Title: Gale Ann Lynch, et als. v. Laurence M. Scheininger, M.D., et als.

State: new-jersey

Issuer: New Jersey Supreme Court

Document:

(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for the convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please note that, in the interests of brevity, portions of any opinion may not have been summarized). STEIN, J., writing for a unanimous Court. This appeal presents an issue of first impression concerning recognition of and limitations on a physician's liability for a preconception tort allegedly resulting in harm to a child conceived after the negligence occurred. In connection with its resolution of this appeal, the Court considers whether the parents' voluntary act of conception, although aware of an increased risk of harm to a child born of the pregnancy, is a superseding cause that relieves the physician of liability, and, further, whether communication of an adequate warning of the increased risk of harm by the negligent physician or by others limits the physician's liability. This appeal arises from a medical malpractice action against Drs. Laurence M. Scheininger and Lawrence A. Seitzman for obstetrical services rendered to Gale Lynch during a 1984 pregnancy that terminated in a stillbirth. The uncontroverted medical evidence at trial in that matter established that the 1984 stillbirth was attributable to erythroblastosis fetalis, a condition of fetus caused by the incompatibility of maternal and fetal blood Rh factors. The process resulting in erythroblastosis fetalis, known as Rh isoimmunization, can be prevented by a drug called Rhogam if it is administered before the mother's immune system reacts to the incompatible fetal blood by producing antibodies to attack them. Dr. Scheininger acknowledged that he did not diagnose Mrs. Lynch's Rh isoimmunization during the 1984 pregnancy, and that his failure to treat her for that condition was a factor that resulted in the stillbirth of the infant boy named Brian. In 1986, Mrs. Lynch and her husband instituted a malpractice action against Dr. Scheininger and others to recover damages relating to the stillbirth. While that action was pending, Mrs. Lynch gave birth to Joseph Lynch on January 11, 1987. Joseph was born with significant and permanent neurological disabilities caused by erythroblastosis fetalis, the very condition that led to the 1984 stillbirth. Although Mrs. Lynch and her husband moved to amend their complaint in the suit arising out of the stillbirth to assert damage claims relating to Joseph's birth, that motion was denied. Therefore, the Lynches instituted a second action against Drs. Scheininger, Seitzman, and others, alleging that their failure to diagnose and treat Mrs. Lynch's Rh isoimmunization during her 1984 pregnancy resulted in an intensification of that isoimmunization that increased the risk of harm to children subsequently conceived. In that second suit, the Lynches asserted a claim of wrongful birth on their own behalf, a claim of wrongful life on Joseph's behalf based on the doctors' alleged failure to inform them of the risks of a future pregnancy, and a claim on Joseph's behalf alleging that the doctors' malpractice during the 1984 pregnancy was a substantial a contributing cause of Joseph's severe impairments and resultant medical and other expenses. In 1992, while the second action was pending, the earlier suit against Dr. Scheininger relative to the 1984 stillbirth was settled, with an express reservation of the claims asserted against Dr. Scheininger in the second action. During the course of trial in the second action, the Law Division conducted a Lopez hearing, in response to the doctors' contention that the wrongful birth claim was barred by the two-year statute of limitations because the suit was not instituted within two years of Joseph's birth. The Lynches relied on the discovery rule, contending that they did not become aware of the connection between Joseph's impairments and the doctors' 1984 negligence until they received the report of their expert in October 1989. At the conclusion of the Lopez hearing, the trial court determined that the Lynches knew or should have known at the time of Joseph's birth of their potential claim against the doctors for Joseph's impairments, and consequently dismissed the Lynches' wrongful birth claim. The trial court also dismissed Joseph's wrongful life claim at the close of the Lynches' case, concluding that the evidence adduced at trial could not support a jury finding that the Lynches relied on the doctors' advice in deciding to conceive another child. Two significant factual issues were sharply contested at trial. The first one concerned whether the doctors' alleged malpractice during the 1984 pregnancy was a proximate cause of Joseph's disabilities. The second one concerned when the Lynches acquired knowledge that Mrs. Lynch's Rh isoimmunization posed a danger to the health of children born as a result