Title: McAllister v. Sem Ha

State: north-carolina

Issuer: North Carolina Supreme Court

Document:

IN THE SUPREME COURT OF NORTH CAROLINA
No. 298PA97
FILED: 6 MARCH 1998
THOMASINE B. McALLISTER and EDWARD McALLISTER
v.
KHIE SEM HA, M.D.
On discretionary review pursuant to N.C.G.S. § 7A-31 of
a unanimous decision of the Court of Appeals, 126 N.C. App. 326,
485 S.E.2d 84 (1997), reversing an order allowing defendant's
motion to dismiss entered 22 March 1996 by Britt (Joe Freeman),
J., in Superior Court, Robeson County, and remanding for further
proceedings.  Heard in the Supreme Court 9 February 1998.
Britt & Britt, P.L.L.C., by William S. Britt, for
plaintiff-appellees.
Cranfill, Sumner & Hartzog, L.L.P., by Gregory M. Kash
and Leigh Ann Garner, for defendant-appellant.
Patterson, Dilthey, Clay & Bryson, L.L.P., by Robert M.
Clay and Charles George, on behalf of N.C. Association
of Defense Attorneys, amicus curiae.
WHICHARD, Justice.
Plaintiffs brought this action for medical malpractice
and negligent infliction of emotional distress arising from
defendant's alleged failure to inform plaintiffs of the results
of certain blood tests he performed.  The trial court granted
defendant's motion to dismiss the complaint pursuant to N.C.G.S.
§ 1A-1, Rule 12(b)(6).  The Court of Appeals reversed, and this
Court granted defendant's petition for discretionary review. 
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The facts set forth herein are taken from the
allegations of the complaint, which, in deciding a motion to
dismiss, must be taken as true.  See Forbis v. Honeycutt, 301
N.C. 699, 701, 273 S.E.2d 240, 241 (1981). 
The complaint alleges that defendant is a duly licensed
physician practicing family medicine.  Plaintiffs, husband and
wife, had a baby boy on 8 May 1991.  In June 1991, plaintiffs
received a letter from the State Health Department advising them
that they needed to be tested for sickle-cell disease because of
genetic traits carried by plaintiff-wife which their son could
have inherited.  
Plaintiffs went to the medical offices of defendant,
where blood was drawn and sent to the State Laboratory of Public
Health.  Defendant told plaintiffs that if there was anything to
be concerned about, he would call them, and that if they did not
hear from him, there was no cause for concern.  Plaintiffs never
heard from defendant on the test results, even though plaintiff-
wife visited defendant for minor ailments approximately four
times between June 1991 and September 1993.
In September 1993, plaintiff-wife became pregnant with
plaintiffs' second child.  Plaintiffs' second son was born on 27
May 1994.  In June 1994, plaintiffs learned that their second son
had Hemoglobin O Arab, a sickle-cell disease.  Plaintiffs further
learned that the results of the 1991 blood tests showed that
plaintiff-husband carried the O Arab factor sickle cell. 
Plaintiffs allege that the traits carried by plaintiff-wife
combined with the factor carried by plaintiff-husband put the
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couple at a one-in-four risk of bearing a child with sickle-cell
disease.
Plaintiffs have had to carry their child to Duke
Medical Center for testing and procedures, and he has been placed
on daily medication until he reaches five years of age. 
Plaintiff-wife has been unable to sleep through the night because
of her fear that her child would stop breathing or would have
other problems.  This lack of sleep has prevented plaintiff-wife
from attaining peak performance in her job as a school teacher. 
Both plaintiffs have missed work because of the requirements of
caring for their child.  
The complaint further alleges defendant was negligent
in one or more of the following respects:  (1) failure to
communicate the results of the blood tests to plaintiffs; (2)
failure to have adequate procedural safeguards to ensure that
test results were properly communicated to patients; (3) breach
of "the appropriate standards of practice for physicians
practicing in Red Springs, or similar communities in 1991, with
the same or similar training [and] experience as Defendant"; (4)
failure "to use his best medical judgment"; and (5) failure "to
use reasonable care and diligence in the application of his
knowledge and skill to the plaintiffs' care and treatment."
Plaintiffs further allege that because of defendant's
negligence, they never received any genetic counseling to prepare
them for being the parents of a child with sickle-cell disease
and were deprived of the opportunity to make an informed decision
regarding whether to have another child.  The complaint also
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alleges that defendant's actions "amounted to extreme and
outrageous conduct that amounts to a wanton and reckless
disregard of the rights and safety of the Plaintiffs."  Finally,
plaintiffs allege that defendant's negligence caused them
"extreme mental and emotional distress, and financial loss."
