IN THE SUPREME COURT OF THE STATE OF WASHINGTON

M.N. and G.T., individually and on behalf of )

all others similarly situated, )

)

Petitioners, ) No. 101537-2 

)

A.B. and W.N., individually and on behalf of ) En Banc

all others similarly situated, )

) Filed ______________

Plaintiffs, ) 

) 

v. ) 

) 

MULTICARE HEALTH SYSTEM, INC., a ) 

Washington corporation, ) 

) 

Respondent. ) 

) 

OWENS, J.—A nurse employed by MultiCare Health System, Cora Weberg

(Nurse Weberg), improperly diverted injectable narcotics for her own use. She infected 

some emergency department patients with hepatitis C and may have exposed many 

more. MultiCare notified all patients who received injectable narcotics while Nurse 

Weberg was on duty that they were potentially exposed. MultiCare encouraged these 

patients to have their blood tested for hepatitis C, hepatitis B, and HIV (human 

: January 18, 2024

FILE 

IN CLERK’S OFFICE

SUPREME COURT, STATE OF WASHINGTON 

JANUARY 18, 2024

THIS OPINION WAS FILED 

FOR RECORD AT 8 A.M. ON

JANUARY 18, 2024

ERIN L. LENNON

SUPREME COURT CLERK 
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

2 

immunodeficiency virus). As a result of these tests, MultiCare determined that only 

patients assigned to Nurse Weberg were actually at risk.

The patients brought a class action suit. They claim MultiCare failed to meet the 

accepted standard of care in supervising and hiring Nurse Weberg. The trial court 

divided the class into two groups: those who were assigned to Nurse Weberg and those 

who were not. It then dismissed the claims of the second group. The trial court ruled 

that legal causation was not satisfied because Nurse Weberg did not directly treat these 

patients. The Court of Appeals affirmed. We reverse both courts and hold that legal 

causation is satisfied. Both classes can proceed with their chapter 7.70 RCW claims. 

FACTS AND PROCEDURAL HISTORY

MultiCare Health System operates Good Samaritan Hospital in Puyallup. 

Clerk’s Papers (CP) at 1-2. In 2018, two patients who had previously received care at 

Good Samaritan tested positive for hepatitis C, despite not having any risk factors for 

the disease. CP at 84. Both patients had received intravenous injections of narcotics 

from the same nurse—Nurse Weberg—in the hospital’s emergency department. CP at 

143. Nurse Weberg was suspected of diverting drugs for her own use. CP at 110.

Drug diversion is a known problem in health care settings. CP at 520-32. Hospitals

usually develop policies and procedures to track drugs at risk of being diverted and 

the personnel administering them. Id. The parties do not contest that Weberg 

committed misconduct and likely caused the hepatitis C outbreak. CP at 143.
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3 

After learning of Nurse Weberg’s misconduct, MultiCare sent a letter to all 

2,762 patients who received injectable narcotics in Good Samaritan’s emergency 

department while Nurse Weberg was on duty. CP at 462-63, 349. The letter stated, 

“an employee in the Emergency Department may have exposed at least two patients to 

Hepatitis C virus, causing them to become infected.” CP at 462. It offered 

complimentary blood testing for hepatitis C, hepatitis B, and HIV to all letter 

recipients and cautioned, “The only way to be certain you were not infected is to have 

your blood tested.” Id. The letter also stated that patients may need to undergo 

additional testing within six months to rule out infection. Id. 

MultiCare sent the letter both to patients who were assigned to Nurse Weberg 

and those who were not. CP at 462-63, 465-66, 468-69. Tacoma-Pierce County 

Health Department (TPCHD) and the United States Centers for Disease Control and 

Prevention (CDC) recommended testing for both groups of patients. CP at 75, 104. 

The hospital internally designated patients assigned to Weberg as “high risk” and the 

others as “low risk.” CP at 364-66. However, it sent the same letter to both groups. 

CP at 462-66. 

Overall, 1,863 people had their blood tested. CP at 85. The tests identified 11 

more cases of hepatitis C. Id. All 13 patients who tested positive for hepatitis C had 

been assigned to Nurse Weberg during their emergency room (ER) visit. CP at 365-

66.
M.N. & G.T. v MultiCare Health System, Inc.

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4 

Procedural History

M.N., A.B., G.T., and W.N. brought this class action on behalf of all persons

who received the notification letter from MultiCare. CP at 7, 27-28. They alleged 

negligent supervision and hiring under a theory of corporate negligence and under 

chapter 7.70 RCW. CP at 298. Chapter 7.70 RCW provides a cause of action for 

injuries resulting “from the failure of a health care provider to follow the accepted 

standard of care.” RCW 7.70.030(1). The class claimed damages for “severe 

emotional and mental anguish” and for “medical care, treatment, and services.” CP at 

2, 12. We note that not all class members had their blood tested, and therefore some 

patients experienced only emotional harm. 

