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                       SUPREME COURT OF THE UNITED STATES

                                    --------
                                   No. 96-320
                                    --------
                       METRO-NORTH COMMUTER RAILROAD COM-
                       PANY, PETITIONER v. MICHAEL BUCKLEY
                                        __


       ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE
                                 SECOND CIRCUIT

                                 [June 23, 1997]

  JUSTICE BREYER delivered the opinion of the Court.

  The basic question in this case is whether a railroad worker negligently
exposed to a carcinogen (here, asbestos) but without symptoms of any disease can
recover under the Federal Employers' Liability Act (FELA), 35 Stat. 65, as
amended, 45 U. S. C. S51 et seq., for negligently inflicted emotional distress. 
                         ________
We conclude that the worker before us here cannot recover unless, and until, he
manifests symptoms of a disease.  We also consider a related claim for medical
monitoring costs, and we hold, for reasons set out below, that the respondent in
this case has not shown that he is legally entitled to recover those costs.
                                        I

  Respondent, Michael Buckley, works as a pipefitter for Metro-North, a
railroad.  For three years (1985-1988) his job exposed him to asbestos for about
one hour per working day.  During that time Buckley would remove insulation from
pipes, often covering himself with insulation dust that contained asbestos. 
Since 1987, when he attended an "asbestos awareness" class, Buckley has feared
that he would develop cancer - and with some cause, for his two expert witnesses
testified that, even after taking account of his now-discarded 15-

                                96-320 - OPINION

2                    METRO-NORTH COMMUTER R. CO. v. BUCKLEY
                                                 __

year habit of smoking up to a pack of cigarettes per day, the exposure created
an added risk of death due to cancer, or to other asbestos-related diseases of
   _____
either 1% to 5% (in the view of one of plaintiff's experts), or 1% to 3% (in the
view of another).  Since 1989, Buckley has received periodic medical check-ups
for cancer and asbestosis. So far, those check-ups have not revealed any
evidence of cancer or any other asbestos-related disease.
  Buckley sued Metro-North under the FELA, a statute that permits a railroad
worker to recover for an "injury . . . resulting . . . from" his employer's
"negligence."  45 U. S. C. S51.  He sought damages for his emotional distress
and to cover the cost of future medical check-ups.  His employer conceded
negligence, but it did not concede that Buckley had actually suffered emotional
distress, and it argued that the FELA did not permit a worker like Buckley, who
had suffered no physical harm, to recover for injuries of either sort.  After
hearing Buckley's case, the District Court dismissed the action.  The court
found that Buckley did not "offer sufficient evidence to allow a jury to find
that he suffered a real emotional injury."  App. 623.  And, in any event,
Buckley suffered no "physical impact"; hence any emotional injury fell outside
the limited set of circumstances in which, according to this Court, the FELA
permits recovery.  Id., at 620; see Consolidated Rail Corporation v. Gottshall,
                   ____             _____________________________    __________
512 U. S. 532 (1994).  The District Court did not discuss Buckley's further
claim for the costs of medical monitoring.
  Buckley appealed, and the Second Circuit reversed.  79 F. 3d 1337 (1996). 
Buckley's evidence, it said, showed that his contact with the insulation dust
(containing asbestos) was "massive, lengthy, and tangible," id., at 1345, and
                                                            ____
that the contact "would cause fear in a reasonable person," id., at 1344.  Under
                                                            ____
these circumstances, the court held, the contact was what this Court in
Gottshall had called a "physical impact" - a "physical
_________

                                96-320 - OPINION

                     METRO-NORTH COMMUTER R. CO. v. BUCKLEY                    3
                                                 __

impact" that, when present, permits a FELA plaintiff to recover for accompanying
emotional distress.  The Second Circuit also found in certain of Buckley's work-
place statements sufficient expression of worry to permit sending his emotional
distress claim to a jury.  Finally, the court held that Buckley could recover
for the costs of medical check-ups because the FELA permits recovery of all
reasonably incurred extra medical monitoring costs whenever a "reasonable
physician would prescribe . . . a monitoring regime different than the one that
would have been prescribed in the absence of" a particular negligently caused
exposure to a toxic substance.  Id., at 1347 (internal quotation marks omitted).
                                ____
  We granted certiorari to review the Second Circuit's holdings in light of
Gottshall.
__________
                                       II
  The critical question before us in respect to Buckley's "emotional distress"
claim is whether the physical contact with insulation dust that accompanied his
emotional distress amounts to a "physical impact" as this Court used that term
in Gottshall.  In Gottshall, an emotional distress case, the Court interpreted
   _________      __________
the word "injury" in S1, FELA a provision that makes "[e]very common carrier by
railroad . . . liable in damages to any person suffering injury while . . .
employed" by the carrier if the "injury" results from carrier "negligence."  45
U. S. C. S51.  In doing so, it initially set forth several general legal
principles applicable here.  Gottshall described FELA's purposes as basically
                             _________
"humanitarian."  Gottshall, supra, at 542; see also, e.g., Urie v. Thompson, 337
                 _________________                   _____ ____    _________
U. S. 163 (1949).  It pointed out that the Act expressly abolishes or modifies a
host of common-law doctrines that previously had limited recovery.  See, e.g.,
                                                                         _____
45  U. S. C. SS51, 53, and 54.  It added that this Court has interpreted the
Act's language "liberally" in light of its humanitarian purposes.  Gottshall,
                                                                   __________
supra,
______

