Title: SANDRA J WICKENS V OAKWOOD HEALTHCARE SYSTEM

State: michigan

Issuer: Michigan Supreme Court

Document:

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________________________________ 
Michigan Supreme Court
Lansing, Michigan 48909 
C hief Justice 
Justices
Maura D. Corrigan  
Michael F. Cavanagh
Elizabeth A. Weaver 
Marilyn Kelly
Clifford W. Taylor
Robert P. Young, Jr.
Stephen J. Markman 
Opinion 
FILED JULY 24, 2001  
SANDRA J. WICKENS and DAVID WICKENS,  
Plaintiff-Appellees,  
and  
BLUE CROSS/BLUE SHIELD,  
Intervening Plaintiff,  
v 
No. 117731  
OAKWOOD HEALTHCARE SYSTEM, an 
assumed name for OAKWOOD  
HEALTHCARE, INC., BELLEVILLE 
HEALTH CARE CENTER, an assumed 
name for OAKWOOD HEALTHCARE  
INC., DR. CHRISTOPHER PABIAN 
and OAKWOOD HEALTHCARE CENTER- 
CANTON, an assumed name for 
OAKWOOD HEALTHCARE, INC.,  
Defendants-Appellants,  
and  
DR. PATRICIA NESTER,  
Defendant.  
BEFORE THE ENTIRE BENCH  
YOUNG, J.  
The trial court directed a verdict in this medical  
malpractice case in defendants’ favor on the basis that  
plaintiff’s claim was barred by MCL 600.2912a(2), which  
precludes recovery for “loss of an opportunity to survive”  
unless the “opportunity was greater than 50%.” We hold that  
a living person may not recover for loss of an opportunity to  
survive, and that plaintiff’s claim is therefore barred to the  
extent that it is based on such loss of opportunity.  We  
further hold that the trial court nevertheless erred in  
dismissing plaintiff’s case in its entirety, because she has  
made additional claims that are independent of her claim for  
loss of an opportunity to survive.  Accordingly, we reverse in  
part and vacate in part the opinion of the Court of Appeals  
and remand this matter to the trial court for further  
proceedings consistent with this opinion.  
I. FACTS AND PROCEEDINGS  
Defendant 
Oakwood 
Healthcare 
System 
operates 
an  
outpatient medical clinic where plaintiff Sandra Wickens1  
consulted 
defendant 
Dr. Christopher Pabian regarding a lump in  
her right breast.  Dr. Pabian referred plaintiff for a  
mammogram that Oakwood personnel administered and interpreted  
in April 1995.  The interpreter reported that the breast  
tissue had abnormalities, but that they were not cause for  
alarm because of plaintiff’s age, forty-eight, and her breast  
1Plaintiff David Wickens’ claim is derivative in nature.  
For the sake of simplicity, we refer to Sandra Wickens as 
“plaintiff.”  
2  
tissue density.  She was told to get a repeat mammogram in six  
months.  
In November 1995, plaintiff tried to get the repeat  
mammogram, 
but 
Oakwood personnel incorrectly told her that her  
insurance would not pay for a second mammogram within twelve  
months.  Plaintiff waited the additional six months and had  
another mammogram in May 1996, when the interpreter spotted a  
mass in the right breast and recommended a biopsy.  The  
biopsy, performed two weeks later, revealed a malignancy.  
On May 29, 1996, plaintiff underwent a mastectomy to  
remove her right breast and the adjacent lymph nodes.  The  
malignant lump in her breast measured about six centimeters in  
diameter.
 Nine of the thirteen lymph nodes contained  
malignant tissue, indicating a substantial probability that  
the cancer had spread.  Plaintiff underwent postsurgery  
chemotherapy and radiation treatments to minimize any chance  
of spreading.  
In 
January 
1997, plaintiff consulted doctors about a lump  
in her left breast.  Although no malignancy was detected,  
plaintiff underwent a mastectomy to remove her left breast.  
That was followed with chemotherapy and radiation treatments.  
Plaintiff filed this medical malpractice suit in  
September 
1997, 
alleging that the one-year delay in diagnosing  
her cancer constituted medical malpractice by the defendants.  
She alleged that the defendants’ malpractice had caused her to  
suffer a poorer prognosis of cure or long-term survival, a  
reduction in the quality of life and life expectancy, the need  
to undergo more radical intervention than would have been  
3  
 
