Title: Simmerer v. Dabbas

State: ohio

Issuer: Ohio Supreme Court

Document:

[Cite as Simmerer v. Dabbas, 89 Ohio St.3d 586, 2000-Ohio-232.] 
 
 
 
SIMMERER ET AL., APPELLANTS, v. DABBAS, APPELLEE, ET AL. 
[Cite as Simmerer v. Dabbas (2000), 89 Ohio St.3d 586.] 
Torts — Negligence — Medical expenses and emotional distress damages 
associated with a child’s birth defect are not recoverable in a wrongful 
pregnancy action, when. 
Medical expenses and emotional distress damages associated with a child’s birth 
defect are not recoverable in a wrongful pregnancy action, when the 
child’s birth defect was not reasonably foreseeable by the defendant who 
negligently performed the sterilization procedure. 
(No. 99-1570 — Submitted May 10, 2000 — Decided September 6, 2000.) 
APPEAL from the Court of Appeals for Summit County, No. 18718. 
 
Following the birth of their second child, appellants, James and Theresa 
Simmerer, decided that Theresa would undergo a permanent sterilization 
procedure.  Appellee Mohamed Dabbas, M.D.,1 negligently performed the 
procedure, however, and Theresa Simmerer gave birth to a third child, Steven.  
Steven suffered from a congenital heart defect and died at approximately fifteen 
months. 
 
The Simmerers, on behalf of themselves and Steven, sued Dabbas and 
others for medical malpractice.  They alleged, inter alia, that Dabbas had 
negligently failed to sterilize Theresa.  Their damages, they asserted, included 
their pregnancy-related costs, Theresa’s pain, suffering, and lost wages during 
pregnancy and delivery, Steven’s medical bills, and emotional suffering as a 
result of caring for Steven.  The Simmerers and Dabbas settled out of court on the 
issues of the Simmerers’ pregnancy-related damages.  Their claims for emotional 
distress and for Steven’s medical bills, however, remained pending, and were the 
 
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 subject of a motion for summary judgment by Dabbas, which the trial court 
granted. 
 
The Simmerers appealed the summary judgment decision that foreclosed 
the nonpregnancy-related damages.  The court of appeals affirmed the judgment 
of the trial court, holding that the Simmerers had failed to establish that Dabbas’s 
negligence was a proximate cause of the medical expenses and emotional distress 
associated with Steven’s heart defect. 
 
The cause is now before this court pursuant to the allowance of a 
discretionary appeal. 
__________________ 
 
Perantinides & Nolan Co., L.P.A., Paul G. Perantinides and Christopher 
L. Parker, for appellants. 
 
Weston Hurd Fallon Paisley & Howley L.L.P., Mark O’Neill and Gary A. 
Vick, for appellee. 
__________________ 
 
COOK, J.  The question raised by this case is whether damages associated 
with parenting a child born with a birth defect are recoverable in a wrongful 
pregnancy action stemming from a negligently performed sterilization procedure, 
when the doctor who performed the unsuccessful sterilization procedure could not 
have reasonably foreseen the birth defect.  We hold that they are not. 
I.  Classification of This Action 
 
To put this case in context, we first categorize the typical birth-based 
medical malpractice actions.  In a wrongful pregnancy action, one or both parents 
of a child born following a negligently performed sterilization procedure bring 
suit for the costs of having an unplanned child.  Johnson v. Univ. Hosp. of 
Cleveland (1989), 44 Ohio St.3d 49, 51, 540 N.E.2d 1370, 1372.  Most United 
States jurisdictions recognize this cause of action.  Smith-Groff, Wrongful 
Conception:  When an Unplanned Child Has a Birth Defect, Who Should Pay the 
 
3 
 Cost? (1996), 61 Mo.L.Rev. 135, 138.  In a wrongful birth action, the parents of 
an unhealthy child born following negligent genetic counseling or negligent 
failure to diagnose a fetal defect or disease bring suit for the costs of having to 
raise and care for an impaired child, arguing that they were wrongfully deprived 
of the ability to avoid or terminate a pregnancy to prevent the birth of a child with 
the defect or disease.  Johnson, 44 Ohio St.3d at 51, 540 N.E.2d at 1372.  The 
legitimacy of this cause of action has not yet been addressed by this court, but has 
been recognized by Ohio’s Fourth District Court of Appeals in Flanagan v. 
Williams (1993), 87 Ohio App.3d 768, 623 N.E.2d 185.  Finally, in a wrongful life 
action, an unhealthy child born following either a negligently performed 
sterilization of one of his or her parents2 or negligent genetic counseling or 
testing3 argues that he or she has been damaged by being born at all.  This court 
has rejected this cause of action,4 as have most other jurisdictions.5 
 
