Case Title: Roberts v. Ohio Permanente Med. Group, Inc.

Citation: 1996-Ohio-375

Docket Number: 19951042

State: ohio

Court: Ohio Supreme Court

Date: 1996-08-28T00:00:00Z

Document:
ROBERTS, APPELLANT, V. OHIO PERMANENTE MEDICAL GROUP, INC., ET AL., 
APPELLEES. 
[Cite as Roberts v. Ohio Permanente Med. Group, Inc. (1996), ___ Ohio St.3d 
___.] 
Physicians and surgeons -- Malpractice -- Claim for loss of chance in 
wrongful death action where decedent had less than fifty-percent 
chance of survival recognized in Ohio -- Requirements necessary 
to maintain action for loss of chance of recovery or survival -- 
Amount of damages recoverable in loss-of-chance case. 
1.  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.  (Cooper v. Sisters of Charity of Cincinnati, 
Inc. [1971], 27 Ohio St.2d 242, 56 O.O.2d 146, 272 N.E.2d 97, 
overruled.) 
2.  The amount of damages recoverable by a plaintiff in a loss-of-chance case 
equals the total sum of damages for the underlying injury or death 
 
2 
assessed from the date of the negligent act or omission multiplied by the 
percentage of the lost chance. 
3.  To ascertain the amount of damages in a case of lost chance of survival or 
recovery, the trial court must instruct the trier of fact to consider the 
expert testimony presented and (1) determine the total amount of 
damages from the date of the alleged negligent act or omission, including 
but not limited to lost earnings and loss of consortium; (2) ascertain the 
percentage of the patient’s lost chance of survival or recovery; and (3) 
multiply that percentage by the total amount of damages.  
 
(No. 95-1042 -- Submitted May 8, 1996 -- Decided August 28, 1996.) 
 
APPEAL from the Court of Appeals for Summit County, No. 16913. 
 
On October 26, 1992, plaintiff-appellant, Joan Roberts, executor of the 
estate of Elaine E. Thomas, filed a wrongful death suit against defendants-
appellees, Ohio Permanente Medical Group, Inc., Dipti Shah, M.D., Akron City 
Hospital and others, for failure to timely diagnose and treat Thomas’s lung 
cancer.1   Plaintiff alleged that defendants were negligent in causing a 
seventeen-month delay in the diagnosis and treatment of lung cancer.  An 
 
3 
amended complaint added claims for loss of support, services, society and 
prospective inheritance. 
 
Defendants filed motions for summary judgment and the parties 
stipulated that, based upon plaintiff’s expert witness, plaintiff’s decedent would 
have had a twenty-eight percent chance of survival had proper and timely care 
been rendered.  Based upon this figure, defendants argued that summary 
judgment was warranted since plaintiff failed to establish that defendants’ 
negligence had, in probability, proximately caused decedent’s death.  Plaintiff, 
however, relying in part on the loss-of-chance theory of recovery, argued that 
she had established a triable issue of fact by presenting evidence that 
defendants’ negligence decreased decedent’s chance of survival from twenty-
eight percent to zero.  The trial court rejected plaintiff’s argument and granted 
defendants’ summary judgment motions on authority of Cooper v. Sisters of 
Charity of Cincinnati, Inc. (1971), 27 Ohio St.2d 242, 56 O.O.2d 146, 272 
N.E.2d 97.  The court of appeals affirmed. 
 
The cause is now before this court pursuant to the allowance of a 
discretionary appeal. 
 
4 
__________ 
 
A. William Zavarello Co., L.P.A., and A. William Zavarello, for 
appellant. 
 
Gallagher, Sharp, Fulton & Norman, Beverly A. Harris and Jay Clinton 
Rice, for appellees Ohio Permanente Medical Group, Inc. and Dipti Shah, M.D. 
 
Roetzel & Andress, Richard R. Strong and Marlene L. Franklin, for 
appellee Akron City Hospital. 
 
