Case Title: McMullen v. Ohio State Univ. Hosp.

Citation: 2000-Ohio-342

Docket Number: 19982358

State: ohio

Court: Ohio Supreme Court

Date: 2000-04-12T00:00:00Z

Document:
[Cite as McMullen v. Ohio State Univ. Hosp., 88 Ohio St.3d 332, 2000-Ohio-342.] 
 
 
 
 
 
MCMULLEN,  EXR., APPELLANT, v. OHIO STATE UNIVERSITY HOSPITALS, APPELLEE. 
[Cite as McMullen v. Ohio State Univ. Hosp. (2000), 88 Ohio St.3d 332.] 
Torts — Wrongful death action against hospital — Applicability of loss-of-chance 
doctrine where plaintiff proves a direct causal relationship between 
decedent’s death and a specific negligent act. 
(No. 98-2358 — Submitted September 21, 1999 — Decided April 12, 2000.) 
APPEAL from the Court of Appeals for Franklin County, Nos. 97API10-1301 and 
97API10-1324. 
 
Georgia G. McMullen died on October 21, 1990, at the age of thirty-nine 
years.  She was survived by her husband, a son, a daughter, and her mother.  
Following her death, her husband, who had been appointed executor of the estate by 
the Probate Court of Lawrence County, filed a wrongful death action in the Court of 
Claims naming Ohio State University Hospitals as defendant. 
 
The Court of Claims bifurcated the trial, separating the issues of liability and 
damages.  Following trial on the issue of liability, the court, acting as factfinder, 
found the following to have been proven by a preponderance of the evidence. 
 
McMullen was diagnosed in late 1989 or early 1990 with acute myelogenous 
leukemia.  She was given chemotherapy, and in July 1990, when the cancer was in 
remission, McMullen received an allogenic bone marrow transplant from her sister 
 
 
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at OSU Hospitals.  McMullen thereafter moved into a Columbus apartment for 
continued outpatient treatment. 
 
In September 1990, McMullen was readmitted to OSU Hospitals with high 
fevers and a possible viral infection.  Her condition gradually worsened. 
 
In an effort to treat McMullen’s breathing problems, hospital personnel 
administered an eighty-percent concentration of oxygen through an oxygen mask, 
but she continued to experience fluid buildup in her lungs and shortness of breath.  
An OSU resident physician recommended an elective intubation, in which an 
endotracheal tube (“ET tube”) would be inserted through her mouth and throat and 
attached to a ventilator, as the only way to maintain her oxygenation level.  The 
resident further told McMullen that her overall prognosis was poor.  She consented 
to the use of a ventilator, and on October 11, the procedure was performed. 
 
On October 14, 1990, events occurred that the Court of Claims ultimately 
found to constitute a breach of the standard of care due McMullen by OSU Hospitals 
personnel.  In its written findings of fact and conclusions of law on the issue of 
liability, the court described these October 14 events as follows. 
 
The attending nurse testified that McMullen’s overall physical appearance, 
including her facial expression, changed quickly and dramatically.  She heard a 
“squawking noise” or “cuff leak” coming from McMullen’s ET tube and noticed 
that McMullen’s oxygen saturation level had dropped to a critical level. 
 
 
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When a second nurse arrived in response to her call for help, the nurses 
disconnected McMullen from the ventilator and began using an “ambubag” in an 
attempt to force a one-hundred-percent concentration of oxygen through her ET tube 
and into her lungs.  McMullen was cyanotic and dyspneic.  When the oxygen 
saturation level of McMullen’s blood did not increase, they decided to remove the 
ET tube.  The nurses believed McMullen was dying.  However, they chose to utilize 
a “stat” page to call for assistance from the physicians on duty, instead of calling a 
“Code Blue,” during this life-threatening emergency situation. 
 
Two doctors, including a resident in anesthesiology, arrived in response to the 
page and prepared to reintubate McMullen.  Despite their efforts, it took the doctors 
several attempts, including at least six separate attempts by the anesthesiologist, 
before they were able to successfully reintubate McMullen.  Their reintubation 
attempts took in excess of twenty minutes.  McMullen did not regain consciousness.  
She remained on the ventilator until her death seven days later on October 21, 1990. 
 
Based on these facts, the Court of Claims concluded that “the preponderance 
of the evidence in this case supports plaintiff[‘s] experts’ opinion that defendant’s 
nurses breached the standard of care by removing Mrs. McMullen’s ET tube without 
an order from a physician and without the means to immediately re-intubate Mrs. 
McMullen.”  The court further found that the anesthesiologist’s “actions fell below 
the standard of care expected of a third-year resident in anesthesiology when it took 
 
 
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her six or more attempts to re-intubate Mrs. McMullen.  This delay in re-intubation 
deprived Mrs. McMullen of proper oxygenation for over twenty minutes.  The delay 
further caused Mrs. McMullen’s oxygen saturation level in her blood to fall to a low 
of twenty-nine percent.  An oxygen saturation level of twenty-nine percent is 
inconsistent with life and subsequently caused irreversible damage to Mrs. 
McMullen’s brain, lungs, and heart.” 
 
The court then turned to consider the decision in Roberts v. Ohio Permanente 
Med. Group, Inc. (1996), 76 Ohio St.3d 483, 668 N.E.2d 480, decided after the first 
phase of the trial, which dealt with claims for the loss of a less-than-even chance of 
recovery or survival.  Based on Roberts, the court believed that “the sole remaining 
issues in the liability phase of this case are whether those deviations proximately 
caused Mrs. McMullen’s death or proximately caused her to lose any chance of 
survival.”  In its findings at the end of the liability phase of the trial, the court 
summarized the conflicting expert testimony presented by both the plaintiff and the 
defendant as follows: 
 
“On the issue of the proximate cause of Mrs. McMullen’s death, plaintif[f] 
offered the expert testimony of Gerald Penn, M.D., Ph.D., who opined that an 
immediate cause of Mrs. McMullen’s death ‘ * * * was a combination of diffuse 
alveolar damage of the lungs associated with a mass of ischemic damage to the 
heart, pancreas, adrenals, brain and, most likely, the gastrointestinal tract.’  Dr. Penn 
 
 
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further testified that the anoxic or hypoxic episode on October 14, 1990, was a direct 
cause of all of these underlying causes of Mrs. McMullen’s death.  Finally, Dr. Penn 
testified that prior to the events on the morning of October 14, 1990, there was a 
‘high probability’ that Mrs. McMullen would survive and leave the hospital.  
Accordingly the court can infer that in Dr. Penn’s opinion, after the events of 
October 14, 1990, Mrs. McMullen had a diminished chance of surviving to leave the 
hospital. 
 