The parties here seem to agree in the briefing to this court, and we concur, 
that this case is an action sounding in wrongful pregnancy only, based on the 
definitions outlined above.  The only negligence alleged is that Dabbas failed to 
sterilize Theresa though he attempted to perform a sterilization procedure.  The 
fact that Steven was not born healthy does not convert this action into one for 
wrongful birth, as we have defined that (consistent with the weight of authority) 
as involving negligent genetic counseling or negligent failure to diagnose a fetal 
defect. 
II.  Law and Discussion 
 
Across the United States, courts have recognized four general theories of 
recovery in wrongful pregnancy cases.  They are  (1) full recovery, which 
includes pregnancy-related damages as well as reasonable child-rearing costs,  (2) 
limited damages, in which only damages related to the failed sterilization, 
pregnancy, and birth are recoverable,  (3) the benefits rule, which allows full 
recovery offset by the benefits to the parent(s) of having and raising the child,  
 
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 and (4) no recovery.  Johnson, supra, 44 Ohio St.3d at 52-57, 540 N.E.2d at 
1372-1377;  Simmons, Zehr v. Haugen and the Oregon Approach to Wrongful 
Conception:  An Occasion for Celebration or Litigation? (1995), 31 Willamette 
L.Rev. 121, 127-135. 
 
In Johnson, where we considered the birth of a healthy child following a 
negligent sterilization, this court adopted a limited-damages rule for wrongful 
pregnancy actions in Ohio.  Johnson, supra, at paragraph two of the syllabus.  We 
held that the plaintiffs could recover the medical costs of the pregnancy and 
delivery, damages for emotional distress due to pregnancy, lost wages due to 
pregnancy, damages for the husband’s loss of consortium during pregnancy, and 
damages for the mother’s pain and suffering during pregnancy and delivery.  Id. 
at 58-59, 540 N.E.2d at 1378, fn. 8.  Our decision foreclosed recovery of the costs 
of raising the child, however, given “Ohio’s public policy that the birth of a 
normal, healthy child cannot be an injury to her parents.”  Id. at paragraph two of 
the syllabus. 
 
The Simmerers invite this court to expand the damages recoverable in a 
wrongful pregnancy action when the resulting child is born with birth defects, as 
Steven was.  They argue that, even if, under Johnson, normal child-rearing costs 
are not recoverable, they are entitled to recover the extraordinary costs and 
damages associated with Steven’s heart defect.  Dabbas, on the other hand, argues 
that this court should follow the reasoning in Simmons v. Hertzman (1994), 99 
Ohio App.3d 453, 651 N.E.2d 13, in which the First District Court of Appeals 
held that the plaintiffs, who had given birth to a child with severe abnormalities, 
could not recover the extraordinary costs associated with raising that child 
because (1) child-rearing costs are not recoverable regardless of whether a child is 
“healthy” or “abnormal,” because everyone has some kind of abnormality and, 
hence, the distinction is too difficult to draw, and (2) the negligent sterilization 
 
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 did not proximately cause the child’s abnormalities.  Id. at 458-459, 651 N.E.2d 
at 17. 
 
The majority rule favors Dabbas’s position.  It is axiomatic that a 
medical negligence claim requires a showing of duty, breach of that duty, and 
damages proximately caused by the breach.  See Hester v. Dwivedi (2000), 89 
Ohio St.3d 575, 578, 733 N.E.2d 1161, 1164.  Courts deciding cases like this one 
have generally held that, although a negligently performed sterilization is a 
proximate cause of a subsequent birth, it is not a proximate cause of the birth 
defect and, therefore, the negligent doctor cannot be held liable for the costs 
associated with that defect.  See, e.g., Williams v. Univ. of Chicago Hosps. (1997), 
179 Ill.2d 80, 227 Ill.Dec. 793, 688 N.E.2d 130;  Williams v. Van Biber 
(Mo.App.1994), 886 S.W.2d 10;  Pitre v. Opelousas Gen. Hosp. (La.1988), 530 
So.2d 1151, 1158;  Garrison v. Foy  (Ind.App.1985), 486 N.E.2d 5, 10;  LaPoint 
v. Shirley (W.D.Tex.1976), 409 F.Supp. 118.6 
 