                                96-320 - OPINION

4                    METRO-NORTH COMMUTER R. CO. v. BUCKLEY
                                                 __

at 543.  But, at the same time, the Court noted that liability under the Act
rests upon "negligence" and that the Act does not make the railroad "`the
insurer'" for all employee injuries.  512 U. S., at 543 (quoting Ellis v. Union
                                                                 _____    _____
Pacific R. Co., 329 U. S. 649, 653 (1947)).  The Court stated that "common-law
_______________
principles," where not rejected in the text of the statute, "are entitled to
great weight" in interpreting the Act, and that those principles "play a
significant role" in determining whether, or when, an employee can recover
damages for "negligent infliction of emotional distress."  512 U. S., at 544. 
See also id., at 558 (SOUTER, J., concurring) (Court's duty "in interpreting
         ____
FELA . . . is to develop a federal common law of negligence . . . informed by
reference to the evolving common law"); Atchison, T. & S. F. R. Co. v. Buell,
                                        ___________________________    ______
480 U. S. 557 (1987).
  The Court also set forth several more specific legal propositions.  It
recognized that the common law of torts does not permit recovery for negligently
inflicted emotional distress unless the distress falls within certain specific
                             ______
categories that amount to recovery-permitting exceptions.  The law, for example,
does permit recovery for emotional distress where that distress accompanies a
physical injury, see, e.g., Simmons v. Pacor, Inc., 543 Pa. 664, 678, 674 A. 2d
                      _____ _______    ____________
232, 239 (1996); Restatement (Second) of Torts S924(a) (1977), and it often
permits recovery for distress suffered by a close relative who witnesses the
physical injury of a negligence victim, e.g., Dillon v. Legg, 68 Cal. 2d 728,
                                        _____ ______    _____
441 P. 2d 912 (1968); Gottshall, 512 U. S., at 549, n. 10 (citing cases).  The
                      __________
Court then held that FELA S1, mirroring the law of many States, sometimes
permitted recovery "for damages for negligent infliction of emotional distress,"
id., at 550, and, in particular, it does so where a plaintiff seeking such
____
damages satisfies the common law's "zone of danger" test.  It defined that test
by stating that the law permits "recovery for emotional injury" by 

                                96-320 - OPINION

                     METRO-NORTH COMMUTER R. CO. v. BUCKLEY                    5
                                                 __


   "those plaintiffs who sustain a physical impact as a result of a defendant's
                         _________________________
   negligent conduct, or who are placed in immediate risk of physical harm by
   that conduct."  Id., at 547-548, (emphasis added).
                   ____

  The case before us, as we have said, focuses on the italicized words "physical
impact."  The Second Circuit interpreted those words as including a simple
physical contact with a substance that might cause a disease at a future time,
so long as the contact was of a kind that would "cause fear in a reasonable
person."  79 F. 3d, at 1344.  In our view, however, the "physical impact" to
which Gottshall referred does not include a simple physical contact with a
      _________
substance that might cause a disease at a substantially later time - where that
substance, or related circumstance, threatens no harm other than that disease-
related risk.  
  First, Gottshall cited many state cases in support of its adoption of the
         _________
"zone of danger" test quoted above.  And in each case where recovery for
emotional distress was permitted, the case involved a threatened physical
contact that caused, or might have caused, immediate traumatic harm.  Keck v.
                                                                      ____
Jackson, 122 Ariz. 114, 593 P. 2d 668 (1979) (car accident); Towns v. Anderson,
________                                                     _____    _________
195 Colo. 517, 579 P. 2d 1163 (1978) (gas explosion); Robb v. Pennsylvania R.
                                                      ____    _______________
Co., 58 Del. 454, 210 A. 2d 709 (1965) (train struck car); Rickey v. Chicago
____                                                       ______    _______
Transit Authority, 98 Ill. 2d 546, 457 N. E. 2d 1 (1983) (clothing caught in
__________________
escalator choked victim); Shuamber v. Henderson, 579 N. E. 2d 452 (Ind. 1991)
                          ________    __________
(car accident); Watson v. Dilts, 116 Iowa 249, 89 N. W. 1068 (1902) (intruder
                ______    ______
assaulted plaintiff's husband); Stewart v. Arkansas Southern R. Co., 112 La.
                                _______    __________________________
764, 36 So. 676 (1904) (train accident); Purcell v. St. Paul City R. Co., 48
                                         _______    _____________________
Minn. 134, 50 N. W. 1034 (1892) (near streetcar collision); Bovsun v. Sanperi,
                                                            ______    ________
61 N. Y. 2d 219, 461 N. E. 2d 843 (1984) (car accident); Kimberly v. Howland,
                                                         ________    ________
143 N. C. 398, 55