“Defendant, on the other hand, provided the court with substantial expert 
medical testimony, all of which essentially maintained that Mrs. McMullen would 
never have survived to be taken off the ventilator and leave the hospital, regardless 
of the actions of its nurses and resident doctors.  Dr. Neena Kapoor, Mrs. 
McMullen’s attending physician and a bone marrow transplant specialist, testified 
that prior to October 14, 1990, Mrs. McMullen’s chances of survival were less than 
fifty percent.  Likewise, Dr. Wilmer testified that given her overall condition, Mrs. 
McMullen’s prognosis was ‘quite poor.’  In addition, Dr. Roland Skeel, an 
oncologist, opined that Mrs. McMullen would have died within thirty days, 
notwithstanding the events of October 14, 1990.” 
 
Based on this evidence, the court concluded:  “Upon review of all the expert 
testimony, the court finds that prior to the events of October 14, 1990, Mrs. 
McMullen had a chance of surviving to leave the hospital.  However, after the 
 
 
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negligent medical treatment provided by defendant’s critical care nurses and Dr. 
Campbell on October 14, 1990, Mrs. McMullen’s chance of survival decreased to 
zero.  Accordingly, the court shall render judgment in favor of plaintif[f].  
Nevertheless, the court specifically leaves open for the damages phase of this trial 
the percentage of the chance of survival that Mrs. McMullen lost as a result of 
defendant’s agents’ negligence.” 
 
Thereafter, the court conducted a trial on the issue of damages and determined 
that damages flowing from McMullen’s death totaled $1 million.  The court further 
found that plaintiff had “proven by a preponderance of the evidence that the 
decedent had a twenty-five percent chance of survival” prior to the events of 
October 14.  The court, applying the second paragraph of the syllabus of Roberts, 
then multiplied the total damages of $1 million by the twenty-five percent lost 
chance of survival and arrived at a preliminary award of damages in the amount of 
$250,000. 
 
The court further held that the $250,000 preliminary award was subject to 
reduction pursuant to R.C. 3345.40(B)(2) for collateral benefits received by the 
survivors, and ordered the case transferred to the Probate Court of Lawrence County 
for allocation of damages among the survivors and application of setoffs, pursuant to 
the procedures prescribed in Van Der Veer v. Ohio Dept. of Transp. (1996), 113 
Ohio App.3d 60, 680 N.E.2d 230. 
 
 
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The probate court allocated $245,000 of the award to Ruth Blackburn Gibson, 
the decedent’s mother.  The remaining $5,000 was allocated to McMullen’s husband 
and two children, but was deemed wholly offset by collateral insurance recoveries 
by these members of McMullen’s immediate family.  Upon transfer of the case back 
to the Court of Claims, the court adopted the findings of the probate court and 
rendered final judgment for the executor in the amount of $245,000. 
 
Both the executor and the hospital appealed, although there was no challenge 
to the finding of the Court of Claims that OSU Hospitals employees had breached 
their standards of care in treating the decedent on the morning of October 14, 1990. 
 
In the court of appeals, the executor claimed that the trial court had erred in 
applying the Roberts loss-of-chance doctrine to the case and in reducing the full 
amount of $1 million damages.  According to the executor, the loss-of-chance 
doctrine should not be applied to reduce damages in a case where the plaintiff 
proves that the negligence of defendant was the direct and sole cause of the ultimate 
harm. 
 
The hospital did not contest the Court of Claims’ application of Roberts but 
asserted (1) that the Court of Claims’ determination that McMullen had lost a 
twenty-five-percent chance of survival was against the manifest weight of the 
evidence, (2) that the Court of Claims had erred in referring the allocation of 
damages and application of setoffs to the Lawrence County Probate Court, and (3) 
 
 
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that the Court of Claims had erred in adopting the probate court’s allocation of 
ninety-eight percent of the $250,000 damages to decedent’s mother and only two 
percent to her immediate family members and in setting off collateral benefits based 
on those allocations. 
 
In a split decision, the court of appeals agreed with the hospital that the lost-
chance doctrine as set forth in Roberts was applicable but found that the Court of 
Claims had no evidentiary basis for establishing McMullen’s lost chance of survival 
at twenty-five percent and remanded this issue. 
 
The dissenting judge found that plaintiff “does not present a lost chance of 
survival case” but instead “presents a straightforward medical malpractice case. * * 
* Unlike the lost chance case, plaintiff’s case presents a superimposed act of 
malpractice, not a malpractice which hastens or aggravates the pre-existing 
condition.” 
 
However, the court of appeals unanimously agreed with the hospital that the 
Court of Claims had erred in referring the allocation of damages and application of 
setoffs to the Lawrence County Probate Court.  In so doing, the court of appeals 
overruled its decision in Van Der Veer, found that only the Court of Claims had 
jurisdiction to determine issues of liability on the part of the state, and declared the 
probate court’s allocation and setoff judgment void for lack of subject matter 
jurisdiction.  It instructed the Court of Claims, on remand, to hold a hearing on 
 
 
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collateral-benefit setoffs pursuant to R.C. 3345.40(B)(2) and to itself determine the 
amount of collateral benefits that should be deducted from its preliminary $250,000 
judgment.  Final distribution of the judgment among the beneficiaries was then to be 
accomplished by the Lawrence County Probate Court pursuant to R.C. 2125.03(A). 
 
The cause is now before this court pursuant to the allowance of a 
discretionary appeal. 
__________________ 
 
Butler, Cincione, DiCuccio, Dritz & Barnhart, N. Gerald DiCuccio and Gail 
M. Zalimeni, for appellant. 
 
Betty D. Montgomery, Attorney General; Kegler, Brown, Hill & Ritter and 
Anthony C. White, for appellee. 
 