of pregnancies subsequent to the 1984 stillbirth. After a twenty-three day trial, the trial court submitted the case to the jury, reserving decision on the doctors' motions to dismiss Joseph's malpractice claim. However, the jury was unable to reach a verdict. Subsequently, in an unpublished opinion on the reserved motions, the trial court presumed that New Jersey would recognize a cause of action of a preconception tort, characterized as a claim that a doctor's negligence caused damage to a woman's reproductive system resulting in harm to a child conceived after that negligence occurred. However, mischaracterizing its own finding at the Lopez hearing, the trial court determined that because it had determined that the Lynches were aware of the risks presented by Mrs. Lynch's Rh negative condition prior to Joseph's conception, that finding constituted an adjudication on the merits of the issue of when they knew that the condition posed a risk to future pregnancies. Based on that reasoning, the trial court held that the Lynches' intentional conception of Joseph with that knowledge constituted a supervening cause of Joseph's condition that barred imposition of liability on Dr. Scheininger. On appeal, the Appellate Division affirmed the trial court's dismissal of the Lynches' wrongful birth claim on the ground that it was not filed within two years of Joseph's birth. The court also affirmed the dismissal of Joseph's wrongful life claim. However, the Appellate Division reversed the trial court's dismissal of Joseph's malpractice cause of action against Dr. Scheininger. While not disputing the trial court's mischaracterization of its Lopez ruling (that the Lynches were aware of the risks prior to Joseph's conception), the court concluded that that finding was not subject to collateral estoppel on the reserved motion to dismiss Joseph's claims because it was not necessary to support the court's determination to dismiss the parents' wrongful birth claim. The Appellate Division further found that the Lynches' voluntary decision to conceive another child did not constitute a supervening cause of Joseph's disabilities and that Joseph, therefore, was not precluded from pursuing his malpractice action against Dr. Scheininger. Because the Appellate Division found sharply conflicting evidence concerning what warnings were communicated to the Lynches about the risks of a future pregnancy, it declined to decide whether Dr. Scheininger would be insulated from liability if the Lynches knew prior to conceiving Joseph that there was a high likelihood that a child of a subsequent pregnancy would be born with serious disabilities. The Supreme Court granted Dr. Scheininger's petition for certification. HELD: New Jersey recognizes an action based on preconception negligence or tort; in the absence of knowledge of a high level risk of harm to a child born of a pregnancy, parents' voluntary act of conception does not constitute a superseding cause that will relieve a physician of liability for his or her prior negligence; liability may be apportioned pursuant to doctrine of avoidable consequences if parents' voluntary act of conception occurred when parents knew of an d assumed less than a high risk that the child either would not survive or would be born with serious disabilities. 1. In determining what constitutes a superseding cause, New Jersey courts have focused on the specific facts and circumstances that raise the issue, regardless of whether the intervening event involved negligence or intentional conduct by others. (pp. 22-28) 2. A doctrine that may be implicated on retrial is that of avoidable consequences, a doctrine that focuses on diminution of damages on the basis of a plaintiff's failure to avoid the consequences of a defendant's tortious conduct after that conduct has occurred. (pp. 28-32) 3. New Jersey recognizes a medical malpractice cause of action based on preconception negligence that allegedly resulted in injury to a child conceived after the negligence occurred. New Jersey's proximate cause jurisprudence is sufficiently flexible to bar claims for injuries that are unreasonably remote in relation to a defendant's negligence. (pp. 32-35) 4. Despite the stillbirth that terminated the 1984 pregnancy, the Lynches decision to conceive another child was foreseeable in the absence of information or a warning that a subsequent pregnancy involved risks of such magnitude that a high likelihood existed that the child either would not survive or would be born with serious disabilities. However, if on retrial a factual issue is presented about whether the Lynches knew of that high likelihood, such a finding would supersede the doctor's liability for his prior negligence. (pp. 35-38) 5. On retrial, if evidence is adduced that would permit the jury to find that the risks of another pregnancy were significant enough that the Lynches' decision to conceive Joseph, although foreseeable, constituted a