The trial court certified two classes of patients. The “Weberg Treatment Class” 

consists of the 208 patients assigned to Nurse Weberg. CP at 322. The “General 

Treatment Class” consists of the 2,554 patients who were not assigned to Nurse 

Weberg. Id. Neither class contains individuals who were infected with the strain of 

hepatitis C linked to Weberg. CP at 664 n.1. 

MultiCare moved to dismiss the General Treatment Class’s claims on a motion 

for summary judgment. CP at 325-45. It argued that the General Treatment Class 

failed to prove legal causation. CP at 340. MultiCare said that because Nurse 

Weberg did not treat this group, they did not experience harm “caused by” a 

negligently supervised employee. Id. (emphasis omitted). Furthermore, it argued that 
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

5 

this group could not prove they were ever at risk of exposure to the virus. CP at 336. 

MultiCare urged the court to adopt a rule that would require proof of actual exposure 

to a disease before plaintiffs can recover. CP at 332. The trial court granted 

MultiCare’s motion, reasoning that imposing liability without actual exposure could

chill a hospital’s investigation of disease outbreaks. CP at 724. It dismissed the 

General Treatment Class’s claims. CP at 660-61.

Division II affirmed the trial court’s dismissal in a divided opinion. The 

majority held that the General Treatment Class did not establish legal causation. M.N. 

v. MultiCare Health Sys., Inc., 23 Wn. App. 2d 558, 568, 519 P.3d 932 (2022). It held

that public policy weighed in favor of limiting liability when a hospital responds to a 

disease outbreak. Id. This court accepted review. M.N. v. MultiCare Health Sys.,

Inc., 1 Wn.3d 1001 (2023). 

ISSUES

(1) Do the General Treatment Class’s alleged injuries arise “as the result of

health care” as required for a chapter 7.70 RCW claim?

(2) Is legal causation met when a hospital’s negligent supervision and hiring

potentially exposes patients to a bloodborne pathogen, inducing fear and requiring 

blood testing?
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

6 

ANALYSIS

This court is reviewing an order granting summary judgment and considers

questions of law de novo. Jones v. Allstate Ins. Co., 146 Wn.2d 291, 300, 45 P.3d 

1068 (2002).

1. The General Treatment Class’s Alleged Injuries Arise “as the Result of

Health Care” as Required for a Chapter 7.70 RCW Claim

MultiCare argues that the General Treatment Class does not have a claim under 

chapter 7.70 RCW because their injuries do not arise as the result of health care.

MultiCare Health Sys., Inc.’s Suppl. Br. (Resp’t’s Suppl. Br.) at 26. It points out that 

they were never treated by Nurse Weberg and Nurse Weberg is the one who 

committed misconduct. Id. However, the General Treatment Class does not argue 

they were harmed by Weberg’s negligence but by the hospital’s negligence in 

supervising and hiring her.

Chapter 7.70 RCW governs “all civil actions and causes of action, whether 

based on tort, contract, or otherwise, for damages for injury occurring as a result of 

health care.” RCW 7.70.010. The General Treatment Class’s claim falls under RCW 

7.70.030(1) as it argues that MultiCare failed “to follow the accepted standard of 

care.” To prevail, the General Treatment Class must prove that MultiCare failed to 

exercise the degree of care, skill, and learning of a reasonably prudent health care 

provider and that such failure proximately caused their injury. RCW 7.70.040(1). 
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

7 

However, for a plaintiff’s claim to fall under chapter 7.70 RCW, the injury must occur 

“as a result of health care.” RCW 7.70.010.

Chapter 7.70 RCW does not define “health care,” but Washington courts have 

defined it as “‘the process in which [a physician is] utilizing the skills which he had 

been taught in examining, diagnosing, treating, or caring for the plaintiff as his 

patient.’” Sherman v. Kissinger, 146 Wn. App. 855, 867, 195 P.3d 539 (2008)

(alteration in original) (quoting Branom v. State, 94 Wn. App. 964, 969-70, 974 P.2d 

335 (1999)).

Individuals and entities beyond physicians can provide health care. Chapter 

7.70 RCW defines “health care provider” as “[a] person licensed by this state to 

provide health care or related services.” RCW 7.70.020(1). “Health care provider” 

also includes nonhuman actors, such as a “hospital,” “facility, or institution” that 

employs a person providing health care. RCW 7.70.020(3). 