A. William Zavarello Co., L.P.A., A. William Zavarello and Rhonda Gail 
Davis, urging reversal for amicus curiae, Ohio Academy of Trial Lawyers. 
__________________ 
 
ALICE ROBIE RESNICK, J.  The issue to be decided in this case is whether 
the loss-of-chance doctrine applies in a case where a plaintiff proves a direct causal 
relationship between the decedent’s death and a specific negligent act.  Further, 
although the court of appeals correctly decided that the Court of Claims, rather 
than the probate court, has exclusive, original jurisdiction to determine collateral-
 
 
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source deductions under R.C. 3345.40(B)(2), it erred in requiring that those 
deductions be made before the damage award is allocated among the beneficiaries. 
I 
Loss of Chance 
 
The Court of Claims found that appellee’s negligence “caused Mrs. 
McMullen’s oxygen saturation level in her blood to fall to a low of twenty-nine 
percent.  An oxygen saturation level of twenty-nine percent is inconsistent with life 
and subsequently caused irreversible damage to Mrs. McMullen’s brain, lungs, and 
heart.”  (Emphasis added.) 
 
Since the only suggested cause of death in this case is the anoxic or hypoxic 
episode on October 14, 1990, which the trial court attributed solely to negligence on 
the part of appellee, the above-quoted finding should have been dispositive of the 
causation aspect of this case.  The case became complicated only when the trial 
court began to analyze the issue of causation in terms of increased risk.  Apparently 
the trial court believed, as did the majority of the court of appeals, that a wrongful 
death claimant must involuntarily use an increased-risk theory of recovery, with its 
attendant formula for reducing damages, whenever the decedent’s chance of survival 
from any preexisting condition is less than even.  However, in recognizing a cause 
of action for the loss of a less-than-even chance of recovery or survival, we never 
 
 
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intended to force this theory on a plaintiff who could otherwise prove that specific 
negligent acts of the defendant caused the ultimate harm. 
 
In Cooper v. Sisters of Charity of Cincinnati, Inc. (1971), 27 Ohio St.2d 242, 
56 O.O.2d 146, 272 N.E.2d 97, at the syllabus, we held: 
 
“In an action for wrongful death, where medical malpractice is alleged as the 
proximate cause of death, and plaintiff’s evidence indicates that a failure to 
diagnose the injury prevented the patient from an opportunity to be operated on, 
which failure eliminated any chance of the patient’s survival, the issue of proximate 
cause can be submitted to the jury only if there is sufficient evidence showing that 
with proper diagnosis, treatment and surgery, the patient probably would have 
survived.”  (Emphasis added.) 
 
In Roberts v. Ohio Permanente Med. Group, Inc. (1996), 76 Ohio St.3d 483, 
668 N.E.2d 480, paragraph one of the syllabus, we overruled Cooper, holding: 
 
“In order to maintain an action for the loss of a less-than-even chance of 
recovery or survival, the plaintiff must present expert medical testimony showing 
that the health care provider’s negligent act or omission increased the risk of harm to 
the plaintiff.  It then becomes a jury question as to whether the defendant’s 
negligence was a cause of the plaintiff’s injury or death.”  (Emphasis added.) 
 
In so holding, we followed the approach set forth in 2 Restatement of the Law 
2d, Torts (1965), Section 323, which provides: 
 
 
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“One who undertakes, gratuitously or for consideration, to render services to 
another which he should recognize as necessary for the protection of the other’s 
person or things, is subject to liability to the other for physical harm resulting from 
his failure to exercise reasonable care to perform his undertaking, if 
 
“(a) his failure to exercise such care increases the risk of such harm.” 
 
In Hamil v. Bashline (1978), 481 Pa. 256, 269-270, 392 A.2d 1280, 1286-
1287, the Supreme Court of Pennsylvania explained: 
 
“Section 323(a) recognizes that a particular class of tort actions, of which the 
case at bar is an example, differs from those cases normally sounding in tort.  
Whereas typically a plaintiff alleges that a defendant’s act or omission set in motion 
a force which resulted in harm, the theory of the present case is that the defendant’s 
act or omission failed in a duty to protect against harm from another source.  To 
resolve such a claim a fact-finder must consider not only what did occur, but also 
what might have occurred, i.e., whether the harm would have resulted from the 
independent source even if defendant had performed his service in a non-negligent 
manner.  Such a determination as to what might have happened necessarily requires 
a weighing of probabilities.”  (Emphasis sic; footnote omitted.) 
 
In reviewing the many cases on the subject, a particular factual situation is 
discernible to which the loss-of-chance doctrine is invariably applied.  In those 
cases, the plaintiff or the plaintiff’s decedent is already suffering from some injury, 
 
 
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condition, or disease when a medical provider negligently diagnoses the condition, 
fails to render proper aid, or provides treatment that actually aggravates the 
condition.  As a result, the underlying condition is allowed to progress, or is 
hastened, to the point where its inevitable consequences become manifest.  Unable 
to prove that the provider’s conduct is the direct and the only cause of the harm, the 
plaintiff relies on the theory that the provider’s negligence at least increased the risk 
of injury or death by denying or delaying treatment that might have inured to the 
victim’s benefit.  The focus then shifts away from the cause of the ultimate harm 
itself, and is directed instead on the extent to which the defendant’s negligence 
caused a reduction in the victim’s likelihood of achieving a more favorable outcome.  
See Wendland v. Sparks (Iowa 1998), 574 N.W.2d 327; Delaney v. Cade (1994), 
255 Kan. 199, 873 P.2d 175; Donnini v. Ouano (1991), 15 Kan.App.2d 517, 810 
P.2d 1163; Perez v. Las Vegas Med. Ctr. (1991), 107 Nev. 1, 805 P.2d 589; 
McKellips v. St. Francis Hosp., Inc. (Okla.1987), 741 P.2d 467; Herskovits v. Group 
Health Coop. of Puget Sound (1983), 99 Wash.2d 609, 664 P.2d 474; Jones v. 
Montefiore Hosp. (1981), 494 Pa. 410, 431 A.2d 920; Hamil, supra; Daniels v. 
Hadley Mem. Hosp. (C.A.D.C.1977), 566 F.2d 749; Bellaire Gen. Hosp., Inc. v. 
Campbell (Tex.Civ.App.1974), 510 S.W.2d 94; Kallenberg v. Beth Israel Hosp. 
(1974), 45 A.D.2d 177, 357 N.Y.S.2d 508, affirmed (1975), 37 N.Y.2d 719, 374 
N.Y.S.2d 615, 337 N.E.2d 128; Hernandez v. Clinica Pasteur, Inc. (Fla.App.1974), 
 
 
14
293 So.2d 747; Whitfield v. Whittaker Mem. Hosp. (1969), 210 Va. 176, 169 S.E.2d 
563; Hicks v. United States (C.A.4, 1966), 368 F.2d 626; Annotation, Medical 
Malpractice:  Measure and Elements of Damages in Actions Based on Loss of 
Chance (1990), 81 A.L.R.4th 485; Annotation, Medical Malpractice:  “Loss of 
Chance” Causality (1987), 54 A.L.R.4th 10. 
 