deliberate election not to avoid the known but unquantified risk of future injury, the jury may be instructed to consider that evidence as bearing on the apportionment of responsibility for Joseph's injuries under the avoidable consequences doctrine. (pp. 38-43) 7. Although permitting the parent's willingness to bear the risk of conception to bear on a child's recovery of damages may stretch the contours of traditional applications of comparative fault, that apportionment of responsibility for the child's injuries reflects a pragmatic evaluation of the respective alleged causes of those injuries. (pp. 44-45) Judgment of the Appellate Division is AFFIRMED and the matter is REMANDED to the Law Division for further proceedings consistent with this opinion. CHIEF JUSTICE PORITZ and JUSTICES O'HERN, GARIBALDI, COLEMAN, LONG, and VERNIERO join in JUSTICE STEIN's opinion. SUPREME COURT OF NEW JERSEY A- 57 September Term 1998 GALE ANN LYNCH and ROBERT LOUIS LYNCH, her husband, and JOSEPH LYNCH, an infant, by his Guardians ad Litem, GALE ANN LYNCH and ROBERT LOUIS LYNCH, and GALE ANN LYNCH and ROBERT LOUIS LYNCH, individually and per quod, Plaintiffs-Respondents, v. LAURENCE M. SCHEININGER, M.D., Defendant-Appellant, and ESTATE OF JERROLD S. FINKEL, M.D., PAUL DRUCKER, M.D., LAWRENCE A. SEITZMAN, M.D., DRS. FINKEL, DRUCKER & SEITZMAN, PROFESSIONAL ASSOCIATION, DRUCKERS, SEITZMAN & SCHEININGER PROFESSIONAL ASSOCIATION, either a corporation, partnership, individual proprietorship, JOHN F. KENNEDY MEDICAL CENTER, and STEPHEN A. GROCHMAL, M.D., Defendants. Argued September 13, 1999 -- Decided January 25, 2000 On certification to the Superior Court, Appellate Division, whose opinion is reported at 314 N.J. Super. 318 (1998). Hugh P Francis argued the cause for appellant (Francis & O'Farrell, attorneys; Mr. Francis and John O'Farrell of counsel; Beth A. Hardy, on the briefs). Richard C. Swarbrick argued the cause for respondents. The opinion of the Court was delivered by STEIN, J. This appeal presents an issue of first impression concerning recognition of and limitations on a physician's liability for a preconception tort allegedly resulting in harm to a child conceived after the negligence occurred. The questions that primarily will determine our resolution of this appeal are first, whether the parents' voluntary act of conception, although aware of an increased risk of harm to a child born of the pregnancy, is a superseding cause that relieves the physician of liability, and second, whether communication of an adequate warning of the increased risk of harm by the negligent physician or by others limits the physician's liability. Reversing the Law Division and remanding the matter for a new trial on the infant's malpractice claim, the Appellate Division in a published opinion, Lynch v. Scheininger, 314 N.J. Super. 318 (App. Div. 1998), held that the parent's "voluntary decision to conceive another child did not constitute a supervening cause" that precluded the child from maintaining a malpractice claim to recover damages for devastating and irremediable birth defects allegedly caused in part by the preconception negligence of the mother's physician during a prior pregnancy. Id. at 329. In that court's view, the evidence of the extent of the parents' knowledge of the risk of harm to children of subsequent pregnancies was "sharply conflicting." Accordingly, the Appellate Division did not decide whether voluntary conception coupled with knowledge that a child of a subsequent pregnancy was highly likely to be born with serious disabilities would insulate the physician from liability. Id. at 330-31. See also, J.S. v. R.T.H., 155 N.J. 330, 352 (1998) (holding that prolonged sexual abuse of neighboring adolescent girls by defendant's husband with known proclivity for such behavior not a superseding cause of wife's negligent failure to warn victims or take other reasonable steps to prevent harm to them); Cowan v. Doering, 111 N.J. 451, 465-66 (1988) (affirming judgment after jury verdict for plaintiff hospitalized after overdosing on sleeping pills in earlier suicide attempt who claimed that physicians, nurses, and hospital negligently failed to prevent her jumping from second-story hospital room, and holding that issue whether plaintiff's leap from hospital room constituted superseding cause insulating defendants from liability properly was submitted to trial jury for resolution); Parks v. Pep Boys, 282 N.J. Super. 