Case Title: Curtis v. MRI Imaging Services II

Citation: 

Docket Number: S44395

State: oregon

Court: Oregon Supreme Court

Date: 1998-04-09T00:00:00Z

Document:
Filed:  April 9, 1998

IN THE SUPREME COURT OF THE STATE OF OREGON

ROBERT CURTIS,

	Respondent on Review,

	v.

MRI IMAGING SERVICES II,
an Oregon limited partnership,
and ABCT, Inc., an Oregon corporation,

	Petitioners on Review,

	and

NORTH LINCOLN HOSPITAL HEALTH 
DISTRICT dba North Lincoln 
Hospital, an Oregon non-profit
corporation,

	Defendant.

(CC 941288; CA A92095; SC S44395)

	On review from the Court of Appeals.*

	Argued and submitted January 9, 1998.

	Alexander Gordon, Portland, argued the cause and filed the
petition for petitioners on review.

	J. Michael Alexander, of Burt, Swanson, Lathen, Alexander,
McCann & Smith, P.C., Salem, argued the cause for respondent on
review.

	Before Carson, Chief Justice, and Gillette, Van Hoomissen,
Durham, and Kulongoski, Justices.**

	GILLETTE, J.

	The decision of the Court of Appeals is affirmed.  The
judgment of the circuit court is reversed, and the case is
remanded to that court for further proceedings. 	

	*Appeal from Lincoln County Circuit Court,
      Charles Littlehales, Judge.
	 148 Or App 607, 941 P2d 602 (1997).

    **Fadeley, J., retired January 31, 1998, and did not
participate in this decision; Graber, J., retired March 31, 1998,
and did not participate in this decision.

		GILLETTE, J.

		In this tort action, plaintiff sought damages from
corporate medical providers for psychological injuries that
allegedly resulted from a negligently performed diagnostic test. 
Pursuant to ORCP 21, the trial court entered judgment for
defendants on the pleadings.  Noting that plaintiff had alleged
only psychological injuries, the court concluded that plaintiff's
claim actually was for negligent infliction of emotional distress
-- a claim that the trial judge did not believe existed in this
state.  The Court of Appeals reversed.  Curtis v. MRI Imaging
Services II, 148 Or App 607, 941 P2d 602 (1997).  We allowed
defendants' petition for review to consider whether, despite its
failure to allege any physical injury, plaintiff's complaint
nevertheless states a valid claim.  We conclude that it does and,
accordingly, affirm the decision of the Court of Appeals.

		For purposes of the issue before us, we accept the
facts alleged in the complaint as true.  See Sager v. McClenden,
296 Or 33, 35, 672 P2d 697 (1983) (stating principle).  Briefly,
the complaint alleges that plaintiff arranged to undergo an MRI,(1)
that defendants, two Oregon corporations, administered the test,
and that, in doing so, defendants were negligent in the following
particulars:

	"1.  In failing to properly explain the nature of the
MRI procedure to the Plaintiff prior to instituting
such procedure, particularly in failing to warn the
Plaintiff of the possible claustrophobic effects of the
MRI; 

	"2.  In failing to take an adequate medical and
psychological history from the Plaintiff, including the
history of a pre-existing asthmatic condition; 

	"3.  In failing to properly monitor the progress of the
Plaintiff during the course of the MRI procedure; and

	"4.  In failing to promptly terminate the MRI procedure
when Plaintiff complained of difficulties with
breathing, and indicated a desire for the procedure to
end."

The complaint further alleges that plaintiff became extremely
distressed during the procedure, that his distress was
exacerbated by his pre-existing asthma, and that, ultimately,
defendants' negligent performance of the test resulted in
"permanent psychological damage, including post-traumatic stress
disorder, adjustment disorder with anxious mood, major
depression, generalized anxiety disorder and panic disorder with
agoraphobia."

		In their answer, defendants denied most of what
plaintiff had alleged.  Defendants also asserted an "affirmative
defense," viz., that the allegations of the complaint, although
evidently directed toward stating a claim for negligent
infliction of emotional distress, were insufficient for that
purpose, because they did not allege an actual or threatened
physical injury or injury to another legally protected interest. 
Before trial, defendants raised that same argument in a motion
for judgment on the pleadings, pursuant to ORCP 21.