necessary a year earlier, and pain and suffering.  
Both parties deposed plaintiff’s expert, Dr. David  
Schapira, an oncologist.  Dr. Schapira testified that the  
malignant lump in plaintiff’s right breast would most likely  
have measured less than two centimeters in April 1995; that at  
that time fewer than nine of plaintiff’s lymph nodes, probably  
between one and three, would have been affected by the cancer;  
and that it was generally regarded that appropriate treatment  
for a cancerous condition of that type would consist of a  
lumpectomy and radiation therapy, rather than a mastectomy.  
Moreover, according to Dr. Schapira, plaintiff’s probability  
of living ten years after the 1996 diagnosis was fifteen  
percent. If plaintiff’s breast cancer had been diagnosed in  
April 1995, she would have had (1) a seventy percent chance of  
surviving ten years if the cancer involved only one lymph  
node, or (2) a fifty-five percent chance of surviving ten  
years if the cancer involved three lymph nodes.  On cross­
examination, Dr. Schapira opined that plaintiff’s cancer had  
likely affected two or three lymph nodes in 1995.  
Defendants filed a motion in limine for a directed  
verdict, arguing that according to Dr. Schapira’s testimony,  
plaintiff 
could 
not 
meet the requirements of MCL 600.2912a(2).  
Section 2912a(2) provides:  
In an action alleging medical malpractice, the 
plaintiff has the burden of proving that he or she 
suffered an injury that more probably than not was 
proximately caused by the negligence of the  
defendant or defendants.  In an action alleging 
medical malpractice, the plaintiff cannot recover 
for loss of an opportunity to survive or an 
opportunity to achieve a better result unless the 
opportunity was greater than 50%.  
4  
 
Defendants argued that Dr. Schapira’s testimony showed that  
any malpractice by defendants reduced plaintiff’s probability  
of surviving ten years by forty percent.2  Because defendants  
calculated plaintiff’s loss at only forty percent, they  
contended that she therefore could not prove that she lost a  
greater 
than 
fifty 
percent opportunity to survive, as required  
by § 2912a(2).  
The trial court agreed and granted defendants’ motion,  
dismissing plaintiff’s entire case.  
The Court of Appeals reversed, holding that § 2912a(2)  
only requires that the plaintiff demonstrate that had the  
defendant not been negligent, there was a greater than fifty  
percent opportunity to survive.3  Additionally, the Court of  
Appeals 
held 
that 
plaintiff satisfied § 2912a(2) by presenting  
expert testimony that she would have had a fifty-five to  
seventy percent chance of surviving ten years if her cancer  
had been diagnosed in April 1995.  The panel further ruled  
that the trial court should not have dismissed plaintiff’s  
case in its entirety:  
Plaintiffs further argue that the trial court 
erred in not allowing this case to proceed to trial 
on their claim that, as a result of defendants’ 
negligence, Wickens was deprived of the opportunity 
for a better result.  We agree. 
Pursuant to MCR  
2.515, a “party may move for a directed verdict at 
the close of the evidence offered by an opponent. 
The motion must state specific grounds in support  
2Defendants arrived at forty percent by subtracting the May 
1996 ten-year survival rate of fifteen percent from the April 
1995 rate of fifty-five percent, given Dr. Schapira’s opinion 
that the cancer had likely affected two to three lymph nodes 
in 1995. 
 3242 Mich App 385; 619 NW2d 7 (2000).  
5  
of the motion.” . . . Thus, the trial court erred 
in dismissing plaintiffs’ entire cause of action 
without affording plaintiffs the opportunity to 
present their case at trial.  Furthermore, the 
trial court’s dismissal of plaintiffs’ entire cause 
of action was erroneous because defendants merely 
discussed plaintiffs’ claim for loss of opportunity 
to survive in their motion for directed verdict.  
[242 Mich App 393.]  
We granted defendants’ application for leave to appeal,  
directing the parties to brief the issue whether a living  
plaintiff can bring a cause of action for loss of an  
opportunity to survive when the claimed injury is a reduction  
in her projected chances of long-term survival.4 
 II. STANDARD OF REVIEW  
Before trial, defendants filed a motion in limine for  
directed verdict to dismiss plaintiff’s claims for loss of an  
opportunity to survive and loss of an opportunity to achieve  
a better result.  At the hearing on the motion, however,  
defendants 
referred 
to the motion as “defendants[’] motion for  
summary disposition, directed verdict.”  The trial court  
granted the motion for defendants, on the basis of defendants’  
interpretation of § 2912a(2). Because MCR 2.515 states that  
“[a] party may move for a directed verdict at the close of the  
evidence offered by an opponent[,]” we find defendants’  
characterization of the motion as a directed verdict at the  
pretrial 
stage 
incorrect.  Motions for summary disposition are  
brought at this stage, and we therefore treat defendants  
motion as a motion for summary disposition.  This Court  
4463 Mich 907 (2000). 
The order continued the stay of 
proceedings in the Wayne Circuit Court that we had previously 
ordered on October 20, 2000.  
6  
 