                                96-320 - OPINION

6                    METRO-NORTH COMMUTER R. CO. v. BUCKLEY
                                                 __

S. E. 778 (1906) (rock from blasting crashed through plaintiffs' residence);
Simone v. Rhode Island Co., 28 R. I. 186, 66 A. 202 (1907) (streetcar
______    _________________
collision); Mack v. South-Bound R. Co., 52 S. C. 323, 29 S. E. 905 (1898) (train
            ____    ___________________
narrowly missed plaintiff); Gulf, C. & S. F. R. Co. v. Hayter, 93 Tex. 239, 54
                            _______________________    _______
S. W. 944 (1900) (train collision); Pankopf v. Hinkley, 141 Wis. 146, 123 N. W.
                                    _______    ________
625 (1909) (automobile struck carriage); Garrett v. New Berlin, 122 Wis. 2d 223,
                                         _______    ___________
362 N. W. 2d 137 (1985) (car accident).  Cf. Deutsch v. Shein, 597 S. W. 2d 141
                                             _______    ______
(Ky. 1980) (holding that exposure to x rays was "physical contact" supporting
recovery for emotional suffering where immediate physical harm to fetus was
suspected).
  Second, Gottshall's language, read in light of this precedent, seems similarly
          __________
limited.  Gottshall, 512 U. S., at 555 ("zone of danger test . . . is consistent
          __________
with FELA's central focus on physical perils"); id., at 556 (quoting Lancaster
                                                ____                 _________
v. Norfolk & Western R. Co., 773 F. 2d 807, 813 (CA7 1985), cert. denied, 480 U.
   _________________________
S. 945 (1987)) (FELA seeks to protect workers "`from physical invasions or
menaces'"); 512 U. S., at 556. (employer should be liable for "emotional injury
caused by the apprehension of physical impact"); id., at 547-548 (quoting
                                                 ____
Pearson, Liability to Bystanders for Negligently Inflicted Emotional Harm - A
Comment on the Nature of Arbitrary Rules, 34 U. Fla. L. Rev. 477, 488-489)
(1982) ("`[T]hose within the zone of danger of physical impact' " should be able
to "`recover for fright' " because "`a near miss may be as frightening as a
direct hit'").
  Taken together, language and cited precedent indicate that the words "physical
impact" do not encompass every form of "physical contact."  And, in particular,
they do not include a contact that amounts to no more than an exposure - an
exposure, such as that before us, to a substance that poses some future risk of
disease and which contact causes emotional distress only because the worker
learns that he may become ill after a substantial

                                96-320 - OPINION

                     METRO-NORTH COMMUTER R. CO. v. BUCKLEY                    7
                                                 __

period of time.
  Third, common-law precedent does not favor the plaintiff.  Common law courts
do permit a plaintiff who suffers from a disease to recover for related
negligently caused emotional distress, see supra at 4, and some courts permit a
                                           _____
plaintiff who exhibits a physical symptom of exposure to recover, see, e.g.,
                                                                       _____
Herber v. Johns-Manville Corp., 785 F. 2d 79, 85 (CA3 1986); Mauro v. Owens-
______    _____________________                              ______   ______
Corning Fiberglas Corp., 225 N. J. Super. 196, 542 A. 2d 16 (App. Div. 1988). 
________________________
But with only a few exceptions, common law courts have denied recovery to those
who, like Buckley, are disease and symptom free.  E.g., Burns v. Jacquays Mining
                                                  ___________    _______________
Corp., 156 Ariz. 375, 752 P. 2d 28 (Ct. App. 1987), review dism'd, 162 Ariz.
______
186, 781 P. 2d 1373 (1989); Mergenthaler v. Asbestos Corp. of Am., 480 A. 2d 647
                            ____________    ______________________
(Del. 1984); Eagle-Picher Industries, Inc. v. Cox, 481 So. 2d 517 (Fla. App.
             _____________________________    ____
1985), review den., 492 So. 2d 1331 (Fla. 1986); Capital Holding Corp. v.
                                                 _____________________
Bailey, 873 S. W. 2d 187 (Ky. 1994); Payton v. Abbott Labs, 386 Mass. 540, 437
_______                              _______   ____________
N. E. 2d 171 (1982); Simmons  v. Pacor, Inc., 543 Pa. 664, 674 A. 2d 232 (1996);
                     ________    ____________
Ball v. Joy Technologies, Inc., 958 F. 2d 36 (CA4 1991); Deleski v. Raymark
____    _______________________                          _______    _______
Industries, Inc., 819 F. 2d 377 (CA3 1987) (Pennsylvania and New Jersey law);
_________________
Adams v. Johns-Manville Sales Corp., 783 F. 2d 589 (CA5 1986) (Louisiana law);
_____    ___________________________
Wisniewski v. Johns-Manville Corp., 759 F. 2d 271 (CA3 1985) (Pennsylvania law);
__________    _____________________
In re Hawaii Federal Asbestos Cases, 734 F. Supp. 1563 (Haw. 1990) (Hawaii law);
____________________________________
Amendola v. Kansas City So. R. Co., 699 F. Supp. 1401 (WD Mo. 1988) (FELA); see
________    ________________________
also Potter v. Firestone Tire & Rubber Co., 6 Cal. 4th 965, 863 P. 2d 795 (1993)
     ______    _____________________________
(in banc) (no recovery for fear of cancer in a negligence action unless
plaintiff is "more likely than not" to develop cancer).
  Fourth, the general policy reasons to which Gottshall referred - in its
                                              _________
explanation of why common law courts have restricted recovery for emotional harm
to cases