The Supreme Court of Illinois decided a case in 1997 that is directly on 
point.  That court, in a well-reasoned opinion, held that the parents of a child born 
with attention deficit hyperactivity disorder could not recover for the 
extraordinary expenses of raising a child with that affliction because any 
negligence in the performance of the failed sterilization procedure was not a 
proximate cause of the disorder.  See Williams v. Univ. of Chicago Hosps., supra, 
179 Ill.2d 80, 227 Ill.Dec. 793, 688 N.E.2d 130.  That court noted that the case 
before it did not involve an allegation that the defendants “knew that [the mother] 
sought sterilization as a means of avoiding the conception of a child with the 
particular defect involved here,” and left for another day the question of whether, 
given such knowledge by the defendants, the parents would be able to recover the 
expenses they sought.  Id. at 87, 227 Ill.Dec. at 797, 688 N.E.2d at 134.  The 
Williams court then concluded that “proximate cause [cannot] be established in 
the absence of allegations forging a closer link between the defendant’s 
 
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 negligence and the eventual birth of the defective child.”  Id.  The court went on 
to discuss the concept of proximate cause and its application to the case before 
it: 
 
“In Neering v. Illinois Central R.R. Co., 383 Ill. 366, 380, 50 N.E.2d 497 
(1943), this court stated: 
 
“ ‘What constitutes proximate cause has been defined in numerous 
decisions, and there is practically no difference of opinion as to what the rule is.  
The injury must be the natural and probable result of the negligent act or omission 
and be of such a character as an ordinarily prudent person ought to have foreseen 
as likely to occur as a result of the negligence, although it is not essential that the 
person charged with negligence should have foreseen the precise injury which 
resulted from his act.  [Citations.]’ 
 
“Thus, ‘[i]f the result is one that an ordinarily prudent person would have 
foreseen as likely to occur, then the party will be held responsible, even if the 
precise injury which resulted is not foreseen.’ Scott & Fetzer Co. v. Montgomery 
Ward & Co., 112 Ill.2d 378, 393, 98 Ill.Dec. 1, 493 N.E.2d 1022 (1986). 
 
“We do not believe that the plaintiffs can establish that the defendant’s 
conduct was a proximate cause of their injury, for under the allegations in this 
case the plaintiffs’ injury cannot be said to be of such a character that an 
ordinarily prudent person should have foreseen it as a likely consequence of the 
alleged negligence.  The plaintiffs do not allege that any act or omission by the 
defendants caused the child’s condition, that the defendants knew of the 
possibility that a child conceived in the wake of a failed operation would suffer 
from a particular defect, or even that the parents were seeking to avoid a specific 
risk and that the defendants were aware of that, assuming that allegations of that 
nature would be a sufficient basis for liability.”  Williams v. Univ. of Chicago 
Hosps., 179 Ill.2d at 87-88, 227 Ill.Dec. at 797, 688 N.E.2d at 134. 
 
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We find the reasoning in Williams persuasive, and, accordingly, reject 
the Simmerers’ assertion that Steven’s heart condition was a reasonably 
foreseeable result of Dabbas’s negligence.  Even accepting as true their 
statement that a negligently performed sterilization may lead to the conception 
and birth of an unhealthy child, it would not establish proximate cause, as 
“proximate cause” contemplates a “probable” or “likely” result, not merely a 
“possible” one.  Furthermore, the Simmerers’ “but for” argument—that Steven’s 
heart defect would not have existed but for Dabbas’s negligence—is insufficient 
to establish proximate cause.  A “but for” test is, at most, “ ‘a rule of exclusion:  if 
the event would not have occurred “but for” the defendant’s negligence, it still 
does not follow that there is liability, since other considerations remain to be 
discussed and may prevent liability.  It should be quite obvious that, once events 
are set in motion, there is, in terms of causation alone, no place to stop.’ ”  
Anderson v. St. Francis-St. George Hosp., Inc. (1996), 77 Ohio St.3d 82, 86, 671 
N.E.2d 225, 228, citing Prosser & Keeton, Law of Torts (5 Ed.1984) 266.  See, 
also, Hester, 89 Ohio St.3d at 580-581, 733 N.E.2d at 1165. 
 