The plaintiff should not, however, be involuntarily confined within the limits 
of an increased-risk or loss-of-chance theory where her efforts to prove a direct 
causal relationship between the defendant’s negligence and the decedent’s death are 
successful.1  “Section 323(a) was designed to relax a plaintiff’s burden of proving 
causation, not to compound it.”  (Emphasis sic.)  Jones, supra, 494 Pa. at 418, 431 
A.2d at 924.  As one writer explains, the lost-chance “issue must be conditioned 
upon a negative finding of proximate cause.”  Perdue, Recovery for a Lost Chance 
of Survival:  When the Doctor Gambles, Who Puts Up the Stakes? (1987), 28 
So.Tex.L.Rev. 37, 60. 
 
In Ulmer v. Ackerman (1993), 87 Ohio App.3d 137, 621 N.E.2d 1315, which 
was decided after our decision in Cooper but before our decision in Roberts, 
plaintiff brought a medical malpractice action alleging that decedent’s death was 
caused by an anesthesiologist’s premature removal of an endotracheal tube.  At trial, 
plaintiff presented expert medical testimony that defendant’s conduct was the sole 
cause of decedent’s death, but the trial court directed a verdict in defendant’s favor, 
 
 
15
finding that plaintiff failed to prove that decedent would have survived but for 
defendant’s negligence.  The court of appeals reversed, finding that “the 
establishment of the sole cause of death necessarily imports that the individual 
would have survived absent the departure from the standard of care.”  Id., 87 Ohio 
App.3d at 144, 621 N.E.2d at 1319.  However, more basic than that, the court of 
appeals found: 
 
“The trial court, in granting the motion for directed verdict, mistakenly relied 
on [Cooper] as requiring plaintiff’s showing by expert testimony that Ulmer would 
have survived his surgery and postoperative difficulties but for the negligence of the 
anesthesiologist.  In the matter at hand, however, where no other alternative save 
decedent’s death may be inferred from the defendant’s conduct according to expert 
medical testimony, no occasion arose for disproof of other alternatives, as in the case 
of the claimed wrong diagnosis and ensuing wrong treatment of the dying patient in 
Cooper.  The issue of whether the physician’s misjudgment precluded an alternative 
certain chance of survival is not presented.”  Id., 87 Ohio App.3d at 143, 621 N.E.2d 
at 1319. 
 
In Anderson v. Picciotti (1996), 144 N.J. 195, 676 A.2d 127, plaintiff alleged 
that the defendant negligently amputated her right great toe pursuant to a 
misdiagnosis of osteomyelitis.  After the cause was tried, the defendant requested a 
 
 
16
charge on loss of chance, arguing that there was a risk that the toe would have been 
amputated in any event.  The trial court denied the defendant’s request, stating: 
 
“I kept getting a feeling I was trying to force a square peg into a round hole by 
trying to make this case fit into that increased risk, loss of chance line of cases.  I 
don’t think that this is the type of case that the courts were looking at when they 
rendered their decisions in these cases.  This isn’t really a lost chance case, the 
testimony and the allegations by the plaintiff really don’t go to any allegations of 
increased risk based on what the defendant did or did not do * * *.  I don’t think that 
there is an argument that the defendant’s negligence combined with the pre-existing 
condition to cause the injury * * *.”  Id., 144 N.J. at 202, 676 A.2d at 131. 
 
The New Jersey Supreme Court agreed, holding that the defendant was not 
entitled to a charge on increased risk absent “any evidence that defendant’s 
negligence combined with a preexistent condition to cause plaintiff harm.”  In order 
for the defendant to benefit from the loss-of-chance concept, he must “establis[h] 
that plaintiff’s damages were induced by concurrent causes, one of which was a 
preexistent condition unrelated to defendant’s negligence.”  Id., 144 N.J. at 207-208, 
676 A.2d at 134. 
 
In the present case, the negligence of hospital personnel did not merely 
combine with a preexisting condition to create the ultimate harm, it directly caused 
the ultimate harm.  Their actions in this case did not merely make it uncertain 
 
 
17
whether the decedent would have survived, they made it certain that she would not 
survive.  Appellee’s personnel not only failed in their duty to protect decedent from 
harm, they set in motion another, independent force that directly caused her death.  
This is not a situation where negligence merely hastened or aggravated the effects of 
a preexisting condition or allowed it to progress untreated.  Once the trial court 
determined that actions by hospital personnel were inconsistent with decedent’s life, 
it became wholly unnecessary to inquire as to whether their negligence also 
increased the risk of physical harm to decedent.  Having determined that negligence 
caused the death, the trial court should not have proceeded to consider what 
probably would have happened in the absence of negligence.  The former finding 
should have subsumed the latter. 
 
Thus, we agree with Judge Peggy Bryant, who, dissenting below, stated that 
this “case presents a straightforward medical malpractice case, not a case under 
Cooper and Roberts.  Whether or not a lost chance of survival should be an 
additional element of recovery is not at issue. * * * Unlike the lost-chance case, 
plaintiff’s case presents a superimposed act of malpractice, not a malpractice which 
hastens or aggravates the pre-existing condition.” 
 
Accordingly, the judgment of the court of appeals is reversed on this issue. 
II 
Collateral-Benefit Setoffs 
 
 
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Section 16, Article I of the Ohio Constitution provides that “[s]uits may be 
brought against the state, in such courts and in such manner, as may be provided by 
law.”  R.C. 2743.03 created the Court of Claims, vesting it with “exclusive, original 
jurisdiction of all civil actions against the state permitted by the waiver of immunity 
contained in section 2743.02 of the Revised Code.”  Under R.C. 2743.02(A)(1), the 
state’s waiver of immunity “is subject to the limitations set forth in this chapter and, 
in the case of state universities or colleges, in section 3345.40 of the Revised Code.” 
 