                                96-320 - OPINION

8                    METRO-NORTH COMMUTER R. CO. v. BUCKLEY
                                                 __

falling within rather narrowly defined categories - militate against an
expansive definition of "physical impact" here.  Those reasons include: (a)
special "difficult[y] for judges and juries" in separating valid, important
claims from those that are invalid or "trivial," Gottshall, 512 U. S., at 557;
                                                 __________
(b) a threat of "unlimited and unpredictable liability," ibid.; and (c) the
                                                         ______
"potential for a flood" of comparatively unimportant, or "trivial," claims,
ibid.
_____
  To separate meritorious and important claims from invalid or trivial claims
does not seem easier here than in other cases in which a plaintiff might seek
recovery for typical negligently caused emotional distress.  The facts before us
illustrate the problem.  The District Court, when concluding that Buckley had
failed to present "sufficient evidence to allow a jury to find . . . a real
emotional injury," pointed out that, apart from Buckley's own testimony, there
was virtually no evidence of distress.  App. 623-625.  Indeed, Buckley continued
to work with insulating material "even though . . . he could have transferred"
elsewhere, he "continued to smoke cigarettes" despite doctors' warnings, and his
doctor did not refer him "either to a psychologist or to a social worker."  Id.,
                                                                            ____
at 624.  The Court of Appeals reversed because it found certain objective
corroborating evidence, namely "workers' complaints to supervisors and investi-
gative bodies."  79 F. 3d, at 1346.  Both kinds of "objective" evidence - the
confirming and disconfirming evidence - seem only indirectly related to the
question at issue, the existence and seriousness of Buckley's claimed emotional
distress.  Yet, given the difficulty of separating valid from invalid emotional
injury claims, the evidence before us may typify the kind of evidence to which
parties and the courts would have to look.
  The Court in Gottshall made a similar point:
               _________
   "[T]esting for the `genuineness' of an injury alone . . . . would be bound to
   lead to haphazard results. 

                                96-320 - OPINION

                     METRO-NORTH COMMUTER R. CO. v. BUCKLEY                    9
                                                 __

   Judges would be forced to make highly subjective determinations concerning
   the authenticity of claims for emotional injury, which are far less
   susceptible to objective medical proof than are their physical counterparts. 
   To the extent the genuineness test could limit potential liability, it could
   do so only inconsistently."  Gottshall, supra, at 552.
                                _________________

And JUSTICE GINSBURG, too, in her dissenting opinion, seems to recognize this
problem, for she would limit recovery in emotional injury cases to those who can
show more objective evidence than simply having expressed fear and concern to
supervisors.  See post, at 2.
                  _____
  More important, the physical contact at issue here - a simple (though
extensive) contact with a carcinogenic substance - does not seem to offer much
help in separating valid from invalid emotional distress claims.  That is
because contacts, even extensive contacts, with serious carcinogens are common. 
See e.g., Nicholson, Perkel & Selikoff, Occupational Exposure to Asbestos:
    _____
Population at Risk and Projected Mortality - 1980-2030, 3 Am. J. Indust. Med.
259 (1982) (estimating that 21 million Americans have been exposed to work-
related asbestos); U. S. Dept. of Health and Human Services, 1 Seventh Annual
Report on Carcinogens 71 (1994) (3 million workers exposed to benzene, a
majority of Americans exposed outside the workplace); Pirkle, et al., Exposure
of the U S Population to Environmental Tobacco Smoke, 275 JAMA 1233, 1237 (1996)
(reporting that 43% of U. S. children lived in a home with at least one smoker,
and 37% of adult nonsmokers lived in a home with at least one smoker or reported
environmental tobacco smoke at work).  They may occur without causing serious
emotional distress, but sometimes they do cause distress, and reasonably so, for
cancer is both an unusually threatening and unusually frightening disease.  See
Statistical Abstract of United States 94 (1996) (23.5