 
 
 
 
 
reviews a trial court’s decision to grant summary disposition  
de novo. Sewell v Southfield Pub Schs, 456 Mich 670, 674; 576  
NW2d 153 (1998). 
Similarly, questions of statutory  
interpretation 
are 
reviewed 
de 
novo. 
In 
re 
MCI  
Telecommunications, 460 Mich 396, 413; 596 NW2d 164 (1999).  
III. ANALYSIS  
A.  A LIVING PLAINTIFF MAY NOT RECOVER FOR 
 
LOSS OF AN OPPORTUNITY TO SURVIVE  
Plaintiff 
contends that she can recover for the reduction  
in her chances of survival caused by the delayed diagnosis as  
a claim for loss of an opportunity to survive under §  
2912a(2). We reject plaintiff’s contention that a living  
plaintiff may recover for a loss of an opportunity to survive  
under § 2912a(2) because it is contrary to the Legislature’s  
intent, as evidenced by the statute’s plain language.  
The 
paramount 
rule of statutory interpretation is that we  
are to effect the intent of the Legislature. Tryc v Michigan  
Veterans’ Facility, 451 Mich 129, 135; 545 NW2d 642 (1996).  
To do so, we begin with the statute’s language.  If the  
statute’s language is clear and unambiguous, we assume that  
the Legislature intended its plain meaning, and we enforce the  
statute as written.  People v Stone, 463 Mich 558, 562; 621  
NW2d 702 (2001). In reviewing the statute’s language, every  
word should be given meaning, and we should avoid a  
construction that would render any part of the statute  
surplusage or nugatory.  Altman v Meridian Twp, 439 Mich 623,  
635; 487 NW2d 155 (1992).  
The first sentence of § 2912a(2) provides, “In an action  
7  
 
