s conduct was the cause of their emotional distress.
With respect to the fourth criterion, the court concludes that Carolyn Witt has alleged the facts necessary to support her claim that her emotional distress was severe, but that Thomas Witt has not. Although Carolyn Witt alleges that she suffered sleep disturbances, nightmares,
Ill
CONCLUSION
For the reasons set forth previously, the court denies the defendant’s motion to strike as to count one (negligent infliction of emotional distress by Carolyn Witt), count two (intentional infliction of emotional distress by Carolyn Witt), and count three (negligent infliction of emotional distress by Thomas Witt). The court, however, grants the defendant’s motion to strike count four (intentional infliction of emotional distress by Thomas Witt).
Notes
The court notes as a threshold matter that this is an ordinary negligence case and does not sound in medical malpractice. “[T]he relevant considerations in determining whether a claim sounds in medical malpractice are whether (1) the defendants are sued in their capacities as medical professionals, (2) the alleged negligence is of a specialized medical nature that arises out of the medical professional-patient relationship, and (3) the alleged negligence is substantially related to medical diagnosis or treatment and involved the exercise of medical judgment.” (Internal quotation marks omitted.)
Dimmock
v.
Lawrence & Memorial Hospital, Inc.,
Additionally instructive is that courts have further explained that “[t]he rule of law that distinguishes between medical malpractice and ordinary
negligence requires a determination of whether the injury alleged occurred during treatment because of a negligent act or omission that was substantially related to treatment.”
Trimel
v.
Lawrence & Memorial Hospital Rehabilitation Center,
In this case, it is alleged that the defendant discarded ovarian tissue that was supposed to remain cryogenically stored; no medical treatment or procedure was occurring at the time. Thus, although the defendant is sued in its capacity as a medical care provider, the alleged negligence at issue did not require professional judgment or the performance of any particular medical skill. Accordingly, because the claims in this case stem from the disposal of tissue that should not have been discarded—an act that is tantamount to poor record keeping and which does not require any medical expertise—the court concludes that the standards governing ordinary negligence apply.
In this respect, it is also noteworthy that Connecticut law distinguishes general negligence claims that result in a derivative emotional injury caused by witnessing or receiving a physical injury on the one hand from negligent infliction of emotional distress, which does not require proof of either an ensuing physical injury or a risk of harm from physical impact, on the other. Compare
Bushnell
v. Bushnell,
As will be further discussed, this distinction is important not only in terms of properly assessing the elements to be pleaded, but also because ART cases from other jurisdictions that are seemingly analogous to the improper disposal of ovarian tissue at issue here shed their persuasive value due to requirements in those jurisdictions of an accompanying physical injury.
In its supplemental brief, the defendant draws a distinction between an embryo and ovarian tissue, arguing that “the wrongful disposal of preembiyos is of a fundamentally different nature and magnitude than the foreseeability of emotional distress arising from the disposal of ovarian tissue that requires ‘medical advances’ in order to ‘make pregnancy a possibility.’ ” Unlike ovarian tissue, embryos are commonly defined as fertilized eggs resulting from insemination. See, e.g., J. Robertson, “In the Beginning: The Legal Status of Early Embryos,” 76 Va. L. Rev. 437, 441-43 (1990) (discussing biological status of early embyros); see also
Kass
v.
Kass,
Although this argument merits attention, after careful consideration, the court concludes that it is misplaced in this context. The question here is not what legal rights ovarian tissue, embryos, previability fetuses or postviability fetuses enjoy in their own right, but rather what type of emotional injury is foreseeable for parents to incur as a result of the defendant’s discarding the ovarian tissue, reproductive material which, according to the complaint, resulted in the Witts losing the potential to conceive a child together at some point in the future.
And in this respect,
Del Zio
v.
The Presbyterian Hospital,
supra,
These same two factual predicates are also present in this case, and these considerations are equally compelling in determining the foreseeability issue before this court. The court, therefore, concludes that ART cases involving the lost opportunity to ever potentially conceive a child are analogous to the facts of this case and are particularly so when they involve developing technologies. Accordingly, the court views these cases as persuasive.
The defendant argues that it is not reasonably foreseeable for it to have comprehended the emotional distress that could result from its discarding the plaintiffs ovarian tissue, as no pregnancy could be guaranteed in the first place. This argument, however, confuses the loss of a pregnancy itself with the loss of an opportunity to potentially become pregnant, and thereby experience pregnancy, prenatal bonding and the birth of a child. As in Perry-Rogers and in Del Zio, it is the loss of the opportunity potentially to become pregnant rather than the loss of an actual fetus that caused the emotional distress.
It is noted that the type of severe anxiety that the court found likely to result in illness or physical injury in the case of Carolyn Witt is equally likely in the case of Thomas Witt. Indeed, the emotional distress claims sustained in Del Zio were advanced by both parents. Moreover, as discussed previously, the ART experience is “emotionally draining for both prospective parents.” T. Feliciano, supra, 26 Conn. L. Rev. 308. That both potential parents who are desirous of conceiving a child together predictably suffer severe anxiety capable of resulting in ipjury is not surprising, given the unique nature of the experience.
And while the ovarian tissue in this case had not yet been fertilized by Thomas Witt, the loss of that tissue has prevented him from conceiving a child with his wife as much as if the defendant had discarded the plaintiffs’ embryos. Consequently, the court concludes that the defendant’s conduct in eliminating any chance that Thomas Witt had in conceiving a child with his wife was as likely to foreseeably result in Thomas Witt’s emotional distress as in the case of Carolyn Witt for the reasons discussed previously.
By way of example, just as “[tjhere is a cognizable and compensable interest ... in the comfort of knowing that the deceased has been given a comfortable and dignified resting place” (internal quotation marks omitted);
Del Core
v.
Mohican Historic Housing Associates,
A majority of other jurisdictions to consider this issue have likewise held that a mortician owes a duty of care to the immediate family members of a decedent. See, e.g.,
Nagle
v.
Riverview Cemetery Co.,
This court, of course, is adjudicating only the specific claims alleged in this case, and this is not intended to be an exclusive enumeration of the duties that an ART practitioner owes to the parent-patient it counsels and treats. Obviously, the contours of the duty owed will be more fully defined as different cases with different facts and allegations are adjudicated.
It is sufficient for the purposes of this case, however, to note that the duty of care owed by an ART practitioner to its parent-patients is broadly analogous to the duty a mortician owes to the immediate family members of a deceased. At a minimum, this includes mitigating the potential for conduct that would foreseeably result in an even greater emotional ir\jury than the circumstances that brought them to the practitioner’s office in the first place by notifying or consulting with the parent-patients of developments or decisions that affect their ability to conceive a child together.
In this respect, the duty owed by an ART practitioner to both participating parents is limited in the same manner as a spousal consortium claim. See
Mendillo
v.
Board of Education,
supra,
It is noted that
Jeter
v.
Mayo Clinic Arizona,
supra,
In this case, the court does not purport to recognize a new cause of action but instead looks to the duty a mortician owes to the family members of a decedent to inform its understanding of whether a similar duty is owed in the context of an emotional distress claim by an ART practitioner to a couple seeking fertility treatment. Moreover, that court did not examine the duty issue at all. Accordingly, the court does not find this case to be persuasive with respect to the nature of the duty presented here.