Thus, “health care” under chapter 7.70 RCW is the process by which any health 

care provider uses the skills they have been taught to examine, diagnose, treat, or care 

for the plaintiff as their patient.

We hold that the General Treatment Class’s injuries arise as a result of health 

care, allowing their claim under chapter 7.70 RCW to proceed. Every member of the 

General Treatment Class was a patient in Good Samaritan’s ER and received 

injections from a health care provider as part of their treatment. These injections were 
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

8 

part of the process of being treated or cared for by a health care provider who was 

using the skills they had been taught. The potential exposure to hepatitis C results 

from MultiCare’s alleged failure to follow the accepted standard of care in the process 

of providing this health care. Thus, the General Treatment Class has a chapter 7.70 

RCW claim even without evidence they were treated by Weberg.

2. Legal Causation Is Satisfied

The General Treatment Class brings claims under chapter 7.70 RCW and the 

common law doctrine of corporate negligence. Both causes of action have a proximate 

cause requirement. Under chapter 7.70 RCW, a plaintiff must prove that a health care 

provider’s negligence was the “proximate cause of the injury complained of.” RCW 

7.70.040(1)(b). Corporate negligence claims similarly require a breach of care that 

proximately caused plaintiff’s injury. Douglas v. Freeman, 117 Wn.2d 242, 248, 814 

P.2d 1160 (1991). “Proximate cause has two elements: cause in fact and legal cause.”

N.L. v. Bethel Sch. Dist., 186 Wn.2d 422, 436-37, 378 P.3d 162 (2016).

Legal causation “involves a determination of whether liability should attach as 

a matter of law given the existence of cause in fact.” Hartley v. State, 103 Wn.2d 768, 

779, 698 P.2d 77 (1985). Courts evaluate whether “the connection between the 

ultimate result and the act of the defendant is too remote or insubstantial to impose 

liability.” Schooley v. Pinch’s Deli Mkt., Inc., 134 Wn.2d 468, 478-79, 951 P.2d 749 

(1998). Legal causation is “grounded in policy determinations as to how far the 
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

9 

consequences of a defendant’s acts should extend.” Id. at 478. Courts weigh “‘mixed 

considerations of logic, common sense, justice, policy, and precedent.’” Id. at 479

(internal quotation marks omitted) (quoting King v. City of Seattle, 84 Wn.2d 239, 

250, 525 P.2d 228 (1974)).

The Court of Appeals did not find legal causation in this case. M.N. v. 

MultiCare, 23 Wn. App. 2d at 568. It concluded that there is no “bright-line 

rule” governing legal causation in fear of disease transmission cases. Id. at 

566. Therefore, it decided “[a]s a policy matter” not to impose liability on

MultiCare. Id. at 567. We reverse the Court of Appeals for three reasons. 

First, chapter 7.70 RCW allows claims for purely emotional damages. 

Therefore, the fact that some class members suffered only emotional harm does

not preclude their chapter 7.70 RCW claim. Second, the General Treatment 

Class’s harm is directly caused by the hospital’s conduct, not from being 

treated by Nurse Weberg or receiving the notification letter. And third, public 

policy favors finding legal causation when a hospital’s negligence leads to an 

objectively reasonable fear of contracting a disease through a medically 

recognized means of transmission.
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

10

A. While Washington Law Often Disfavors Damages for Purely

Emotional Harm, Chapter 7.70 RCW Does Not Impose Such a

Restriction

MultiCare argues that because the General Treatment Class’s damages are 

largely emotional, their interest in recovery is outweighed by other policy 

considerations. Resp’t’s Suppl. Br. at 10-11. However, chapter 7.70 RCW does not 

distinguish between emotional and physical harms. Purely emotional damages can be

a valid basis for a chapter 7.70 RCW claim. Therefore, the fact that some class 

members did not undergo blood testing and suffered only emotional harms should not 

preclude them from bringing a claim as a matter of law.

Washington courts have recognized the need to limit claims for purely 

emotional damages under some causes of action. Courts were concerned that 

“feigned claims of emotional distress would lead to ‘intolerable and interminable 

litigation.’” Bylsma v. Burger King Corp., 176 Wn.2d 555, 560, 293 P.3d 1168 

(2013) (internal quotation marks omitted) (quoting Corcoran v. Postal Tel.-Cable Co., 

80 Wash. 570, 579, 142 P. 29 (1914)). Therefore, we established an “objective 

symptomatology” requirement for negligent infliction of emotional distress (NIED) 

claims. Hunsley v. Giard, 87 Wn.2d 424, 436, 553 P.2d 1096 (1976). NIED 

claimants may recover for purely emotional harm, but it must manifest in “physical 

symptoms evidencing and resulting from the emotional distress.” Id. at 433
M.N. & G.T. v MultiCare Health System, Inc.