  		In response to that motion, plaintiff acknowledged that
the right to recover for negligently caused emotional distress is
limited in this state.  Nevertheless, he argued that his
complaint stated a valid claim, because (among other things)
defendants had infringed on a "legally protected interest" that
was distinct from a person's general interest in freedom from
emotional distress.  That interest, plaintiff argued, arose out
of defendants' and plaintiff's relationship as medical provider
and patient.  Ultimately, the trial court rejected that argument
and granted defendants' motion for judgment on the pleadings.  

		As noted, on plaintiff's appeal, the Court of Appeals
reversed.  The court began by noting that, although evidence of
an accompanying physical injury generally is required, negligent
infliction of emotional distress is actionable without physical
injury, if the negligent conduct infringed on some "legally
protected interest" apart from causing the claimed emotional
distress.  See Hammond v. Central Lane Communications Center, 312
Or 17, 22-24, 816 P2d 593 (1991) (stating that standard).  After
examining the relevant case law, the Court of Appeals concluded
that the phrase, "legally protected interest," refers to a duty
that goes beyond or is distinct from the general duty that this
court described in Fazzolari v. Portland School Dist. No. 1J, 303
Or 1, 734 P2d 1326 (1987), to avoid foreseeable injuries.  The
court then held that the duty that arose out of defendants'
relationship with plaintiff in this case met the Hammond
requirement:

	"We conclude that the relationship between
plaintiff and defendant medical professionals, as
alleged in the complaint, does give rise to such an
actionable 'legally protected interest.'  Obviously, an
action for malpractice and, particularly, failure to
obtain informed consent, sounds, at least in part, in
negligence.  Just as obviously, a medical
professional's standard of care toward his or her
patients -- and liability for breach of that standard 
-- transcends mere Fazzolari foreseeability.  That is,
the relationship between medical professionals and
their patients, of the sort alleged in this case,
imposes a duty on the care providers that goes beyond
the general common-law duty to exercise reasonable care
to prevent foreseeable harm." 

Curtis, 148 Or App at 618.  The Court of Appeals then concluded
that, because the complaint thus alleged an invasion of a
distinct "legally protected interest" and the alleged invasion
was of a sufficient magnitude, the absence of any allegation of
physical injury did not defeat plaintiff's claim.  Id. at 620-22. 

		In their petition to this court, defendants argue that
the Court of Appeals' holding represents an unwarranted expansion
of the notion that invasion of a distinct "legally protected
interest" will justify recovery for negligently inflicted
emotional distress.  Defendants insist that the "legally
protected interests" described in Hammond and its progeny are
only those that exist apart from the societal relationship in
which the parties find themselves.  From that premise, defendants
maintain that the present action is not one from the limited
category of negligent infliction of emotional distress actions
that can be maintained without a showing of physical injury.  

		Although the parties argue this case on the 
battleground labeled negligent infliction of emotional distress,
we see it from a different perspective.  In our view, the most
obvious claim stated by the pleadings is a straightforward claim
for medical malpractice.  Although that characterization of the
claim does not relieve this court of its responsibility to
explain why purely psychological harm might be actionable in this
case, it does provide the more appropriate vehicle for resolving
the issue that is before us.  

  		Recently, in Zehr v. Haugen, 318 Or 647, 653-54, 871
P2d 1006 (1994), this court described the elements that must be
pleaded and proved in a medical malpractice claim:  (1) a duty
that runs from the defendant to the plaintiff; (2) a breach of
that duty; (3) a resulting harm to the plaintiff measurable in
damages; and (4) a causal link between the breach and the harm. 
(Citing Stevens v. Bispham, 316 Or 221, 227-28, 851 P2d 556
(1993).)  Viewing the pleadings in this case in the light most
favorable to the plaintiff (as we are obliged to do in reviewing
a judgment on the pleadings issued pursuant to ORCP 21, plaintiff
alleges all those elements here.

		Plaintiff has alleged that defendants performed a
medical procedure on him, which is conduct that would give rise
to a duty running to plaintiff to exercise that degree of care,
knowledge and skill ordinarily possessed and exercised by the
average provider of that type of medical service.  In addition,
it is possible to infer, from plaintiff's specific allegations of
negligence, that particular aspects of the relevant standard of
care were at issue:  a duty to explain the nature of the
procedure, to warn of its possible claustrophobic effects, to
take an adequate medical history in order to discover any
particular physical or psychological sensitivities that might be
affected by the procedure, and, finally, to terminate the
procedure if the patient begins to experience physical or
psychological difficulties.