1, 8-12 (App. Div. 1995) (affirming denial of summary judgment on liability and holding that question whether decedent's voluntary inhalation of Freon sold by defendant to decedent's fourteen-year-old companion constituted superseding cause that barred defendant's liability for negligent sale of Freon raised causation issue for determination by jury at trial). In other contexts, our courts have determined that intervening events constituted superseding causes as a matter of law, where such events were sufficiently extraordinary or so clearly unrelated to the antecedent negligence that imposition of liability would be unreasonable. See Caputzal v. Lindsay Co., 48 N.J. 69, 77-80 (1966) (holding that even if defect in water softener caused rusty discoloration of water, manufacturer was not liable to plaintiff who suffered idiosyncratic and unanticipated heart attack brought on by fright at sight of discolored water); Meyer v. Board of Ed. of Middletown Twp., 9 N.J. 46, 54-55 (1952) (affirming directed verdict for defendants and holding that even assuming school board's negligence in failing to install guard over belt-drive mechanism of power jig saw, intervening act of classmate in throwing electric switch that started jig saw while plaintiff was cleaning it constituted superseding cause that broke chain of causation and insulated school board from liability); Glaser v. Hackensack Water Co., 49 N.J. Super. 591, 600-01 (App. Div. 1958) (holding that water company whose employee entered plaintiffs' garage without notice to read meter was insulated from liability by intervening act of plaintiff who became frightened for safety of infant daughter and injured herself while running down stairs to first floor to ascertain who had entered garage). In Ostrowski, supra, in which we held that the plaintiff's post-operative health habits could limit the damages recoverable for defendant's allegedly negligent toenail surgery, Justice O'Hern emphasized that even if the plaintiff did not follow her physician's post-operative instructions, that conduct would not extinguish defendant's liability but would instead diminish the recoverable damages: [I]t would be the bitterest irony if the rule of comparative negligence, designed to ameliorate the harshness of contributory negligence, should serve to shut out any recovery to one who would otherwise have recovered under the law of contributory negligence. Put the other way, absent a comparative negligence act, it would have never been thought that "avoidable consequences" or "mitigation of damages" attributable to post-accident conduct of any claimant would have included a shutout of apportionable damages proximately caused by another's negligence. Negligent conduct is not "immunized by the concept of 'avoidable consequences.' This argument should more properly be addressed to the question of diminution of damages; it does not go to the existence of a cause of action." Associated Metals & Minerals Corp. v. Dixon Chem. & Research, Inc., 82 N.J. Super. 281, 306 (App. Div. 1963), certif. denied, 42 N.J. 501 (1964); see also Flynn v. Stearns, 52 N.J. Super. 115, 120-21 (App. Div. 1958) ( Where the fault of the patient was subsequent to the fault of the physician and merely aggravated the injury inflicted by the physician, it only affects 'the amount of the damages recoverable by the patient.'" (emphasis added) (citation omitted)); Restatement (Second) of Torts, 918 at 500 and comment a (doctrine of avoidable consequences "applies only to the diminution of damages and not to the existence of a cause of action"). [Ostrowski, supra, 111 N.J. 441-42.] Depending on the proofs elicited at retrial concerning the substance of warnings given to the Lynches after the 1984 stillbirth about the risks to be anticipated from future pregnancies, the court may be required to instruct the jury concerning the doctrine of avoidable consequences and its application to the Lynches' decision to conceive Joseph. [i]f the defendant was negligent in the respects charged by plaintiff, plaintiff's failure to exercise was subsequent to the fault of the physician and merely aggravated the injury inflicted by the physician and therefore it affected only the amount of the damages recoverable by the patient. [Id. at 123-24 (quoting 41 Am. Jur. Physicians & Surgeons, 80, p. 199.] Our leading case on the doctrine of avoidable consequences is Ostrowski, supra, 111 N.J. 429, where the plaintiff, an overweight, diabetic smoker, allegedly exacerbated the effects of defendant's negligent removal of her left big toenail by failing to maintain her weight, diet, and blood sugar at acceptable levels. Ibid. The trial court allowed the jury to find that plaintiff's post-operative health habits constituted comparative negligence that could bar recovery rather than reduce damages. Ibid. Reversing, we held that under the doctrine of avoidable consequences a plaintiff's post-negligence conduct that increased the risk of harm from defendant's negligence could be considered by the jury as fault-based conduct that would reduce plaintiff's damages but would not bar recovery. Id. at 443. We cited with approval the Uniform Comparative Fault Act (U.C.F.A.) 12 U.L.A 38 (1988 Supp.), which includes in its definition of fault an unreasonable failure to avoid an injury or to mitigate damages. U.C.F.A. 1(b). The primary holding of Ostrowski may apply to the retrial of this matter. If evidence is adduced that would