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However, the objective symptomatology requirement applies only to NIED 

claims. It does not apply to claims of intentional infliction of emotional distress, 

Kloepfel v. Bokor, 149 Wn.2d 192, 66 P.3d 630 (2003), attorney negligence, Schmidt v. 

Coogan, 181 Wn.2d 661, 335 P.3d 424 (2014) (plurality opinion), or wrongful 

adoption, Price v. State, 114 Wn. App. 65, 57 P.3d 639 (2002), among others.

Most importantly, there is no objective symptomatology requirement under 

chapter 7.70 RCW. In Berger v. Sonneland, this court addressed this question directly.

144 Wn.2d 91, 26 P.3d 257 (2001) reversing 101 Wn. App. 141, 1 P.3d 1187 (2000). 

In Berger, a woman sued her doctor under chapter 7.70 RCW for negligently disclosing 

her confidential medical history. Id. at 95-96. We held that plaintiffs can recover for 

purely emotional damages under chapter 7.70 RCW without any proof of objective 

symptomatology. Id. at 113. We agreed with the lower court that chapter 7.70 RCW

claims are already limited, as they must arise from health care and must fit within the 

statute’s narrow framework. Berger, 101 Wn. App. at 158. Therefore, an objective 

symptomatology requirement is unnecessary.

The General Treatment Class may pursue a claim for purely emotional 

damages under chapter 7.70 RCW. Therefore, the fact that some class 

members suffered purely emotional damages is irrelevant in determining legal 

causation in this case.
M.N. & G.T. v MultiCare Health System, Inc.

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B. The General Treatment Class’s Harm Was Directly Caused by

the Alleged Negligence of the Hospital in Supervising and

Hiring Employees

Because Nurse Weberg did not directly treat the General Treatment 

Class, MultiCare argues other policy concerns outweigh the General Treatment 

Class’s fear of disease transmission. Resp’t’s Suppl. Br. at 16. This is 

irrelevant to the issue of legal causation because the General Treatment Class’s 

claim is not based on direct treatment by Nurse Weberg. Instead, the General 

Treatment Class has demonstrated that they reasonably feared infection based 

on their treatment in a negligently managed emergency department.

The General Treatment Class provided several bases for this fear. Nurse 

Weberg kept inconsistent records about what patients she cared for and what 

drugs she administered. CP at 103-12, 613-18. A patient in a busy ER may be 

treated by whatever nurse is available, whether or not they are assigned to that 

patient. CP at 573. Health workers who divert drugs may contaminate a 

generally available supply of syringes that can then infect patients they did not 

directly treat. CP at 617. See also Exeter Hosp., Inc. v. Kwiatkowski, No. 

14-CV-09-PB, 2014 WL 1795055 (D.N.H. May 6, 2014) (doctor infected

patients with hepatitis C by placing contaminated syringes in general 

distribution). Finally, MultiCare, TPCHD, and the CDC all believed the 

General Treatment Class was at risk of contracting a bloodborne disease
M.N. & G.T. v MultiCare Health System, Inc.

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13

regardless of whether they were treated by Weberg. This is why they 

recommended testing to this group. CP at 104, 462.

No plaintiffs in this suit—whether in the Weberg Class or the General 

Treatment Class—base their claim for damages on treatment by Nurse Weberg.

Patients were unaware that Nurse Weberg was responsible for spreading the 

virus when they learned of the outbreak. MultiCare’s letter stated only that “an 

employee in the Emergency Department” may have exposed patients to 

hepatitis C. CP at 468. The same notification letter was sent to all at-risk 

patients, whether they were treated by Nurse Weberg or not. Instead, the fear 

arose from a real risk of exposure to bloodborne pathogens, as determined by 

public health experts, not from being directly treated by Nurse Weberg. Thus, 

the fact that Nurse Weberg did not treat the General Treatment Class is not 

relevant to legal causation. 

MultiCare also suggests that the General Treatment Class’s distress was 

“‘caused by MultiCare’s notification letter.’” Resp’t’s Suppl. Br. at 30 (quoting M.N. 

v. MultiCare, 23 Wn. App. 2d at 568). It argues that sending the notification letter

was nonnegligent, therefore the General Treatment Class’s distress upon receiving the 

letter is too remote from any actual negligence and MultiCare should not be held 

liable. Resp’t’s Suppl. Br. at 8.
M.N. & G.T. v MultiCare Health System, Inc.