                                96-320 - OPINION

10                   METRO-NORTH COMMUTER R. CO. v. BUCKLEY
                                                 __

percent of Americans who died in 1994 died of cancer); American Cancer Society,
Cancer Facts & Figures - 1997, p. 1 (half of all men and one third of all women
will develop cancer).  The relevant problem, however, remains one of evaluating
a claimed emotional reaction to an increased risk of dying.  An external circum-
                                   _________
stance - exposure - makes some emotional distress more likely.  But how can one
determine from the external circumstance of exposure whether, or when, a claimed
strong emotional reaction to an increased mortality risk (say from 23% to 28%)
                                _________
is reasonable and genuine, rather than overstated - particularly when the
relevant statistics themselves are controversial and uncertain (as is usually
the case), and particularly since neither those exposed nor judges or juries are
experts in statistics?  The evaluation problem seems a serious one.
  The large number of those exposed and the uncertainties that may surround
recovery also suggest what Gottshall called the problem of "unlimited and
                           _________
unpredictable liability."  Does such liability mean, for example, that the costs
associated with a rule of liability would become so great that, given the nature
of the harm, it would seem unreasonable to require the public to pay the higher
prices that may result?  Cf. Priest, The Current Insurance Crisis and Modern
Tort Law, 96 Yale L. J. 1521, 1585-1587 (1987).  The same characteristics
further suggest what Gottshall called the problem of a "flood" of cases that, if
                     _________
not "trivial," are comparatively less important.  In a world of limited
resources, would a rule permitting immediate large-scale recoveries for wide-
spread emotional distress caused by fear of future disease diminish the
likelihood of recovery by those who later suffer from the disease?  Cf. J.
Weinstein, Individual Justice in Mass Tort Litigation 10-11, 141 (1995); Schuck,
The Worst Should Go First: Deferral Registries in Asbestos Litigation, 15 Harv.
J. L. & Pub. Pol'y 541 (1992).

                                96-320 - OPINION

                     METRO-NORTH COMMUTER R. CO. v. BUCKLEY                   11
                                                 __

  We do not raise these questions to answer them (for we do not have the
answers), but rather to show that general policy concerns of a kind that have
led common law courts to deny recovery for certain classes of negligently caused
harms are present in this case as well.  That being so, we cannot find in
Gottshall's underlying rationale any basis for departing from Gottshall's
__________                                                    __________
language and precedent or from the current common-law consensus.  That is to
say, we cannot find in Gottshall's language, cited precedent, other common law-
                       __________
precedent, or related concerns of policy, a legal basis for adopting the
emotional-distress recovery rule adopted by the Court of Appeals.
  Buckley raises several important arguments in reply.  He points out, for
example, that common law courts do permit recovery for emotional distress where
a plaintiff has physical symptoms; and he argues that his evidence of exposure
and enhanced mortality risk is as strong a proof as an accompanying physical
symptom that his emotional distress is genuine.
  This argument, however, while important, overlooks the fact that the common
law in this area does not examine the genuineness of emotional harm case by
case.  Rather, it has developed recovery-permitting categories the contours of
which more distantly reflect this, and other, abstract general policy concerns. 
The point of such categorization is to deny courts the authority to undertake a
case by case examination.  The common law permits emotional-distress recovery
for that category of plaintiffs who suffer from a disease (or exhibit a physical
symptom), for example, thereby finding a special effort to evaluate emotional
symptoms warranted in that category of cases - perhaps from a desire to make a
physically injured victim whole or because the parties are likely to be in court
in any event.  In other cases, however, falling outside the special recovery-
permitting categories, it has reached a

                                96-320 - OPINION

12                   METRO-NORTH COMMUTER R. CO. v. BUCKLEY
                                                 __

different conclusion.  The relevant question here concerns the validity of a
rule that seeks to redefine such a category.  It would not be easy to redefine
"physical impact" in terms of a rule that turned on, say, the "massive, lengthy,
[or] tangible" nature of a contact that amounted to an exposure, whether to
contaminated water, or to germ-laden air, or to carcinogen-containing
substances, such as insulation dust containing asbestos.  But, in any event, for
the reasons we have stated, supra, at 5-11, we cannot find that the common law
                            ______
has done so.
  Buckley also points to a series of common-law cases that he believes offer him
support.  Many of these cases, however, find that the plaintiff at issue fell
within a category where the law already permitted recovery for emotional
distress.  E.g., Marchica v. Long Island R. Co., 31 F. 3d 1197 (CA2 1994)
           _____ ________    ___________________
(traumatic injury); Clark v. Taylor, 710 F. 2d 4 (CA1 1983) (intentional
                    _____    ________
infliction of harm); Laxton v. Orkin Exterminating Co., 639 S. W. 2d 431,
                     ______    ________________________
433-434 (Tenn. 1982) (nuisance claim); Lavelle v. Owens-Corning Fiberglas Corp.,
                                       _______    ______________________________
30 Ohio Misc. 2d 11, 507 N. E. 2d 476 (Ct. Common Pleas, Cayahoga Cty. 1987)
(emotional distress damages sought by asbestosis-afflicted plaintiff).  We have
found only three asbestos-related cases, all involving state law, that support
Buckley directly.  Watkins v. Fibreboard Corp., 994 F. 2d 253, 259 (CA5 1993)
                   _______    _________________
(Texas law) (recognizing cause of action for emotional distress based on
exposures to asbestos in the absence of physical symptoms); In re Moorenovich,
                                                            __________________
634 F. Supp. 634 (Me. 1986) (Maine law) (same); Gerardi v. Nuclear Utility
                                                _______    _______________
Services, Inc., 149 Misc. 2d 657, 566 N. Y. S. 2d 1002 (Westchester Cty. 1991)
_______________
(same).  None of them was decided by the highest court of the relevant State. 
And we do not find that minority view a sufficient basis for reaching Buckley's
proposed conclusion.
  Finally, Buckley argues that the "humanitarian"