permit the jury to find that the risks of another pregnancy were significant enough that the Lynches' decision to conceive Joseph, although clearly a foreseeable consequence of defendant's negligence, constituted a deliberate election not to avoid the known but unquantified risk of future injury, the jury may be instructed to consider that evidence as bearing on the apportionment of responsibility for Joseph's injuries under the avoidable consequences doctrine. We note that pursuant to the Proposed Final Draft of the chapter of the American Law Institute's Restatement (Third) of Torts dealing with Apportionment of Liability, among the factors material to assigning shares of responsibility is the character and nature of each person's risk-creating conduct, irrespective of whether evidence of that conduct is necessary to prove or disprove a claim or defense. Restatement (Third) of Torts: Apportionment of Liability 8 comment c (Proposed Final Draft, March 22, 1999). The Restatement's discussion implies that risk-creating conduct, whether or not an element of a cause of action, may be germane to the apportionment of damages. We acknowledge that in Ostrowski it was plaintiff's conduct that increased the risk of harm from defendant's negligence, whereas the risk-avoidance issue in this case relates to the conduct of the Lynches, Joseph's parents. Nevertheless, in terms of the fair allocation of responsibility to defendant Scheininger the relevance, if proved, of the Lynches' election to assume the risks of a subsequent pregnancy would be clear and compelling. We would not characterize the Lynches' election to conceive a child as fault-based because the decision to procreate is so fundamentally subjective, and no standard of objective reasonableness adequately could inform a decision about whether the determination to assume the risks of conception was a reasonable one. Nevertheless, we reiterate our observation in Ostrowski that given the understandable complexity of concurrent causation, characterizing plaintiffs' decision to bear that risk as a percentage of fault [that] reduces plaintiff's damages may aid juries in their just apportionment of damages. Ostrowski, supra, 111 N.J. at 443. The automobile seat-belt cases offer a rough analogy to the apportionment of responsibility methodology that we contemplate. In Waterson v. General Motors Corp., 111 N.J. 238 (1988), we held that in an automobile accident proximately caused by a defendant's negligence, only those additional damages incurred as a partial result of the plaintiff's failure to wear a seat belt are subject to an apportionment of responsibility between the parties. However, those damages that would have been incurred irrespective of plaintiff's failure to wear a seat belt were not subject to apportionment. Id. at 241-42. In the context of this record, we would regard the damages resulting from Brian's stillbirth as damages for which defendant (and his colleagues in that delivery) are solely responsible, and the responsibility for damages resulting from Joseph's disabilities as being allocable among defendant and Dr. Grochmal as tortfeasors, and the Lynches under the avoidable consequences doctrine. Depending on the record at retrial, the trial court on remand will make the ultimate discretionary determination whether the jury should be instructed to apportion responsibility for Joseph's injuries in accordance with the doctrine of avoidable consequences. If that instruction is given, we contemplate that the trial court, consistent with Ostrowski, supra, 111 N.J. at 443, will permit the jury to treat the Lynches' election to conceive Joseph and bear the risk of an adverse result as fault based for purposes of the jury's allocation of responsibility for Joseph's damages. Underlying our conclusion is an evaluation of the capability of the judicial system, often proceeding in these cases through trial by jury, to appraise such a claim. Also at work is an appraisal of the role of tort law in compensating injured parties, involving as that role does, not only reason, but also fairness, predictability, and even deterrence of future wrongful acts. . . . [T]he ultimate decision is a policy choice summoning the most sensitive and careful judgment. [Id. at 354.] NO. A-57 GALE ANN LYNCH and ROBERT LOUIS LYNCH, her husband, and JOSEPH LYNCH, an infant, by his Guardians ad Litem, GALE ANN LYNCH and ROBERT LOUIS LYNCH, and GALE ANN LYNCH and ROBERT LOUIS LYNCH, individually and per quod, Plaintiffs-Respondents, v. LAURENCE M. SCHEININGER, M.D., Defendant-Appellant, and ESTATE OF JERROLD S. FINKEL, M.D., PAUL DRUCKER, M.D., LAWRENCE A. SEITZMAN, M.D., DRS. FINKEL, DRUCKER & SEITZMAN, PROFESSIONAL ASSOCIATION, DRUCKERS, SEITZMAN & SCHEININGER PROFESSIONAL ASSOCIATION, either a corporation, partnership, individual proprietorship, JOHN F. KENNEDY MEDICAL CENTER, and STEPHEN A. GROCHMAL, M.D., Defendants. DECIDED January 25, 2000 Chief Justice Poritz