alleging medical malpractice, the plaintiff has the burden of  
proving that he or she suffered an injury that more probably  
than not was proximately caused by the negligence of the  
defendant or defendants.”  The plain language of the statute,  
therefore, expressly limits recovery to injuries that have  
already been suffered and more probably than not were caused  
by the defendant’s malpractice.  Thus, plaintiff can only  
recover for a present injury, not for a potential future  
injury.  Plaintiff claims that a living plaintiff who suffers  
a reduction in chances of long-term survival because of  
medical malpractice may have a cause of action for loss of an  
opportunity to survive under the statute.  The testimony that  
plaintiff’s chances of surviving for a ten-year period  
decreased, however, is evidence of a potential future  
injury–death–which is not an injury already suffered, as  
required by the plain language of the statute. Thus, a loss  
of an opportunity to survive claim only encompasses injuries  
already suffered, which clearly limits recovery to situations  
where death has already occurred.  Because the evidence  
concerning the reduction in her chances of survival over a  
ten-year period is relevant only to her potential, future  
death, the living plaintiff in this case may not recover for  
this “loss of opportunity.”  
B.  THE TRIAL COURT ERRED IN DISMISSING  
PLAINTIFF’S ENTIRE CASE  
Plaintiff alleged in her complaint that defendants’  
negligent one-year delay in diagnosing her breast cancer  
caused past and future damages including, inter alia, the need  
8  
 