R.C. 3345.40(B)(2) provides that “[i]f a plaintiff receives or is entitled to 
receive benefits for injuries or loss allegedly incurred from a policy or policies of 
insurance or any other source, the benefits shall be disclosed to the court, and the 
amount of the benefits shall be deducted from any award against the state university 
or college recovered by the plaintiff.” 
 
In contrast, the probate court has exclusive jurisdiction to “order the 
distribution of estates.”  R.C. 2101.24(A)(1)(c).  This includes the jurisdiction to 
distribute among the beneficiaries the amount received by a personal representative 
in an action for wrongful death.  R.C. 2125.03(A)(1).  In that case, “[t]he court that 
appointed the personal representative * * * shall adjust the share of each beneficiary 
in a manner that is equitable, having due regard for the injury and loss to each 
beneficiary resulting from the death and for the age and condition of the 
beneficiaries.”  Id.  However, this section does not empower the probate court to 
 
 
19
determine collateral-source deductions in actions brought against a state university, 
and that function remains exclusively with the Court of Claims. 
 
Thus, the court of appeals correctly concluded that the Court of Claims, rather 
than the probate court that appointed the personal representative, has exclusive, 
original jurisdiction to determine the deduction of collateral benefits pursuant to 
R.C. 3345.40(B)(2).  However, in remanding the cause on this issue, the court of 
appeals erred when it directed the Court of Claims to offset collateral benefits before 
the probate court allocates the aggregate award among the beneficiaries pursuant to 
R.C. 2125.03(A)(1). 
 
In Sorrell v. Thevenir (1994), 69 Ohio St.3d 415, 633 N.E.2d 504, syllabus, 
we held that “R.C. 2317.45 violates Sections 2, 5 and 16, Article I of the Ohio 
Constitution, and is unconstitutional in toto.”  In holding R.C. 2317.45 to be 
violative of the Due Process Clause of Section 16, Article I of the Ohio Constitution, 
we explained: 
 
“Of primary significance is that the statute requires deductions from jury 
verdicts irrespective of whether a collateral benefit defined in R.C. 2317.45(A)(1) is 
actually included in the verdict.  While the goal of preventing double recoveries is 
not arbitrary or unreasonable, * * * R.C. 2317.45 fails to take into account whether 
the collateral benefits to be deducted are within the damages actually found by the 
jury, especially where there are no interrogatories to quantify the categories of 
 
 
20
damages that make up the general verdict.  Thus, the statute can arbitrarily reduce 
damages that a jury awards a plaintiff, since under the statute it is irrelevant whether 
any collateral benefit actually represents any portion of the jury’s award.”  Id., 69 
Ohio St.3d at 423-424, 633 N.E.2d at 511. 
 
In Buchman v. Wayne Trace Local School Dist. Bd. of Edn. (1995), 73 Ohio 
St.3d 260, 652 N.E.2d 952, we considered the constitutionality of R.C. 2744.05(B), 
which provides for the deduction of collateral benefits from awards against political 
subdivisions.  In so doing, we adhered to the proposition that deductions for 
collateral benefits are constitutionally permitted only to the extent that the loss for 
which the collateral benefit compensates is actually included in the award.  We put it 
succinctly that “there shall be no constitutionality without a requirement that 
deductible benefits be matched to those losses actually awarded.”  Id., 73 Ohio St.3d 
at 269, 652 N.E.2d at 960.  We upheld the constitutionality of R.C. 2744.05(B) 
because its language was susceptible of an interpretation that requires the matching 
of deductible benefits to damages actually awarded. 
 
However, even more basic than this, due process requires that the collateral 
benefits to be deducted belong to the party whose recovery is to be offset.  Due 
process does not allow one party’s recovery to be reduced by another person’s 
collateral benefits.  Thus, we held in Buchman that “[t]he Social Security benefits 
which Donald’s children have received or are entitled to receive, however, are not 
 
 
21
deductible from the jury’s verdict.  No part of the $5,082,482 verdict against which 
Wayne Trace seeks to offset these benefits was awarded to Donald’s children.”  Id., 
73 Ohio St.3d at 265, 652 N.E.2d at 957. 
 
Since the language of R.C. 3345.40(B)(2) is virtually identical to that of R.C. 
2744.05(B), the court of appeals correctly determined that it too is susceptible of an 
interpretation that requires the matching of deductible benefits to losses actually 
awarded.  The court of appeals also seemed to accept the idea, at least in principle, 
that deductions be taken on a beneficiary-by-beneficiary basis, when it held that “the 
Court of Claims shall deduct the collateral benefits received by each beneficiary 
from the damage award to the extent that the loss for which a given collateral benefit 
compensates is duplicated in the damages actually awarded to that beneficiary.”  
(Emphasis added.) 
 
However, the court of appeals failed to account for the fact that, in a wrongful 
death action involving multiple beneficiaries, the beneficiaries may not be entitled to 
recover the amounts respectively awarded to each of them in the Court of Claims.  
Instead, their proportionate shares of the aggregate award are subject to adjustment 
by the probate court under R.C. 2125.03(A)(1).  Simply put, the probate court may 
allocate the aggregate award among the beneficiaries differently than was done in 
the Court of Claims.  In this situation, the approach taken by the court of appeals, 
which requires collateral-source deductions before final distribution, could 
 
 
22
arbitrarily reduce one beneficiary’s award by another beneficiary’s collateral 
benefits. 
 
Appellant effectively illustrates this point by use of the following example: 
 
“For example, the Court of Claims could determine that the surviving spouse 
suffered damages in the amount of Five Hundred Thousand Dollars ($500,000.00) 
and that a minor child has been damage[d] in the amount of Two Hundred Fifty 
Thousand Dollars ($250,000.00).  The Court of Claims could then set off Five 
Hundred Thousand Dollars ($500,000.00) in insurance proceeds received by the 
surviving spouse and enter an award in the amount of Two Hundred Fifty Thousand 
Dollars ($250,000.00).  Under the Court of Appeals procedure, a Probate Court 
would then determine the distribution of the Two Hundred Fifty Thousand Dollars 
($250,000.00).  If the Probate Court determines that the surviving spouse and the 
minor child are each entitled to One Hundred Twenty-Five Thousand Dollars 
($125,000.00), the amount recoverable by the minor child would have been 
decreased by insurance proceeds not actually received by the minor child.  This 
result would violate the mandate of Buchman.” 
 