Dinsmore & Shohl, Stephen K. Shaw and Sara Simrall Rorer, urging 
affirmance for amicus curiae, Ohio Association of Civil Trial Attorneys. 
 
Jacobson, Maynard, Tuschman & Kalur Co., L.P.A., and Janis L. Small, 
urging affirmance for amicus curiae, Defense Research Institute. 
 
Bricker & Eckler, James J. Hughes, Jr. and Catherine M. Ballard, urging 
affirmance for amicus curiae, Ohio Hospital Association and Ohio State 
Medical Association. 
 
Spangenberg, Shibley, Lancione & Liber, John G. Lancione and Pamela 
Pantages, urging reversal for amicus curiae, Ohio Academy of Trial Lawyers. 
__________ 
 
5 
 
FRANCIS E. SWEENEY, SR., J.   The issue presented in this case is whether 
Ohio should recognize a claim for loss of chance in a wrongful death action 
where the decedent had a less than fifty-percent chance of survival.  For the 
following reasons, we answer this question in the affirmative. 
I  Overview of Loss-of-Chance Theory 
 
In medical malpractice cases, the general rule is that the plaintiff must 
prove causation through medical expert testimony in terms of probability to 
establish that the injury was, more likely than not, caused by the defendant’s 
negligence.  Shumaker v. Oliver B. Cannon & Sons, Inc. (1986), 28 Ohio St.3d 
367, 28 OBR 429, 504 N.E.2d 44. However,  the “loss of chance” theory, 
which compensates an injured plaintiff for his or her diminished chance of 
recovery or survival, provides an exception to the traditionally strict standard 
of proving causation in a medical malpractice action.  Instead of being required 
to prove with reasonable probability that defendant’s tortious conduct 
proximately caused injury or death, the 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 
 
6 
is less than probable.  Keith, Loss of Chance:  A Modern Proportional 
Approach to Damages in Texas (1992), 44 Baylor L.Rev. 759, 760. 
 
The rationale underlying the loss-of-chance theory is that traditional 
notions of proximate causation may unjustly deprive a plaintiff of recovery in 
certain cases even where the physician is blatantly at fault; thus, the 
requirement of proving causation is relaxed to permit recovery.  As explained 
by one court, when a patient is deprived of a chance for recovery, “the health 
care professional should not be allowed to come in after the fact and allege that 
the result was inevitable inasmuch as that person put the patient’s chance 
beyond the possibility of realization.  Health care providers should not be given 
the benefit of the uncertainty created by their own negligent conduct.  To hold 
otherwise would in effect allow [health] care providers to evade liability for 
their negligent actions or inactions ***.”  McKellips v. St. Francis Hosp., Inc. 
(Okla.1987), 741 P.2d 467, 474. 
 
The loss-of-chance theory has its early roots in the decision of Hicks v. 
United States (C.A.4, 1966), 368 F.2d 626.  In Hicks, the plaintiff’s decedent 
died from an obstruction of the intestine after being misdiagnosed as suffering 
 
7 
from gastroenteritis.  Expert testimony established that the decedent would 
have survived given proper treatment.  The defendant argued that proximate 
causation was not established because it was speculative that surgery would 
have saved the patient’s life.  The court, in finding that plaintiff had proved 
proximate causation, stated the following:   
 
“When a defendant’s negligent action or inaction has effectively 
terminated a person’s chance of survival, it does not lie in the defendant’s 
mouth to raise conjectures as to the measure of the chances that he has put 
beyond the possibility of realization.  If there was any substantial possibility of 
survival and the defendant has destroyed it, he is answerable.  Rarely is it 
possible to demonstrate to an absolute certainty what would have happened in 
circumstances that the wrongdoer did not allow to come to pass.  The law does 
not in the existing circumstances require the plaintiff to show to a certainty that 
the patient would have lived had she been hospitalized and operated on 
promptly.”  (Emphasis added.)  Id. at 632. 
 