                                96-320 - OPINION

                     METRO-NORTH COMMUTER R. CO. v. BUCKLEY                   13
                                                 __

nature of the FELA warrants a holding in his favor.  We do not doubt that, the
FELA's purpose militates in favor of recovery for a serious and negligently
caused emotional harm.  Cf. Gottshall, 512 U. S., at 550.  But just as courts
                            __________
must interpret that law to take proper account of the harms suffered by a
sympathetic individual plaintiff, so they must consider the general impact, on
workers as well as employers, of the general liability rules they would thereby
create.  Here the relevant question concerns not simply recovery in an
individual case, but the consequences and effects of a rule of law that would
                                                     _________ ______________
permit that recovery.  And if the common law concludes that a legal rule
_____________________
permitting recovery here, from a tort law perspective, and despite benefits in
some individual cases, would on balance cause more harm than good, and if we
____
find that judgment reasonable, we cannot find that conclusion inconsistent with
the FELA's humanitarian purpose.
                                       III
  Buckley also sought recovery for a different kind of "injury," namely the
economic cost of the extra medical check-ups that he expects to incur as a
result of his exposure to asbestos-laden insulation dust.  The District Court,
when it dismissed the action, did not discuss this aspect of Buckley's case. 
But the Second Circuit, when reversing the District Court, held that "a
reasonable jury could award" Buckley the "costs" of "medical monitoring" in this
case.  79 F. 3d, at 1347.  We agreed to decide whether the court correctly found
that the FELA permitted a plaintiff without symptoms or disease to recover this
economic loss.
  The parties do not dispute - and we assume - that an exposed plaintiff can
recover related reasonable medical monitoring costs if and when he develops
symptoms.  As the Second Circuit pointed out, a plaintiff injured through
negligence can recover related reasonable

                                96-320 - OPINION

14                   METRO-NORTH COMMUTER R. CO. v. BUCKLEY
                                                 __

medical expenses as an element of damages.  79 F. 3d, at 1347 (citing C.
McCormick, Law of Damages S90 (1935)); see also Restatement (Second) of Torts
S924(c) (1977); J. Stein, Stein on Personal Injury Damages S5.18 (2d ed. 1991). 
No one has argued that any different principle would apply in the case of a
plaintiff whose "injury" consists of a disease, a symptom, or those sorts of
emotional distress that fall within the FELA's definition of "injury."  See Part
II, supra.  Much of the Second Circuit's opinion suggests it intended only to
    _____
apply this basic principle of the law of damages.  See, e.g., 79 F. 3d, at 1342
                                                        _____
("[T]his case turns upon whether . . . emotional harm . . . is an injury
compensable under FELA"); id., at  1347 (monitoring costs are a "traditional
                          ____
element of tort damages").  Insofar as that is so, Part II of our opinion,
holding that the emotional distress at issue here is not a compensable "injury,"
requires reversal on this point as well.
  Other portions of the Second Circuit's opinion, however, indicate that it may
have rested this portion of its decision upon a broader ground, namely that
medical monitoring costs  themselves represent a separate negligently caused
economic "injury," 45 U. S. C. S51, for which a negligently exposed FELA
plaintiff (including a plaintiff without disease or symptoms) may recover to the
extent that the medical monitoring costs that a reasonable physician would
prescribe for the plaintiff exceed the medical monitoring costs that "would have
been prescribed in the absence of [the] exposure."  79 F. 3d, at 1347 (citation
omitted).  This portion of the opinion, when viewed in light of Buckley's
straightforward claim for an "amount of money" sufficient to "compensate" him
for "future medical monitoring expenses," Plaintiff's Proposed Charges to the
Jury 25, Record, Doc. 33, suggests the existence of an ordinary, but separate,
tort law cause of action permitting (as tort law ordinarily permits) the
recovery of medical cost

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                     METRO-NORTH COMMUTER R. CO. v. BUCKLEY                   15
                                                 __