In addition, by forcing collateral-source deductions before final distribution, 
the court of appeals causes the statute to operate contrary to its presumed 
constitutional goal, which is to eliminate or prevent double recovery.  Sorrell, supra, 
69 Ohio St.3d at 423-424, 633 N.E.2d at 511. 
 
 
23
 
Both the parties and the court of appeals in this case have led us to believe 
that we must choose between two extreme procedural approaches in attempting to 
resolve the interplay between Section 16, Article I of the Ohio Constitution, R.C. 
3345.40(B)(2), and 2125.03(A)(1).  They have presented us with the options of 
either having the probate court effectuate collateral-source deductions, which it 
clearly has no jurisdiction to do, or allowing the Court of Claims to make the 
deductions before the probate court allocates the award among the beneficiaries, 
which is clearly in violation of Buchman and Sorrell. 
 
It is not necessary to choose between these two options.  Rather, the solution 
is to have the Court of Claims make the collateral-source deductions required by 
R.C. 3345.40(B)(2) in accordance with Buchman, but only after the probate court 
adjusts the share of each beneficiary pursuant to R.C. 2125.03(A)(1). 
 
Accordingly, the judgment of the court of appeals is reversed as to this issue. 
 
Based on all of the foregoing, the judgment of the court of appeals is reversed, 
and the cause is remanded to the Court of Claims to do the following:  (1) enter 
judgment in appellant’s favor on the issue of liability for causing decedent’s death; 
(2) without conducting a new trial on the issue of damages, assess damages from the 
evidence already submitted based on decedent’s life expectancy, taking into account 
decedent’s condition at the time of her death, as in any other malpractice case; (3) 
refer the cause to the Probate Court of Lawrence County to distribute that award 
 
 
24
among the beneficiaries; and (4) deduct collateral benefits received by each 
beneficiary, pursuant to Buchman, from that beneficiary’s share of the award as 
adjusted by the probate court. 
Judgment reversed 
and cause remanded. 
 
DOUGLAS, F.E. SWEENEY and PFEIFER, JJ., concur. 
 
MOYER, C.J., COOK and LUNDBERG STRATTON, JJ., dissent. 
FOOTNOTE: 
 
1. 
Appellee directs our attention to Wendland, supra, and Dickey v. 
Daughety (1996), 260 Kan. 12, 917 P.2d 889, and points out that the loss-of-chance 
doctrine has not been limited to cases involving negligent diagnosis.  We agree, but 
that is a different issue from whether and under what circumstances the doctrine can 
be forced upon a plaintiff or used defensively.  In Wendland, and in those cases cited 
in Wendland, the doctrine was applied to situations where defendant’s negligence 
caused a failure or delay in treatment.  In Dickey, the doctrine was applied against a 
physician who, while attempting to replace a chest tube, accidentally lacerated the 
patient’s artery, causing her death.  However, it was the estate of the deceased 
patient that brought the wrongful death action based on loss of chance of survival.  
Thus, the issue of whether the doctrine could have been raised defensively, despite 
direct causative evidence, was not an issue in that case. 
 
 
25
__________________ 
 
MOYER, C.J., dissenting.  I dissent from the holding of the majority that the 
theory of loss of a less-than-even chance of recovery or survival adopted by this court 
in Roberts v. Ohio Permanente Med. Group, Inc. (1996), 76 Ohio St.3d 483, 668 
N.E.2d 480, is not applicable to the case at bar. 
 
In recounting the facts of this case, the majority acknowledges that McMullen 
was very, very ill in the days preceding October 14, 1990, prior to any acts alleged to 
have constituted breaches of standards of care required of OSU Hospital employees.  
The majority recognizes it to be fact that McMullen’s oxygen saturation level “had 
dropped to a critical level,” and that she was cyanotic and dyspneic on that morning, 
before hospital nurses attended to her.  It concedes that McMullen’s oxygen 
saturation level did not increase despite infusion of one hundred percent oxygen 
through the ET tube prior to the nurses’ removal of it. 
 
The evidence thus supports the conclusion that the hypoxia that the majority 
concludes caused McMullen’s death had begun before any acts of alleged 
professional negligence.  It is not factually clear that McMullen would have 
responded favorably, and avoided death resulting from oxygen insufficiency, had the 
nurses not removed the tube or had the residents more quickly reinserted it.  At most, 
their conduct deprived her only of a chance to recover. 
 
 
26
 
The majority concludes that “the negligence of hospital personnel did not 
merely combine with a preexisting condition to create the ultimate harm,” i.e., 
McMullen’s death.  That this conclusion cannot be supported by common sense or 
the law is demonstrated by the fact that the vast majority of people in this world are 
not dependent upon properly inserted endotracheal tubes to ensure blood-oxygen 
levels consistent with life.  The majority further states that hospital personnel “set in 
motion another, independent force that directly caused her death.”  (Emphasis 
added.)  That observation in effect changes the test announced in Roberts. 
 
Under traditional tort law, proof of a causal connection not rising to a level of 
proximate cause is insufficient to justify a finding of liability and award of damages.  
Prior to Roberts, in cases where the injury complained of was death resulting from 
medical malpractice, a plaintiff could establish proximate cause sufficient to support 
liability only by producing evidence that the patient probably would have survived 
had he or she been treated in accordance with the appropriate standard of care.  
Cooper v. Sisters of Charity of Cincinnati, Inc. (1971), 27 Ohio St.2d 242, 56 O.O.2d 
146, 272 N.E.2d 97, syllabus.  No distinction was drawn between patients who were 
healthy before the alleged malpractice and those who already had conditions that 
jeopardized their continued health.  Damages were awarded on an all-or-nothing 
basis. 
 
 
27
 
In Roberts, this court overruled Cooper and adopted a new theory of recovery, 
which it described as “loss of a less-than-even chance of recovery or survival,” in 
which the amount of damages recoverable by a plaintiff equals “the total sum of 
damages for the underlying injury or death assessed from the date of the negligent act 
or omission multiplied by the percentage of the lost chance.”  Roberts, paragraph two 
of the syllabus.  Accordingly, in lost-chance cases, those plaintiffs who are unable to 
meet the “but for” test (that the full extent of their injuries would not have occurred 
but for negligence on the part of medical providers) are not completely barred from 
recovery.  Rather, they receive damages in proportion to the percentage of chance of 
recovery of which they were deprived. 
 