		The fact that plaintiff alleges a standard of care that
includes duties that specifically are directed at psychological
difficulties, such as claustrophobia, rather than solely at
physical ones, is not dispositive.  Plaintiff is entitled to
plead and prove that the distinction between physical and
psychological effects is not always consonant with the thinking
and conduct of medical professionals.  Clearly, at least some
conditions and events that the law deems to be purely
psychological qualify as medical concerns in the mind of a
medical professional.  That being so, a medical professional may
operate under a standard of care that includes a specific duty to
be aware of and guard against particular adverse psychological
reactions or consequences to medical procedures.  That is what
plaintiff has alleged here. 

		There is no question that plaintiff alleges a breach of
the aforementioned duties, or that he alleges a causal link
between that breach and the asserted harm.  The real question is
whether the harm alleged -- severe and continuing psychological
harm -- is the kind of harm that the law is prepared to recognize
as constituting the "harm" element in this kind of claim.  See
Stevens, 316 Or at 228 (distinguishing common meaning of "harm"
from "harm" in its legal sense).  

		Plaintiff's claim invokes specific duties imposed on a
group of medical professionals to guard against recognized
medical risks that happen to be psychological in nature.  It is,
in that sense, like a patient's claim against a psychotherapist
who violates the relevant standard of care by entering into in a
sexual relationship with a patient, thereby causing depression or
anxiety,(2) or against a physician who inappropriately prescribes a
drug that causes or exacerbates a psychological condition.(3)    

		We are persuaded that, when the claim is that a medical
practitioner breached a professional duty to guard against a
specified medical harm, the fact that that harm is psychological
rather than physical is not a bar to liability.  Our holding
should not be read to mean that medical professionals operate
under a general duty to avoid any emotional harm that foreseeably
might result from their conduct.  In that regard, their duty is
no greater than that of the population at large.  But, where the
standard of care in a particular medical profession recognizes
the possibility of adverse psychological reactions or
consequences as a medical concern and dictates that certain
precautions be taken to avoid or minimize it, the law will not
insulate persons in that profession from liability if they fail
in those duties, thereby causing the contemplated harm.

		When read in the light most favorable to plaintiff, the
complaint alleges that defendants were medical professionals who
owed a duty to plaintiff to identify and guard against
predictable psychological reactions or consequences -- including
claustrophobic reactions -- to the MRI procedure.  It further
alleges that defendants breached that duty and that plaintiff
suffered severe and continuing psychological injury -- anxiety,
panic, depression, and post-traumatic stress disorder -- as a
result.  So understood, we hold that plaintiff's complaint states
a claim for medical malpractice.  

		As noted, the parties have argued this case on the
assumption that negligent infliction of emotional distress is the
relevant claim.  We need not decide that issue now.  Judgment on
the pleadings is permissible only if the allegations, when taken
in their entirety and viewed in the light most favorable to the
plaintiff, affirmatively establish that the plaintiff has no
claim.  Hawkins v. Conklin, 307 Or 262, 264, 767 P2d 66 (1988). 
Our sole task is to determine whether plaintiff has pleaded any
claim for relief.  He has; the trial court erred in concluding
otherwise.

		The decision of the Court of Appeals is affirmed.  The
judgment of the circuit court is reversed, and the case is
remanded to that court for further proceedings. 

1. 	The MRI (magnetic resonance imaging) procedure uses
radiofrequency pulses to produce three dimensional images of the
body's interior, showing muscle, bone, blood vessels, nerves,
organs, and tumor tissue.  Stedman's Medical Dictionary 851 (26th
ed. 1995).

2. 	Courts in other jurisdictions have held that a
psychiatrist's or psychologist's negligent handling of the
"transference phenomenon" in indulging in a sexual relationship
with a patient or a patient's spouse is actionable, regardless of
the fact that only psychological harm is alleged.  See, e.g.,
Rowe v. Bennett, 514 A2d 802 (Me 1986) (illustrating
proposition); Richard H. v. Larry D., 198 Cal App 3d 591, 243 Cal
Rptr 807 (Cal App 1 Dist 1988) (same); Mazza v. Huffaker, 61 NC
App 170, 300 SE2d 833 (1983) (same).  See also Sisson v. Seneca
Mental Health Council, 404 SE2d 425, 428 (W Va 1991) (listing and
describing other cases).

3. 	See, e.g., Kampe v. Colom, 906 SW2d 796 (Mo App W D
1995) (medical malpractice action based on prescription of drugs
that had adverse psychological effect on plaintiff).