This case is before the Court on a motion to dismiss
for failure to state a claim upon which relief can be granted
pursuant to N.C.G.S. § 1A-1, Rule 12(b)(6).  "A complaint is
sufficient to withstand a motion to dismiss where no
insurmountable bar to recovery on the claim alleged appears on
the face of the complaint and where allegations contained therein
are sufficient to give a defendant notice of the nature and basis
of plaintiffs' claim so as to enable him to answer and prepare
for trial."  Forbis, 301 N.C. at 701, 273 S.E.2d at 241. 
Further, "when the allegations in the complaint give sufficient
notice of the wrong complained of[,] an incorrect choice of legal
theory should not result in dismissal of the claim if the
allegations are sufficient to state a claim under some legal
theory."  Stanback v. Stanback, 297 N.C. 181, 202, 254 S.E.2d
611, 625 (1979).  "A complaint may be dismissed pursuant to Rule
12(b)(6) if no law exists to support the claim made, if
sufficient facts to make out a good claim are absent, or if facts
are disclosed which will necessarily defeat the claim."  Burgess
v. Your House of Raleigh, Inc., 326 N.C. 205, 209, 388 S.E.2d
134, 136 (1990).  
Plaintiffs here allege two claims in their complaint,
one for medical malpractice and the other for negligent
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infliction of emotional distress.  We address each in turn in
light of the above standard of review.
The scope of a physician's duty to his patient, the
basis of any medical malpractice claim, was succinctly described
by Justice Higgins in Hunt v. Bradshaw, 242 N.C. 517, 88 S.E.2d
762 (1955), as follows:
A physician or surgeon who undertakes to
render professional services must meet these
requirements:  (1) He must possess the degree
of professional learning, skill and ability
which others similarly situated ordinarily
possess; (2) he must exercise reasonable care
and diligence in the application of his
knowledge and skill to the patient's case; 
and (3) he must use his best judgment in the
treatment and care of his patient.  If the
physician or surgeon lives up to the
foregoing requirements he is not civilly
liable for the consequences.  If he fails in
any one particular, and such failure is the
proximate cause of injury and damage, he is
liable.
Id. at 521-22, 88 S.E.2d at 765 (citations omitted).  The
requirement has been refined such that the physician is now
required to provide care "in accordance with the standards of
practice among members of the same health care profession with
similar training and experience situated in the same or similar
communities at the time of the alleged act giving rise to the
cause of action."  N.C.G.S. § 90-21.12 (1997).  See Jackson v.
Bumgardner, 318 N.C. 172, 175, 347 S.E.2d 743, 745 (1986).
Defendant does not argue that plaintiffs have failed to
allege sufficient facts to support a medical malpractice claim. 
Rather, he contends that plaintiffs have stated a claim for a
particular type of medical malpractice which is not recognized in
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North Carolina, a claim generally referred to as "wrongful
birth."  In Azzolino v. Dingfelder, 315 N.C. 103, 337 S.E.2d 528
(1985), cert. denied, 479 U.S. 835, 93 L. Ed. 2d 75 (1986), this
Court considered a case in which the plaintiffs alleged that the
defendants were negligent in their prenatal care of the
plaintiff-mother by failing to properly advise her regarding the
availability of amniocentesis and genetic counseling.  Id. at
105, 337 S.E.2d at 530.  The plaintiffs further alleged that had
they been properly advised, they would have had amniocentesis
performed and would have discovered that their child would suffer
from Down's syndrome.  The plaintiffs alleged that had they been
aware of this outcome, they would have chosen to terminate the
pregnancy via abortion.  Id.
The Court observed that "[t]he jurisdictions which have
reached the merits of claims for wrongful birth currently appear
to be almost unanimous in their recognition of them when but for
the defendants' negligence, the parents would have terminated the
defective fetus by abortion."  Id. at 110, 337 S.E.2d at 533. 
The Court noted, however, that in order to allow recovery for
such claims, courts must hold "that the existence of a human life
can constitute an injury cognizable at law."  Id. at 111, 337
S.E.2d at 534.  The Court concluded:  "We are unwilling to take
any such step because we are unwilling to say that life, even
life with severe defects, may ever amount to a legal injury." 
Id.  