In addition to the “substantial possibility” rule of Hicks, which permits 
recovery even where there is only a substantial possibility that the result would 
 
8 
have been avoided but for the tortious conduct, a number of jurisdictions that 
have adopted the loss-of-chance theory rely upon 2 Restatement of the Law 2d, 
Torts (1965), Section 323.  This provision provides: 
 
“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 
***.” 
 
Most of the courts that apply Section 323 hold that once the plaintiff 
proves that the defendant has increased the risk of harm by depriving the 
patient of a chance to recover, the case can go to the jury on the issue of 
causation regardless of whether the plaintiff could prove to a degree of medical 
probability that the defendant caused the patient’s injury or death.  See, e.g., 
Hamil v. Bashline (1978), 481 Pa. 256, 273, 392 A.2d 1280, 1288; Herskovits 
v. Group Health Coop. of Puget Sound (1983), 99 Wash.2d 609, 664 P.2d 474.  
 
9 
Although the plaintiff still has the burden of persuading the jury by a 
preponderance of the evidence that defendant brought about the harm plaintiff 
has suffered, the jury, rather than the medical expert, is given the task of 
balancing probabilities.  Hamil, 481 Pa. at 273, 392 P.2d at 1288. 
II  Application of Loss-of-Chance Theory in 
Ohio:  Cooper v. Sisters of Charity of Cincinnati, Inc. 
 
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, Ohio rejected the loss-of-chance theory in 
favor of adhering to the traditional standard of causation, which requires proof, 
in terms of probability, that defendant’s conduct proximately caused plaintiff’s 
injuries or death. 
 
In Cooper, the plaintiff’s decedent was struck by a truck while riding a 
bicycle.  He went to the emergency room, where he complained of a headache 
and vomited.  The physician failed to diagnose a fractured skull and instead 
released the boy, who died the next day from intracranial hemorrhaging.  
According to plaintiff’s expert, the decedent had a chance of recovery with 
surgery.  However, the expert was unclear as to the exact percentage, stating, 
 
10 
“[T]here certainly is a chance and I can’t say exactly what--maybe some place 
around 50%--that he would survive with surgery.”  (Emphasis omitted.)  Id. at 
247, 56 O.O.2d at 149, 272 N.E.2d at 101.  Another expert testified that it 
would be speculative to attempt to ascertain whether the boy would have 
survived surgery.  This court affirmed the judgment for the defendants on the 
ground that plaintiff could not establish that defendants’ negligence, in 
probability, proximately caused the death.  
 
Although we acknowledged that the loss-of-chance theory is attractive 
and that “[t]he strong intuitive sense of humanity tends to emotionally direct us 
toward a conclusion that in an action for wrongful death an injured person 
should be compensated for the loss of any chance for survival, regardless of its 
remoteness,” we nevertheless rejected the loss-of-chance theory for fear that it 
would cause more injustice than justice.  Id. at 251-252, 56 O.O.2d at 151, 272 
N.E.2d at 103.  However, since its inception, the rule in Cooper has been 
criticized as an “all-or-nothing” approach by commentators and courts alike. 
 
According to one commentator, “The loss of a chance of achieving a 
favorable outcome or of avoiding an adverse consequence should be 
 
11 
compensable and should be valued appropriately, rather than treated as an all-
or-nothing proposition.  Preexisting conditions must, of course, be taken into 
account in valuing the interest destroyed.  When those preexisting conditions 
have not absolutely preordained an adverse outcome, however, the chance of 
avoiding it should be appropriately compensated even if that chance is not 
better than even.”  King, Causation, Valuation, and Chance in Personal Injury 
Torts Involving Preexisting Conditions and Future Consequences (1981), 90 
Yale L.J. 1353, 1354.  See, also, McKellips, supra, 741 P.2d at 473-474. 
 