As generally viewed, in a case involving loss of a less-than-even chance, the 
plaintiff is not awarded compensation for the death itself.  Rather, the plaintiff seeks 
compensation for the injury of having been deprived of a chance of a more favorable 
ultimate result despite the existence of a preexisting adverse medical condition.  See 
Roberts, 76 Ohio St.3d at 485, 668 N.E.2d at 482 (“[T]he plaintiff, who was already 
suffering from some disease or disorder at the time the malpractice occurred, can 
recover for his or her ‘lost chance’ even though the possibility of survival or 
recovery is less than probable.”  [Emphasis added.]), citing Keith, Loss of Chance: A 
Modern Proportional Approach to Damages in Texas (1992), 44 Baylor L.Rev. 759, 
760.  See, also, King, Causation, Valuation, and Chance in Personal Injury Torts 
 
 
28
Involving Preexisting Conditions and Future Consequences (1981), 90 Yale L.J. 
1353, 1354 (“Courts have had difficulty perceiving that a chance of avoiding some 
adverse result or of achieving some favorable result is a compensable interest in its 
own right.”); id. at 1382 (“Regardless of whether it could be said that the defendant 
caused the decedent’s death, he caused the loss of a chance, and that chance-interest 
should be completely redressed in its own right.”).  Pursuant to Roberts, the value of 
such a chance interest is determined by first calculating the full value of damages 
resulting from the ultimate injury (here, death), and then reducing the damages by 
multiplying them by the percentage of chance lost by the patient due to the 
malpractice of the defendant. 
 
The case before us is analogous to a typical loss-of-chance case based on 
misdiagnosis or nondiagnosis, in which the plaintiff is compensated because tortious 
conduct deprived him or her of an opportunity to attempt to arrest a disease in its 
natural progression.  This is exactly the situation that occurred in the case at bar when 
hospital personnel were unable to provide McMullen with adequate oxygen levels 
through artificial means when her disease had progressed to the point where her 
respiratory system no longer was functioning naturally on its own. 
  
But today the majority sanctions the award of full damages to McMullen’s 
estate despite the fact that the trial court clearly found that McMullen had only a 
twenty-five-percent chance of surviving her medical condition had no medical 
 
 
29
negligence occurred.  Stated differently, the trial court found it to be fact that it was 
three times as likely that McMullen would not have recovered from her illness as it 
was that she would have recovered, even had she been treated in full compliance with 
the required standards of care.  Despite this, the majority finds that an award of full 
damages is appropriate in this case. 
 
The majority simply misinterprets the written opinion of the trial court in 
characterizing it as holding that the defendant’s failure to adhere to the required 
standards of care proximately caused McMullen’s death, thereby justifying an award 
of the full amount of damages arising out of her death. 
 
The court of appeals correctly recognized that it “is clear from the Court of 
Claims’ discussion of causation that the court chose not to adopt [plaintiff’s experts’] 
testimony that decedent had a better than fifty-percent chance of surviving at the time 
of University Hospital’s breach of its duty of care,” and that the Court of Claims 
further found it to be fact that “decedent had less than a fifty-percent chance of 
surviving prior to University Hospital’s breach.” 
 
The majority instead concludes that the trial court found it to be fact that the 
anoxic or hypoxic episode of October 14, 1990, was “solely” attributable to 
negligence on the part of hospital employees.  The majority relies upon a brief 
excerpt from the trial court’s opinion to justify its conclusion.  That excerpt is taken, 
out of context, from the trial court’s discussion of the standard of care required of the 
 
 
30
OSU resident doctors (and not that part of the opinion dealing with legal causation).  
In fuller context, that excerpt states: 
 
“In regard to the standard of care expected of defendant’s resident doctors, 
plaintif[f] offered the videotaped expert medical testimony of Carl Meyer, M.D.  (Dr. 
Meyer), a board certified anesthesiologist.  Dr. Meyer testified that defendant’s 
resident physician, Deborah Campbell, fell below the appropriate standard of care 
expected of an anesthesiologist in her third year of residency operating under the 
same or similar circumstances.  Specifically, Dr. Meyer testified that Dr. Campbell 
deviated from the expected standard of care both by virtue of the number of attempts 
it took her to re-intubate Mrs. McMullen and because she did not seek assistance 
when she could not timely complete the re-intubation. 
 
“Upon review, the court agrees with Dr. Meyer and finds that Dr. Campbell’s 
actions fell below the standard of care expected of a third year resident in 
anesthesiology when it took her six or more attempts to re-intubate Mrs. McMullen.  
This delay in re-intubation deprived Mrs. McMullen of proper oxygenation for over 
twenty minutes.  The delay further caused Mrs. McMullen’s oxygen saturation level 
in her blood to fall to a low of twenty-nine percent.  An oxygen saturation level of 
twenty-nine percent is inconsistent with life and subsequently caused irreversible 
damage to Mrs. McMullen’s brain, lungs, and heart.”  (Emphasis added.) 
 
 
31
 
Several points should be made in regard to this portion of the trial court’s 
decision.  First, the trial court does not state that the removal of the tube, or failure to 
timely reinsert it, caused McMullen’s death.  Rather, in stating that the “delay in re-
intubation deprived Mrs. McMullen of proper oxygenation for over twenty 
minutes,” the trial court does no more than make a factual finding that hospital 
personnel did not timely perform acts that might, or might not, have restored 
McMullen’s blood-oxygen levels to adequate levels in time to avoid permanent 
damage.  The trial court makes this statement in support of its conclusion that that 
failure constituted a violation of the standard of care required of a third-year 
anesthesiology resident—not in connection with determination of proximate cause. 
 
The trial court then continues by concluding that the “delay further caused 
Mrs. McMullen’s oxygen saturation level in her blood to fall to a low of twenty-nine 
percent,” but does not specify what McMullen’s oxygen levels were at the time when 
the nurses responded to the crisis or the time when the tube should have been 
correctly reinserted—the earliest times of alleged professional negligence.  In the 
context of the opinion read as a whole, it is clear that the trial court found as fact that 
McMullen’s oxygen levels had fallen low enough to cause hypoxia before any 
medical negligence, although the failure to timely reintubate resulted in those levels 
falling ultimately to a low of twenty-nine percent. 
 