Defendant argues that the Court's refusal in Azzolino
to recognize a claim for wrongful birth precludes the claim in
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this case.  Defendant argues that because plaintiffs are seeking
damages in connection with the birth of an impaired child, their
claim is one for wrongful birth and thus is not actionable.  We
disagree.
The case of Jackson v. Bumgardner, 318 N.C. 172, 347
S.E.2d 743, is instructive in the analysis of defendant's
contentions.  In Jackson the Court addressed a situation in which
the plaintiffs brought a medical malpractice claim against the
defendant-doctor based on his failure to replace the plaintiff-
mother's intrauterine device (IUD) following surgery.  Id. at
174, 347 S.E.2d at 744-45.  The plaintiffs alleged that before
surgery, they informed the defendant that they could not afford
to have another child and that they were relying on the IUD to
prevent pregnancy.  Id. at 174, 347 S.E.2d at 745.  The
plaintiffs further alleged that the defendant assured them he
would replace the IUD if it became necessary to remove it during
surgery.  Following surgery, the plaintiffs believed they
continued to be protected from pregnancy by the IUD.  After
plaintiff-mother became pregnant, however, they discovered that
the defendant had not in fact retained or replaced her IUD.  Id.  
The defendant in Jackson, like defendant here, argued
that Azzolino precluded the plaintiffs' claim.  Id. at 179-80,
347 S.E.2d at 748.  As in the case at bar, the trial court
dismissed the plaintiffs' claim pursuant to N.C.G.S. § 1A-1, Rule
12(b)(6).  Id. at 174, 347 S.E.2d at 745.  This Court there
concluded, as we do here, that Azzolino did not require dismissal
of the plaintiffs' claim.  Id. at 180-82, 347 S.E.2d at 748-49. 
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The Court observed that the facts alleged by the plaintiffs in
Jackson were similar to those constituting a claim recognized in
other jurisdictions and generally referred to as "wrongful
conception" or "wrongful pregnancy."  Id. at 178-79, 347 S.E.2d
at 747.  The Court stated:
Our survey shows that the vast majority
of courts which have considered wrongful
conception cases have viewed the case as
being indistinguishable from an ordinary
medical malpractice action where the
plaintiff alleges a breach of duty on the
part of a physician and resulting injury for
failure to perform that duty. . . .  We find
both the reasoning and the results of these
authorities quite persuasive.
Id. at 179, 347 S.E.2d at 747-48.  The Court distinguished
Azzolino by observing that "the injury alleged in Azzolino was
the continued existence of the deformed fetus," id. at 180, 347
S.E.2d at 748, whereas in Jackson it was "the fact of the
pregnancy as a medical condition that [gave] rise to compensable
damages and complete[d] the elements for a claim of negligence,"
id. at 181, 347 S.E.2d at 748.  The Court concluded by stating: 
"[W]e find that plaintiff's complaint contains sufficient
allegations to withstand defendant's motion to dismiss pursuant
to Rule 12(b)(6) on plaintiff wife's claim for medical
malpractice.  We also hold that her claim is one that is
recognizable in this State."  Id. at 182, 347 S.E.2d at 749.
In the case at bar, plaintiffs alleged in their
complaint that defendant was negligent in his failure to report
the results of the blood tests he performed, that plaintiffs were
unable to make an informed choice regarding whether to conceive
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another child as a result, and that plaintiff-wife did in fact
become pregnant and give birth to another child.  Plaintiffs
further specifically alleged that defendant breached the
appropriate standards of medical practice in the care he provided
plaintiffs.  The complaint does not allege that plaintiffs' son's
very existence--the injury the Court declined to recognize in
Azzolino--is an injury for which they should be compensated. 
Thus, the claim is not one precluded by Azzolino.  Defendant
makes no argument, and we perceive no reason to hold, that
plaintiffs' allegations are insufficient to give him "notice of
the nature and basis of plaintiffs' claim so as to enable him to
answer and prepare for trial," or that there appears on the face
of plaintiffs' complaint an "insurmountable bar to recovery on
the claim alleged."  Forbis, 301 N.C. at 701, 273 S.E.2d at 241. 
Therefore, we hold that plaintiffs have stated a claim for
medical malpractice sufficient to survive a motion to dismiss
pursuant to N.C.G.S. § 1A-1, Rule 12(b)(6).  We express no
opinion as to whether defendant's alleged negligence actually
caused any injury to plaintiffs.  That is an issue to be resolved
by the trier of fact.  See Williams v. Carolina Power & Light
Co., 296 N.C. 400, 403, 250 S.E.2d 255, 258 (1979) ("'[P]roximate
cause is ordinarily a question of fact for the jury, to be solved
by the exercise of good common sense in the consideration of the
evidence of each particular case.'") (quoting William L. Prosser,
Torts § 45 (4th ed. 1971)). 