for more invasive medical treatments, emotional trauma, and  
pain and suffering.  Defendants sought a “directed verdict” on  
a theory that plaintiff’s claim was precluded by subsection  
2912a(2).
 In support of their motion, defendants relied  
solely on the uncontested expert testimony that the one-year  
delay in plaintiff’s diagnosis and treatment caused her ten­
year-survival rate to be reduced from fifty-five percent to  
fifteen percent.  
The trial court erred in dismissing plaintiff’s entire  
case on the ground that it was barred by application of  
subsection 2912a(2).  The ten-year-survival-rate statistics  
say nothing about plaintiff’s chances of avoiding the other  
injuries she allegedly suffered, such as (1) the more invasive  
medical treatments caused by the one-year delay in her  
diagnosis, (2) the emotional trauma attributable to her  
unnecessarily worsened physical condition, and (3) the pain  
and suffering attributable to her unnecessarily worsened  
physical condition.  Because of these alleged injuries, the  
trial court should not have dismissed plaintiff’s case in its  
entirety on the basis of subsection 2912a(2).  
In light of our determination that a living plaintiff may  
not recover for loss of an opportunity to survive and that  
plaintiff pleaded a cause of action for her injuries from the  
more invasive medical procedures she incurred on account of  
the alleged negligent delay in diagnosis, it was unnecessary  
for the lower courts to have addressed whether plaintiff had  
a cause of action solely on the basis of the reduction in her  
ten-year survival rate. Accordingly, we vacate that portion  
9  
of the Court of Appeals opinion.  
IV. CONCLUSION  
In light of the plain language of MCL 600.2912a(2), which  
allows recovery only for injuries that have already been  
suffered, we conclude that a living plaintiff may not recover  
for loss of an opportunity to survive on the basis of a  
decrease in her chances of long-term survival.  We further  
conclude that, although plaintiff may not recover for loss of  
an opportunity to survive, the trial court improperly  
dismissed her remaining claims, which are not premised upon  
her decreased chances of long-term survival. Accordingly, we  
reverse in part and vacate in part the opinion of the Court of  
Appeals and remand plaintiff’s case to the trial court for  
further proceedings consistent with this opinion.  
CORRIGAN, C.J., and TAYLOR and MARKMAN, JJ., concurred with  
YOUNG, J.  
10  
________________________________ 
v 
S T A T E O F M I C H I G A N  
SUPREME COURT  
SANDRA J. WICKENS and DAVID WICKENS,  
Plaintiff-Appellees,  
and 
No. 117731  
BLUE CROSS/BLUE SHIELD,  
Intervening Plaintiff,  
OAKWOOD HEALTHCARE SYSTEM, an 
assumed name for OAKWOOD  
HEALTHCARE, INC., BELLEVILLE 
HEALTH CARE CENTER, an assumed 
name for OAKWOOD HEALTHCARE  
INC., DR. CHRISTOPHER PABIAN 
and OAKWOOD HEALTHCARE CENTER- 
CANTON, an assumed name for 
OAKWOOD HEALTHCARE, INC.,  
Defendants-Appellants,  
and  
DR. PATRICIA NESTER,  
Defendant.  
CAVANAGH, J. (concurring in part and dissenting in part).  
I concur with the majority’s holding that a living person  
may not recover for a loss of an opportunity to survive under  
the plain language of MCL 600.2912a(2).  The majority,  
however, also holds that the evidence concerning plaintiff’s  
reduced life expectancy is relevant only to her potential  
future death. Thus, the majority fails to address whether  
plaintiff may recover for injuries suffered as a result of  
learning of her reduced life expectancy under the statute as  
a loss of an opportunity to achieve a better result.  Because  
I believe that a living person may recover for injuries  
suffered as a result of learning of a reduction in life  
expectancy as a loss of an opportunity to achieve a better  
result and that the evidence concerning plaintiff’s reduced  
life expectancy is relevant to whether defendant caused these  
injuries, I respectfully dissent.  
Plaintiff asserts she may recover for her reduction in  
life expectancy as either a claim for loss of an opportunity  
to survive or loss of an opportunity to achieve a better  
result under § 2912a(2).  I agree with the majority’s  
reasoning that under the plain language of § 2912a(2), a  
living person may not recover for a loss of an opportunity to  
survive.
 However, the statute also provides for an  
alternative claim, loss of an opportunity to achieve a better  
result.
 Thus, I would conclude that a living person may  
recover for injuries suffered as a result of learning of a  
reduction in life expectancy under that claim, if there is  
evidence that the defendant more probably than not caused the  
injury. I believe plaintiff satisfied this burden.  
The first sentence of § 2912a(2) expressly limits  
recovery to injuries that have already been suffered and more  
probably than not were caused by defendant’s malpractice.  
Thus, as the majority notes, the plaintiff can only recover  
2  
for a present injury, not for a potential future injury.  
Although this precludes plaintiff from asserting a claim for  
loss of an opportunity to survive, it does not preclude  
plaintiff from asserting a claim for loss of an opportunity to  
achieve a better result, as the majority contends. 
The  
statute allows for recovery for injuries already suffered.  In  
this case, the injuries already suffered are the pain and  
suffering, that were generated by the knowledge that  
plaintiff’s chances of living ten years severely decreased.  
Thus, plaintiff’s claim for such injuries already suffered as  
a result of defendant’s malpractice would satisfy the first  
requirement, that there be a present injury.  However, the  
correct claim is for a loss of an opportunity to achieve a  
better result.  Plaintiff asserted a claim for loss of an  
opportunity to achieve a better result on the basis of her  
reduced life expectancy.  Therefore, the next question is  
whether summary disposition on this alternative claim was  
proper.  
The second sentence of § 2912a(2) states that a plaintiff  
may not recover for a loss of an opportunity to survive or  
achieve a better result “unless the opportunity was greater  
than 50%.”  The statute is clear that the Legislature intended  
the word “opportunity” in that phrase to mean the opportunity  
a plaintiff had to survive or achieve a better result, absent  
any malpractice.  Thus, the statute clearly requires that the  
premalpractice opportunity to survive or achieve a better  
result must exceed fifty percent for a plaintiff to recover.  
3  
In this case, plaintiff’s expert Dr. Schapira testified  
that, had plaintiff’s cancer been properly diagnosed, her  
lowest ten-year survival rate percentage would have been  
fifty-five 
percent. 
Regarding 
plaintiff’s 
injury 
of 
undergoing  
more invasive medical procedures, Dr. Schapira testified that  
the delayed diagnosis caused the cancer to spread to more  
lymph nodes, necessitating these procedures. This injury is  
clearly one hundred percent attributable to defendant’s  
delayed diagnosis.  Thus, viewing the evidence in a light most  
favorable to plaintiff, she submitted evidence that would  
allow a jury to conclude that her premalpractice opportunity  
to achieve a better result was greater than fifty percent,  
and, therefore, summary disposition of that claim was  
improper.  
The next question to address is what damages, if any,  
plaintiff may recover for a reduction in life expectancy.  As  
this opinion previously discussed, the first sentence of §  
2912a(2) limits a plaintiff’s recovery to injuries already  
suffered and that were more probably than not caused by  
defendant’s 
malpractice.  Thus, plaintiff can only recover for  
a present injury, not for a potential future injury.  
Plaintiff’s 
injury 
of having to undergo more radical treatment  
is a present injury, and, thus, is recoverable under the  
statute as an injury suffered.  The additional injury  
plaintiff suffered as a result of defendant’s malpractice was  
that her chance to live beyond ten years was severely  
decreased. 
The 
majority 
asserts 
that 
plaintiff’s  
premalpractice chance of surviving ten years, fifty-five  
4  
 