In revisiting Cooper, we recognize that our court has traditionally acted 
as the embodiment of justice and fundamental fairness.  Rarely does the law 
present so clear an opportunity to correct an unfair situation as does this case 
before us.  The time has come to discard the traditionally harsh view we 
previously followed and to join the majority of states that have adopted the 
loss-of-chance theory.  A patient who seeks medical assistance from a 
professional caregiver has the right to expect proper care and should be 
compensated for any injury caused by the caregiver’s negligence which has 
reduced his or her chance of survival.  Over the years, medical technology has 
 
12 
improved and advances have been made in the treatment of many areas of 
medicine, including cancer.  However, these medical strides are meaningless 
unless early detection is practiced diligently by those in the health care field.  
Thus, a health care provider should not be insulated from liability where there 
is expert medical testimony showing that he or she reduced the patient’s 
chances of survival.  Unfortunately, under the traditional view, this is precisely 
the outcome.  The innocent patient is the loser while the health care provider 
escapes liability despite his or her negligence.   
 
We can no longer condone this view and consequently overrule Cooper 
v. Sisters of Charity of Cincinnati, Inc., supra.  Instead, we recognize the loss-
of-chance theory and follow the approach set forth in Section 323, Restatement 
of Torts.  Under this view, we hold as follows:  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.  Once this burden is met, the trier of fact may 
 
13 
then assess the degree to which the plaintiff’s chances of recovery or survival 
have been decreased and calculate the appropriate measure of damages.  The 
plaintiff is not required to establish the lost chance of recovery or survival in an 
exact percentage in order for the matter to be submitted to the jury.  Instead, the 
jury is to consider evidence of percentages of the lost chance in the assessment 
and apportionment of damages.  See McKellips, supra, 741 P.2d at 475. 
III  Measure of Damages 
 
In ascertaining the amount of damages recoverable, we believe that the 
most rational approach is the proportional damage approach advocated by 
Professor King (see 90 Yale L.J., supra, at 1381-1387) and applied by a 
number of courts.  See Delaney v. Cade (Kan.1994), 873 P.2d 175, 186-187; 
McKellips, supra, 741 P.2d 467.  Under this approach, damages are awarded in 
direct proportion to the chance of survival or recovery that the plaintiff lost.  As 
stated by Professor King, “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] 
 
14 
to preexisting conditions.  The effect of preexisting conditions should depend 
on the extent to which such conditions affect the present and future value of the 
interest lost.”  King, supra, at 1360.  This approach provides an equitable 
method of apportioning damages consistent with the degree of fault attributable 
to the health care provider.  Thus, rather than compensating the plaintiff for all 
damages allowed in a malpractice or wrongful death action, the defendant is 
liable only for those damages attributable to his percentage of negligence. 
 
Consequently, the amount of damages recoverable by a plaintiff in a 
loss-of-chance case 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.  Delaney, supra, 255 Kan. at 217-219, 873 
P.2d at 187.  The McKellips court, 741 P.2d at 477, provides the following 
illustration of how damages should be computed: 
 
“To illustrate the method in a case where the jury determines from the 
statistical findings combined with the specific facts relevant to the patient [that] 
the patient originally had a 40% chance of cure and the physician’s negligence 
reduced the chance of cure to 25%, (40% - 25%) 15% represents the patient’s 
 
15 
loss of survival.  If the total amount of damages proved by the evidence is 
$500,000, the damages caused by defendant is 15% x $500,000 or $75,000.” 
 
To ascertain the amount of damages, the trial court must instruct the trier 
of fact to consider the expert testimony presented and (1) determine the total 
amount of damages from the date of the alleged negligent act or omission, 
including but not limited to lost earnings and loss of consortium; (2) ascertain 
the percentage of the patient’s lost chance of survival or recovery; and (3) 
multiply that percentage by the total amount of damages. 
IV  Conclusion 
 
We stress that our decision today is limited in its scope and does not alter 
traditional principles of causation in other areas of tort law.  Instead, in 
overruling Cooper, supra, we join the majority of states that have adopted the 
loss-of-chance theory and recognize the importance of compensating plaintiffs 
in an amount consistent with the defendant’s negligent acts or omissions.  In 
this respect, innocent patients who may have enjoyed a longer health span or 
better quality of life absent the defendant’s wrongdoing are given legal redress 
in proportion to their loss. 
 