We turn next to plaintiffs' claim for negligent
infliction of emotional distress.  This Court examined the nature
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of such a claim at length in Johnson v. Ruark Obstetrics &
Gynecology Assoc., P.A., 327 N.C. 283, 395 S.E.2d 85 (1990).  The
Court explained:
[T]o state a claim for negligent infliction
of emotional distress, a plaintiff must
allege that (1) the defendant negligently
engaged in conduct, (2) it was reasonably
foreseeable that such conduct would cause the
plaintiff severe emotional distress . . .,
and (3) the conduct did in fact cause the
plaintiff severe emotional distress. 
Although an allegation of ordinary negligence
will suffice, a plaintiff must also allege
that severe emotional distress was the
foreseeable and proximate result of such
negligence in order to state a claim; mere
temporary fright, disappointment or regret
will not suffice.  In this context, the term
"severe emotional distress" means any
emotional or mental disorder, such as, for
example, neurosis, psychosis, chronic
depression, phobia, or any other type of
severe and disabling emotional or mental
condition which may be generally recognized
and diagnosed by professionals trained to do
so.
. . . Further, a plaintiff may recover
for his or her severe emotional distress
arising due to concern for another person, if
the plaintiff can prove that he or she has
suffered such severe emotional distress as a
proximate and foreseeable result of the
defendant's negligence.
. . . .
 
. . . Questions of foreseeability and
proximate cause must be determined under all
the facts presented, and should be resolved
on a case-by-case basis by the trial court
and, where appropriate, by a jury.
Id. at 304-05, 395 S.E.2d at 97-98 (citations omitted).  The
Court concluded:
The plaintiffs here allege that they
were the parents of the fetus which allegedly
died as a result of the defendants'
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negligence and were in close proximity to and
observed many of the events surrounding the
death of the fetus and its stillbirth.  We
conclude that these plaintiffs may proceed
with their action for severe emotional
distress.
Id. at 306, 395 S.E.2d at 98.
Plaintiffs here alleged that plaintiff-wife became
pregnant and gave birth to a child with sickle-cell disease as a
result of defendant's negligence.  Plaintiffs alleged that
defendant's negligence caused them "extreme mental and emotional
distress," specifically referring to plaintiff-wife's fears
regarding her son's health and her resultant sleeplessness.  Like
the allegations in Johnson, plaintiffs' allegations here, while
sparse, are sufficient to state a claim for negligent infliction
of emotional distress.  The allegations "are sufficient to give
. . . defendant notice of the nature and basis of plaintiffs'
claim so as to enable him to answer and prepare for trial." 
Forbis, 301 N.C. at 701, 273 S.E.2d at 241.  Whether defendant's
alleged negligence in fact caused either of the plaintiffs to
suffer severe emotional distress is a question for the trier of
fact.  See Johnson, 327 N.C. at 305, 395 S.E.2d at 98; Williams,
296 N.C. at 403, 250 S.E.2d at 258.  We therefore affirm the
Court of Appeals decision insofar as it reversed the trial
court's order dismissing plaintiffs' action for failure to state
a claim upon which relief can be granted.
Defendant next argues that the Court of Appeals erred
in its conclusion regarding the damages plaintiffs may seek in
their medical malpractice claim.  Defendant argues that the
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decisions of this Court in Azzolino and Jackson prohibit
plaintiffs from seeking child-rearing damages.  We agree.
As described above, Jackson involved a situation in
which the plaintiffs alleged that their physician negligently
failed to replace the plaintiff-mother's IUD following surgery,
resulting in the birth of a healthy baby.  Jackson, 318 N.C. at
174, 347 S.E.2d at 744-45.  Besides seeking damages for the
expenses of pregnancy and birth, the plaintiffs in Jackson also
sought to recover for "the general cost and maintenance of said
minor child from the date of his birth until such time as he
shall become of legal age or emancipated."  Id. at 177, 347
S.E.2d at 746.  With regard to this claim for damages, the Court
stated:
[W]e hold that plaintiff wife may recover
damages for the expenses associated with her
pregnancy, but that plaintiffs may not
recover for the costs of rearing their 
child. . . .
 
. . . [T]he decision in Azzolino v.