damages in the form of a lump sum, see Stein, supra, at SS5.1 and 5.18, and
                                              ______
irrespective of insurance, Restatement (Second) of Torts S920A(2) (1977).  As so
characterized, the Second Circuit's holding, in our view, went beyond the bounds
of currently "evolving common law."  Gottshall, supra, at 558 (SOUTER, J.,
                                     _________________
concurring).
  Guided by the parties' briefs, we have canvassed the state-law cases that have
considered whether the negligent causation of this kind of harm (i.e., causing a
                                                                 _____
plaintiff, through negligent exposure to a toxic substance, to incur medical
monitoring costs) by itself constitutes a sufficient basis for a tort recovery. 
We have found no other FELA decisions.  We have put to the side several cases
that involve special recovery-permitting circumstances, such as the presence of
a traumatic physical impact, or the presence of a physical symptom, which for
reasons explained in Part II are important but beside the point here. See, e.g.,
                                                                           _____
Friends for All Children, Inc. v. Lockheed Aircraft Corp., 746 F. 2d 816,
______________________________    ________________________
824-825 (CADC 1984) (traumatic impact); Hagerty v. L & L Marine Services, Inc.,
                                        _______    ____________________________
788 F. 2d 315, modified, 797 F. 2d 256 (CA5 1986) (same); Simmons v. Pacor,
                                                          _______    ______
Inc., 543 Pa. 664, 674 A. 2d 232 (1996) (physical symptom).  We have noted that
_____
federal courts, interpreting state law, have come to different conclusions about
the matter.  Compare, e.g., In re Paoli R. Yard PCB Litigation, 916 F. 2d 829
                      _____ ___________________________________
(CA3 1990) (Pennsylvania law) with Ball v. Joy Technologies, Inc., 958 F. 2d 36
                                   ____    _______________________
(CA 4 1991) (West Virginia and Virginia law).  And we have ended up focusing on
several important State Supreme Court cases that have permitted recovery.  Ayers
                                                                           _____
v. Jackson, 106 N. J. 557, 525 A. 2d 287 (1987); Hansen v. Mountain Fuel Supply
   ________                                      ______    ____________________
Co., 858 P. 2d 970 (Utah 1993); Potter, v. Firestone Tire & Rubber Co., 6 Cal.
____                            _______    ____________________________
4th 965, 863 P. 2d 795 (1993); see also Burns v. Jacquays Mining Corp., 156
                                        _____    ______________________
Ariz. 375, 752 P. 2d 28 (Ct. App. 1987).
  We find it sufficient to note, for present purposes, that

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16                   METRO-NORTH COMMUTER R. CO. v. BUCKLEY
                                                 __

the cases authorizing recovery for medical monitoring in the absence of physical
injury do not endorse a full-blown, traditional tort law cause of action for
lump-sum damages - of the sort that the Court of Appeals seems to have endorsed
here.  Rather, those courts, while recognizing that medical monitoring costs can
amount to a harm that justifies a tort remedy, have suggested, or imposed,
special limitations on that remedy.  Compare Ayers, supra, at 608, 525 A. 2d, at
                                             _____________
314 (recommending in future cases creation of "a court-supervised fund to
administer medical-surveillance payments"); Hansen, supra, at 982 (suggesting
                                            _______
insurance mechanism or court-supervised fund as proper remedy); Potter, supra,
                                                                ______________
1010, n. 28, 863 P. 2d, at 825, n. 28 (suggesting that a lump-sum damages award
would be inappropriate); Burns, supra, 381, 752 P. 2d, at 34 (holding that lump-
                         _____________
sum damages are not appropriate) with, e.g., Honeycutt v. Walden, 294 Ark. 440,
                                       _____ _________    _______
743 S. W. 2d 809 (1988) (damages award for future medical expenses made
necessary by physical injury are awarded as lump-sum payment); Rice v. Hill, 315
                                                               ____    _____
Pa. 166, 172 A. 289 (1934) (same); and Restatement (Second) of Torts S920A(2)
(1977) (ordinarily fact that plaintiff is insured is irrelevant to amount of
tort recovery).  Cf. Weinstein, Individual Justice in Mass. Tort Litigation, at
154.  We believe that the note of caution, the limitations, and the expressed
uneasiness with a traditional lump-sum damages remedy are important, for they
suggest a judicial recognition of some of the policy concerns that have been
pointed out to us here - concerns of a sort that Gottshall identified.
                                                 _________
  Since, for example, the particular, say cancer-related, costs at issue are the
extra monitoring costs, over and above those otherwise recommended, their
_____
identification will sometimes pose special "difficult[ies] for judges and
juries."  Gottshall, 512 U. S., at 557.  Those difficulties in part can reflect
          __________
uncertainty among medical professionals about just which tests are most usefully
adminis-

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                     METRO-NORTH COMMUTER R. CO. v. BUCKLEY                   17
                                                 __

tered and when.  Cf. Report of U. S. Preventive Services Task Force, Guide to
Clinical Preventive Services xxvii, xxx-xxxi, xlvii-xcii (2d ed. 1996).  And in
part those difficulties can reflect the fact that scientists will not always see
a medical need to provide systematic scientific answers to the relevant legal
                                     __________                         _____
question, namely whether an exposure calls for extra monitoring.  Cf. App. 182
                                               _____
(testimony by Buckley's expert conceding that periodic colon cancer screening
"is recommended by the American Cancer Society anyway"); id., at 164 (testimony
                                                         ____
by Buckley's expert declining to rule out that periodic chest x rays would
likely benefit smokers such as Buckley, even in the absence of asbestos
exposure).  Buckley's sole expert, then, was equivocal about the need for extra
                                                                          _____
monitoring, and the defense had not yet put on its case.
  Moreover, tens of millions of individuals may have suffered exposure to
substances that might justify some form of substance-exposure-related medical
monitoring.  See supra, at 9.  (The dissent limits its class of potential
                 ______
plaintiffs to employees suing their employers, see post, at 11, but other
                                                   _____
exposed individuals who satisfy the Paoli test, see post, at 6-7, could sue - at
                                    _____           ______
common law.)  And that fact, along with uncertainty as to the amount of
liability, could threaten both a "flood" of less important cases (potentially
absorbing resources better left available to those more seriously harmed, see
supra, at 10) and the systemic harms that can accompany "unlimited and
_____
unpredictable liability" (say, for example, vast testing liability adversely
affecting the allocation of scarce medical resources).  The dissent assumes that
medical monitoring is not a "costly" remedy, see post, at 8 (internal quotation
                                                 _____
marks omitted).  But Buckley here sought damages worth $950 annually for 36
years; by comparison, of all claims settled by the Center for Claims Resolution,
a group representing asbestos manufacturers, from 1988 until 1993, the average