16 
 
Accordingly, we reverse the judgment of the court of appeals and remand 
the matter to the trial court. 
                                                                                               Judgment reversed 
                                                                                              and cause remanded. 
 
DOUGLAS, RESNICK and PFEIFER, JJ., concur. 
 
MOYER, C.J., concurs in part and dissents in part. 
 
COOK and STRATTON, JJ., separately dissent. 
 
Footnote: 
1   Other named defendants were later voluntarily dismissed. 
Roberts v. Ohio Permanente Medical Group, Inc. 
 
MOYER, C. J., concurring in part and dissenting in part.  Though I 
agree with the conclusion of the majority that it is time for Ohio to 
abandon the all-or-nothing rule of Cooper v. Sisters of Charity of 
Cincinnati, Inc. (1971), 27 Ohio St.2d 242, 56 O.O.2d 146, 272 N.E.2d 
97, in medical malpractice wrongful death cases, I would not attempt to 
extend the doctrine to injury cases in which the plaintiff argues that his 
or her recovery was either slower or less complete than it might have 
 
17 
been in the absence of negligence.  I believe such an expansion 
threatens to nullify the advantages of the new doctrine by opening the 
door to confusion, inequity and excessive litigation. 
 
The majority has extended the holding of the case beyond the 
issues specifically raised by the parties on the record, and has 
unnecessarily broadened its holding to create a new common-law cause 
of action unrelated to the wrongful death issue before the court.  Indeed, 
the doctrine is referred to in the briefs as the loss of chance of survival 
doctrine. 
 
The majority attempts to reassure the skeptics by avowing, “our 
decision today is limited in its scope and does not alter traditional 
principles of causation in other areas of tort law.”  That disclaimer is 
unfortunately refuted by the plain words of paragraph one of the 
syllabus.  The second sentence holds:  “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.) 
 
18 
 
For the foregoing reasons, I concur in the judgment and dissent 
from paragraph one of the syllabus and the supporting reference in the 
opinion. 
 
COOK, J., dissenting.  The concept embraced by today’s decision is superficially 
appealing.  It ameliorates the harshness of the traditional rule that prevents any recovery for 
an injury unless one can show by a preponderance of the evidence that the wrongful act of the 
defendant caused the injury.  However, by awarding the estate a percentage of the total 
damages because it cannot show causation by a preponderance of the evidence, the court 
obviates time-honored principles underlying the right to compensation in tort, including the 
basic concept of assessing fault.   
 
Moreover, with the loss-of-chance theory, as recognized in some jurisdictions, the 
injury suffered and the basis of the claim are the reduced possibility of survival, and not the 
death itself.  The only claim filed by the plaintiff in this case is wrongful death.  The majority 
analysis does not fit within the wrongful death parameters.  If the majority decision permits 
recovery  for “injury or death” (emphasis added), as is stated in paragraph one of the 
syllabus, and recognizes  injury to the “innocent patients who may have enjoyed a longer 
health span,” then such a claim is not encompassed by R.C. Chapter 2125.  The wrongful 
death statutes provide a cause of action “for the exclusive benefit of the surviving spouse, the 
children, and the parents of the decedent,” not the decedent.  R.C. 2125.02(A)(1). 
 
19 
 
Despite the sympathetic appeal of its conclusion, I respectfully dissent  because the 
majority decision breaks with sound legal principles. 
 
STRATTON, J., concurs in the foregoing dissenting opinion. 
 
STRATTON, J., dissenting.  I  dissent.  Cooper v. Sisters of Charity of 
Cincinnati, Inc. (1971), 27 Ohio St. 2d 242, 56 O.O.2d 146, 272 N.E.2d 97, 
was soundly grounded in principles of tort and causation and should not be 
abandoned.  In addition, a wrongful death action is a statutory right and does 
not create a cause of action for “loss of chance.”  Such a right of recovery 
should be created by the legislature, not by judicial fiat.  Therefore, I 
respectfully dissent. 
 
COOK, J., concurs in the foregoing dissenting opinion.