According to the Simmerers, this court has already spoken on the issue of 
recovery of extraordinary expenses associated with a birth defect in a wrongful 
pregnancy case when it decided Bowman v. Davis (1976), 48 Ohio St.2d 41, 2 
O.O.3d 133, 356 N.E.2d 496.  But the Simmerers have misunderstood that case.  
In Bowman, the parents of twins born after a negligently performed sterilization 
procedure sued for pregnancy-related damages, damages to the family “due to 
‘the change in the family status,’ ” child-rearing costs of raising the twins, and the 
extraordinary costs of raising one of the twins, who was born with major birth 
defects.  Id. at 42, 2 O.O.3d at 134, 356 N.E.2d at 497.  The jury awarded a 
general verdict of $450,000, untested by interrogatories, and the issue on appeal 
was whether an action in wrongful pregnancy in general was barred on public 
policy grounds—not whether the kinds of damages sought were recoverable.  This 
 
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 court’s affirmance of the verdict, therefore, was not an approval of extraordinary 
costs.  Furthermore, the general nature of the verdict renders it unclear whether 
any part of the damage award was for extraordinary costs.  The Simmerers’ 
argument, therefore, that Bowman constitutes a previous statement by this court 
that post-pregnancy extraordinary costs associated with birth defects are 
recoverable in a wrongful pregnancy action is without merit.  See, also, Hester, 
supra, 89 Ohio St.3d at 579, 733 N.E.2d at 1164 (“Our holding [in Bowman] was 
confined to a determination that public policy did not preclude parents from 
bringing an action in tort against medical providers following a negligently 
performed and unsuccessful sterilization procedure.”). 
 
The Simmerers also point to Flanagan, 87 Ohio App.3d 768, 623 N.E.2d 
185, to support their position.  In that case, the Fourth District Court of Appeals, 
in addition to recognizing wrongful birth as a legitimate cause of action in Ohio 
and rejecting wrongful life, concluded that, based on this court’s statement in 
Johnson that child-rearing costs for a “normal, healthy” child are not recoverable 
in a wrongful pregnancy action, extraordinary costs associated with birth defects 
would be recoverable in such an action.  Id. at 773, 623 N.E.2d at 188.  Based on 
our analysis of this case, however, we conclude that the Fourth District’s 
interpretation of Johnson was incorrect. 
III.  Conclusion 
 
For the above reasons, we hold that medical expenses and emotional 
distress damages associated with a child’s birth defect are not recoverable in a 
wrongful pregnancy action, when the child’s birth defect was not reasonably 
foreseeable by the defendant who negligently performed the sterilization 
procedure. 
Judgment affirmed. 
 
MOYER, C.J., and LUNDBERG STRATTON, J., concur. 
 
PFEIFER, J., concurs in syllabus and judgment only. 
 
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DOUGLAS, RESNICK and F.E. SWEENEY, JJ., dissent. 
FOOTNOTES: 
 
1. 
Dabbas has conceded that he negligently performed the 
sterilization procedure. 
 
2. 
Johnson, supra, 44 Ohio St.3d at 51, 540 N.E.2d at 1372. 
 
3. 
Garrison v. Foy (Ind.App.1985), 486 N.E.2d 5, 7. 
 
4. 
See Hester v. Dwivedi (2000), 89 Ohio St.3d 575, 733 N.E.2d 1161 
(“Judges and jurors are no more able to judge the value of a life with disabilities 
versus nonbeing than they are able to judge the value of life in a ‘normal’ 
condition [however that might be defined] versus nonbeing.”). 
 
5. 
See Strasser, Wrongful Life, Wrongful Birth, Wrongful Death, and 
the Right to Refuse Treatment:  Can Reasonable Jurisdictions Recognize All But 
One? (1999), 64 Mo.L.Rev. 29. 
 
6. 
But, see, Fassoulas v. Ramey (Fla.1984), 450 So.2d 822 
(extraordinary expenses of raising deformed child recoverable in wrongful 
pregnancy action);  Emerson v. Magendantz (R.I.1997), 689 A.2d 409, 414 
(approving the reasoning in Fassoulas). 
__________________ 
 
PFEIFER, J., concurring in syllabus and judgment only.  I concur to 
make clear that the causal chain was too extended in this case for the negligent 
doctor to be liable for damages related to Steven Simmerer’s heart defect.  
However, if the Simmerers had sought a permanent sterilization in order to 
prevent the birth of a child who might be especially at risk for birth defects, I 
would hold differently.  In that instance, I believe there would be enough of a 
direct link to the child’s condition that the doctor who negligently performed the 
sterilization procedure could be held liable. 
__________________ 
 
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ALICE ROBIE RESNICK, J., dissenting.  I would reverse the judgment of 
the court of appeals and remand this cause to the trial court.  I believe that, under 
the standards of Civ.R. 56(C), appellants have succeeded in raising a jury 
question on their claim for medical damages.  This case is distinguishable from 
Johnson v. Univ. Hosp. of Cleveland (1989), 44 Ohio St.3d 49, 540 N.E.2d 1370, 
in that this case does not involve a “normal, healthy child.”  See id. at paragraph 
two of the syllabus. 
 
DOUGLAS and F.E. SWEENEY, JJ., concur in the foregoing dissenting 
opinion.