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18                   METRO-NORTH COMMUTER R. CO. v. BUCKLEY
                                                 __

settlement for plaintiffs injured by asbestos was about $12,500, and the
                          _______
settlement for non-malignant plaintiffs among this group averaged $8,810.  See
App. in No. 96-270, Amchem Products, Inc. v. Windsor, p. 578.
                    _____________________    ________
  Finally, a traditional, full-blown ordinary tort liability rule would ignore
the presence of existing alternative sources of payment, thereby leaving a court
uncertain about how much of the potentially large recoveries would pay for
otherwise unavailable medical testing and how much would accrue to plaintiffs
for whom employers or other sources (say, insurance now or in the future) might
provide monitoring in any event.  Cf. 29 CFR  S1910.1001(l) (1996) (requiring
employers to provide medical monitoring for workers exposed to asbestos).  The
Occupational Safety and Health Administration regulations (which the dissent
cites) help to demonstrate why the Second Circuit erred: where state and federal
regulations already provide the relief that a plaintiff seeks, creating a full-
blown tort remedy could entail systemic costs without corresponding benefits. 
Nor could an employer necessarily protect itself by offering monitoring, see
post, at 11, for that is not part of the rule of law that the dissent would
_____
endorse - a rule that, if traditional, would, as we have noted, allow recovery
irrespective of the presence of a "collateral source" of payment.  See post, at
                                                                       _____
5-6.
  We do not deny important competing considerations - of a kind that may have
led some courts to provide a form of liability.  Buckley argues, for example,
that it is inequitable to place the economic burden of such care on the
negligently exposed plaintiff rather than on the negligent defendant.  See,
e.g., Ayers, supra, at 603-606, 525 A. 2d, at 311-312;  Potter, supra, at
_____ _____________                                     ______________
1007-1009, 863, P. 2d, at 824.  He points out that providing preventive care to
individuals who would otherwise go without can help to mitigate potentially
serious future health effects of diseases by detecting

                                96-320 - OPINION

                     METRO-NORTH COMMUTER R. CO. v. BUCKLEY                   19
                                                 __

them in early stages; again, whether or not this is such a situation, we may
assume that such situations occur.  And he adds that, despite scientific
uncertainties, the difficulty of separating justified from unjustified claims
may be less serious than where emotional distress is the harm at issue.  See
also Ayers v. Jackson, 106 N. J. 557, 525 A. 2d 287 (1987); Potter v. Firestone
     _____    ________                                      ______    _________
Tire & Rubber Co., 6 Cal. 4th 965, 863 P. 2d 795 (1993).  
__________________
  We do not deny that the dissent paints a sympathetic picture of Buckley and
his co-workers; this picture has force because Buckley is sympathetic and he has
                                                       __                    ___
suffered wrong at the hands of a negligent employer.  But we are more troubled
than is the dissent by the potential systemic effects of creating a new, full-
blown, tort law cause of action - for example, the effects upon interests of
other potential plaintiffs who are not before the court and who depend on a tort
system that can distinguish between reliable and serious claims on the one hand,
and unreliable and relatively trivial claims on the other.  See supra, at 13. 
                                                                ______
The reality is that competing interests are at stake - and those interests some-
times can be reconciled in ways other than simply through the creation of a
full-blown, traditional, tort law cause of action.  Cf. post, at 11.
                                                        _____
  We have not tried to balance these, or other, competing considerations here. 
We point them out to help explain why we consider the limitations and cautions
to be important - and integral - parts of the state-court decisions that permit
asymptomatic plaintiffs a separate tort claim for medical monitoring costs. 
That being so, we do not find sufficient support in the common law for the
unqualified rule of lump-sum damages recovery that is, at least arguably, before
us here.  And given the mix of competing general policy considerations,
plaintiff's policy-based arguments do not convince us that the FELA contains a
tort liability rule of that unqualified kind.
                            ___________

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20                   METRO-NORTH COMMUTER R. CO. v. BUCKLEY
                                                 __

  This limited conclusion disposes of the matter before us.  We need not, and do
not, express any view here about the extent to which the FELA might, or might
not, accommodate medical cost recovery rules more finely tailored than the rule
we have considered.
                                       IV
  For the reasons stated, we reverse the determination of the Second Circuit,
and we remand the case for further proceedings consistent with this opinion.

                                                               It is so ordered.
                                                               _________________