 
32
 
Second, the majority inaccurately states that “[o]nce the trial court determined 
that actions by hospital personnel were inconsistent with decedent’s life, it became 
wholly unnecessary to inquire as to whether their negligence also increased the risk 
of physical harm to decedent.”  But the trial court did not find that the doctors’ and 
nurses’ acts were inconsistent with life; rather, it expressly found that “an oxygen 
saturation level of twenty-nine percent” is inconsistent with continued life.  The trial 
court decision can just as reasonably be interpreted to mean that McMullen had 
depressed oxygen levels that ultimately would have led to death irrespective of 
whether negligence occurred subsequently. 
 
Third, the trial court concluded in its first opinion that “prior to the events of 
October 14, 1990, Mrs. McMullen had a chance of surviving to leave the hospital.”  
The trial court did not, however, here express an opinion as to whether it agreed with 
the competing testimony of the appellant’s experts, as opposed to the defense experts, 
as to the percentage chance of recovery McMullen possessed at the time the 
professional negligence occurred.  Instead, the trial court “specifically [left] open for 
the damages phase of this trial the percentage of the chance of survival that Mrs. 
McMullen lost as a result of defendant’s agents’ negligence.”  Moreover, in the 
portion of the trial court’s first decision specifically discussing proximate causation, 
the trial court wrote: 
 
 
33
 
“Given that the court has concluded that the treatment by defendant’s critical 
care nurses and defendant’s resident, Dr. Campbell, fell below the standards of care 
expected of them, the sole remaining issues in the liability phase of this case are 
whether those deviations proximately caused Mrs. McMullen’s death or proximately 
caused her to lose any chance of survival.”  (Emphasis added.) 
 
Had the trial court meant the earlier excerpt, which the majority cites, as a 
finding that the trial court found hospital actions to be the sole cause of McMullen’s 
death, the trial court would not have described the issue of proximate cause as being 
an issue remaining for resolution. 
 
The question remains how it is to be determined whether, in any individual 
case of alleged medical negligence, lost-chance principles should be applied 
(resulting in proportionately reduced damages), as opposed to traditional proximate 
causation analysis (resulting in award of full damages).  Professor King offered such 
guidelines in a 1998 followup to his seminal 1981 article in the Yale Law Journal, 
supra (which the Roberts court cited with approval), by suggesting that the loss-of-
chance doctrine should be applied where the following criteria are present: “(1) the 
defendant tortiously failed to satisfy a duty owed to the victim to protect or preserve 
the victim’s prospects for some more favorable outcome; (2) either (a) the duty owed 
to the victim was based on a special relationship, undertaking, or other basis 
sufficient to support a preexisting duty to protect the victim’s likelihood of a more 
 
 
34
favorable outcome, or (b) the only question was how to reflect the presence of a 
preexisting condition in calculating the damages for a materialized injury that the 
defendant is proven to have probably actively, tortiously caused; (3) the defendant’s 
tortious conduct reduced the likelihood that the victim would have otherwise 
achieved a more favorable outcome; and (4) the defendant’s tortious conduct was the 
reason it was not feasible to determine precisely whether or not the more favorable 
outcome would have materialized but for the tortious conduct.”  King, “Reduction of 
Likelihood” Reformulation and Other Retrofitting of the Loss-of-a-Chance Doctrine 
(1998), 28 U.Mem.L.Rev. 491, 495.  Professor King’s guidelines are consistent with 
our decision in Roberts and should be followed in this case. 
 
Even if the majority were correct that the negligence of OSU Hospital had a 
“direct causal relationship” to McMullen’s death, lost-chance principles should be 
applied pursuant to item 2(b) of King’s guidelines. 
 
Since Roberts, this court has not decided a medical negligence case involving 
a loss of greater than even chance of recovery.  Nor has this court yet entertained the 
argument that the total amount of damages awarded in such a case should be adjusted 
to reflect a patient’s preexisting conditions. 
 
Assuming arguendo that the trial court had accepted the testimony of 
plaintiff’s expert that McMullen had a sixty-percent chance of achieving a full 
recovery had she not been subjected to hospital negligence, i.e., a greater than even 
 
 
35
chance of recovery, we would be faced with the question whether, since the adoption 
of Roberts, an award of damages should be governed by loss-of-chance principles as 
opposed to the all-or-nothing rules established by traditional tort law where a patient 
has significant preexisting life-threatening conditions. 
 
However, in Roberts this court did state that in loss-of-chance cases, “ ‘the 
defendant should be subject to liability only to the extent that he tortiously 
contributed to the harm by allowing a preexisting condition to progress or by 
aggravating or accelerating its harmful effects, or to the extent that he otherwise 
caused harm in excess of that attributable [solely] to preexisting conditions.’ ”  
(Emphasis added.)  Roberts, 76 Ohio St.3d at 489, 668 N.E.2d at 484, quoting King, 
supra, 90 Yale L.J. at 1360.  See, also, id. at 1387 (noting that under the traditional, 
all-or-nothing rule, by compensating the fifty-percent-plus chance as though it were 
one hundred percent, courts overcompensate the plaintiff, and suggesting that this 
result is “as questionable as the extreme reached when the all-or-nothing concept 
denies any redress for the destruction of a not-better-than-even chance”).  See, also, 
Kieffer, The Case for Across-the-Board Application of the Loss-of-Chance Doctrine 
(1997), 64 Def.Couns.J. 568, 569 (arguing that application of the loss-of-chance 
doctrine to better-than-even cases would “allow defendants to limit damages to those 
actually flowing from their negligence, while at the same time allowing courts to 
reach results that intellectually are more credible,” thereby balancing the equities 
 
 
36
between plaintiffs and medical professional defendants). Cf. Ellis,  Note, Loss of 
Chance as Technique: Toeing the Line at Fifty Percent (1993), 72 Tex.L.Rev. 369 
(arguing that the loss-of-chance doctrine should be confined to cases presenting loss 
of a less-than-even chance, and in favor of an award of full damages where the 
patient had a greater-than-even chance of recovery). 
 
In conclusion, the trial court’s determination of the facts compels the 
conclusion that the executor of McMullen’s estate can recover damages in this case 
only under the Roberts theory of loss of less-than-even chance.  I would affirm this 
holding of the court of appeals. 
 
COOK and LUNDBERG STRATTON, JJ., concur in the foregoing dissenting 
opinion.