Dingfelder would prohibit recovery of damages
for the costs of rearing the child.  In that
case this Court held that "life, even life
with severe defects, cannot be an injury in
the legal sense."  Azzolino, 315 N.C. at 109,
337 S.E.2d at 532.  Thus, to permit recovery
of child-rearing expenses would be contra to
both the holding and rationale of Azzolino.
Id. at 182, 347 S.E.2d at 749.  This holding controls our
analysis of this issue.
Plaintiffs attempt to distinguish their damages claim
from the claim in Jackson by arguing that they seek damages only
for the extraordinary care involved in the treatment of their
son's sickle-cell disease, as opposed to all of the expenses
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associated with rearing a child.  We do not find this distinction
availing.  Rather, such extraordinary costs are simply a part of
child-rearing expenses for parents rearing an impaired child. 
Though Jackson involved a healthy child, the Court did not
distinguish between healthy and unhealthy children in its holding
on this issue.  In fact, the Court relied explicitly on Azzolino,
a case involving a child with Down's syndrome.  
Further, the complaint in this case is similar to the
complaint of the plaintiffs in Jackson in many respects.  Both
involved allegations of preconception medical malpractice which
allegedly resulted in each plaintiff-mother becoming pregnant and
giving birth to a child.  Further, both involved alleged
nonfeasance by the defendant-doctor.  In Jackson the alleged
nonfeasance was the failure to replace the plaintiff's IUD, while
in this case it was the failure to inform plaintiffs of their
blood-test results.  
It bears noting that none of these three cases--
Jackson, Azzolino, or the case at bar--involved a situation in
which plaintiffs alleged that the defendant-doctor negligently
injured a fetus and thus caused an otherwise normal child to be
born in an impaired condition.  The child in Jackson was born
without impairment.  The disorder in Azzolino, Down's syndrome,
and the disorder in this case, sickle-cell disease, are both
genetic, and thus are not the result of any injury negligently
inflicted by either defendant-doctor.  
Because we find Jackson controlling, we disavow the
Court of Appeals opinion insofar as it held that plaintiffs could
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seek, in their medical malpractice claim, a version of child-
rearing expenses, the costs of the extraordinary care for their
child.
The final issue involves the timeliness of plaintiffs'
service on defendant of the proposed record on appeal. 
Plaintiffs gave notice of appeal from the trial court's order on
18 March 1996.  Plaintiffs served the proposed record on appeal
on defendant on 5 June 1996, seventy-eight days after giving
notice of appeal.  On the same date, 5 June 1996, plaintiffs
filed a motion with the Court of Appeals seeking an extension of
time under Rule 27(c) of the North Carolina Rules of Appellate
Procedure.  Plaintiffs sought an extension of time because they
had not served the proposed record on appeal on defendant within
the thirty-five days mandated by Rule 11(a) and (b) of the North
Carolina Rules of Appellate Procedure.  On 10 June 1996, the
Court of Appeals granted plaintiffs' motion for an extension of
time and deemed the proposed record timely served.  Defendant now
argues that the Court of Appeals erred by granting plaintiffs'
motion.  
Rule 27(c) of the North Carolina Rules of Appellate
Procedure provides, in pertinent part:
Except as herein provided, courts for good
cause shown may upon motion extend any of the
times prescribed by these rules or by order
of court for doing any act required or
allowed under these rules; or may permit an
act to be done after the expiration of such
time.
N.C. R. App. P. 27(c).  When a lower court is given discretion to
allow an extension of time, the court's decision on the matter
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will be found to be erroneous only upon a showing of an abuse of
discretion.  See Tinkham v. Hall, 47 N.C. App. 651, 654, 267
S.E.2d 588, 591 (1980).  Defendant does not argue that the Court
of Appeals abused its discretion in granting plaintiffs' Rule
27(c) motion, but rather asserts that "based on the plaintiffs'
failure to comply with the time limitations set out by the
applicable Appellate Rules, the plaintiffs' appeal should have
never been reviewed by the Court of Appeals."  We perceive no
reason to hold that the Court of Appeals abused its discretion in
granting plaintiffs' motion; defendant's argument on this issue
is without merit.
Because we affirm the Court of Appeals opinion insofar
as it reversed the trial court's order dismissing plaintiffs'
complaint, we remand the case to the Court of Appeals for further
remand to the Superior Court, Robeson County, to allow plaintiffs
to proceed on their claims for medical malpractice and negligent
infliction of emotional distress.
AFFIRMED.