percent in this case, is irrelevant to whether the defendant  
caused the injuries suffered, i.e., pain and suffering, as a  
result of learning about the reduction in that chance of  
survival.
 I disagree. 
The only way defendant caused  
plaintiff’s secondary injury of pain and suffering from  
learning of her reduced life expectancy is if defendant caused  
plaintiff’s primary injury, the reduction in plaintiff’s life  
expectancy.  The secondary injury, the pain and suffering,  
will always be one hundred percent attributable to the primary  
injury, thus, we must make sure defendant caused the primary  
injury.  To ensure defendant more probably than not caused the  
primary injury and, thus, the resulting secondary injury,  
plaintiff must prove that the primary injury meets the greater  
than fifty percent threshold.  Evidence supporting the  
assertion that defendant’s negligence more probably than not  
caused this injury was plaintiff’s expert who opined that  
defendant’s failure to timely diagnose plaintiff’s breast  
cancer caused plaintiff’s fifty-five percent premalpractice  
chance to live ten years to decrease to fifteen percent.  This  
evidence, which shows that plaintiff had a better than even  
chance of living ten years before defendant’s malpractice,  
supports a finding that defendant, not plaintiff’s cancer,  
more probably than not caused the injury. 
Plaintiff,  
therefore, submitted evidence that would allow a jury to  
conclude that her premalpractice opportunity to achieve a  
better result, i.e., to avoid pain and suffering after  
learning of her reduced life expectancy, was greater than  
fifty percent, and, therefore, summary disposition of that  
5  
claim was improper.  Thus, I would conclude that the reduction  
in plaintiff’s better than even chance to live ten years is a  
recoverable injury under the statute; however, the correct  
claim is for loss of an opportunity to achieve a better  
result, and plaintiff can only recover for the pain and  
suffering generated by the knowledge that her chances of  
living ten years severely decreased.  
CONCLUSION  
In light of the plain language of MCL 600.2912a(2), I  
would conclude that a living person may not recover for a  
reduction in life expectancy as a loss of an opportunity to  
survive, but may recover for a reduced life expectancy as a  
loss of an opportunity to achieve a better result.  The  
recovery for a reduction in life expectancy as a loss of an  
opportunity to achieve a better result claim is not based on  
the plaintiff’s potential future death, but is limited to the  
emotional damages already suffered. However, to recover for  
a loss of either an opportunity to survive or achieve a better  
result, the opportunity, absent any malpractice, must have  
been greater than fifty percent to ensure that defendant’s  
malpractice more probably than not caused the injury.  The  
Court of Appeals applied this interpretation of § 2912a(2) and  
held that plaintiff’s loss of opportunity to achieve a better  
result claim was erroneously dismissed because she submitted  
evidence that, had defendants properly diagnosed her breast  
cancer, she would have had at least a fifty-five percent  
chance of surviving ten years.  I would, therefore, affirm the  
judgment of the Court of Appeals and remand plaintiff’s case  
6  
to the trial court for proceedings consistent with this  
opinion.  
WEAVER and KELLY, JJ., concurred with CAVANAGH, J.  
7