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14

Claims for purely emotional harms often arise from a plaintiff’s knowing

or learning of misconduct. However, it is irrelevant how they learn of the 

misconduct. The content of the notification and the underlying negligence 

causes the harm. For example, in Bylsma, a police officer suffered emotional 

harm after learning that an employee had spit in his burger. 176 Wn.2d at 557. 

Although he discovered the spit by observing it and touching it with his hand, 

the manner of discovery does not matter. Id. If his meal had been delivered 

with a note telling him there was spit in his burger, he would have had an 

equally strong claim. The underlying negligent conduct harmed him, not the 

manner of discovery.

In this case, there is perfect overlap between the injured group and the group 

that received MultiCare’s notification letter. But this does not mean that the letter 

caused the harm. Rather, both classes were harmed by exposure to a high risk of 

infection in MultiCare’s emergency department. Laudably, MultiCare chose to notify

everyone in this at-risk group. But even if the class had learned of their risk of 

exposure from the CDC or the local health department rather than from MultiCare, 

they would have had an equally strong claim.

MultiCare and the Court of Appeals improperly focused on the 

notification letter. The General Treatment Class learned of the outbreak 

through the letter but was harmed by the allegedly negligent acts revealed in 
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

15

the letter. If MultiCare had properly hired, supervised, and monitored potential 

drug diversion by employees, notification likely would not have been 

necessary. The General Treatment Class’s damages are not too remote from 

MultiCare’s acts to impose liability. 

C. Public Policy Favors Finding Legal Causation when There Is

an Objectively Reasonable Fear of Disease, Transmitted by

Medically Recognized Means, and Damages within the

Window of Anxiety

Legal causation is largely a policy question, and there are strong policy 

considerations on both sides of this issue.

General principles of tort law recognize that tortfeasors should be held liable 

for the harm they cause. When someone is harmed by another, it is only fair that the

injured party is compensated by the wrongdoer. Seattle-First Nat’l Bank v. Shoreline 

Concrete Co., 91 Wn.2d 230, 236, 588 P.2d 1308 (1978). Additionally, imposing 

liability on wrongdoers has a deterrent effect. Barr v. Interbay Citizens Bank of 

Tampa, 96 Wn.2d 692, 699, 635 P.2d 441 (1981). If a hospital knows it will be held 

financially accountable for its negligence, it will have a strong incentive to ensure it 

meets the standard of care. As the General Treatment Class points out, a hospital is in 

a much better position than patients to ensure that its employees are providing safe 

and competent care. Suppl. Br. of Pet’rs at 21.
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

16

However, strong policy considerations also weigh against holding a 

hospital liable in disease transmission cases. As TPCHD notes in its amicus 

brief, “health departments across Washington rely on the voluntary actions of 

medical institutions” to communicate with patients in the event of a disease 

outbreak. Br. of Amicus Curiae TPCHD at 8. While Washington law requires 

hospitals to communicate with local health departments, it does not require a 

hospital to notify potentially infected patients. Id. at 16. TPCHD argues that 

holding MultiCare liable to the General Treatment Class “risks creating a 

perverse incentive for medical institutions to withhold . . . notice in future 

potential outbreaks.” Id. at 15. 

Both sides raise valid concerns. This court has yet to weigh these policy 

concerns in a case involving fear of disease transmission. Other jurisdictions to 

consider this issue have adopted legal causation standards of two general types:

(1) an objective “actual exposure” test or (2) a “reasonableness of fear” test.

An “actual exposure” test forces plaintiffs to “demonstrate an exposure to a 

disease causing agent.” Burk v. Sage Prods., Inc., 747 F. Supp. 285, 287 (E.D. Pa. 

1990). One court interprets the test to require both that a disease “was present in the 

alleged disease-transmitting agent . . . and that a medically sound channel of 

transmission existed.” Madrid v. Lincoln County Med. Ctr., 1996-NMSC-049, ¶ 20,

122 N.M. 269, 275, 923 P.2d 1154. This objective standard ensures that public 
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

17

misconceptions about how a disease is spread do not lead to “frivolous litigation.” 

Pendergist v. Pendergrass, 961 S.W.2d 919, 926 (Mo. App. 1998). This was a 

particular concern during the HIV/AIDS (acquired immune deficiency syndrome) 

epidemic, when public misconceptions about the virus and its spread led to 

“‘unreasonable suspicion or general paranoia.’” Id. (quoting Brzoska v. Olson, 668 

A.2d 1355, 1363 (Del. 1995)).

However, proving actual exposure to a disease can be impossible in some cases 

and may be an unjust bar to recovery. Faya v. Almaraz, 329 Md. 435, 455, 620 A.2d 

327 (1993). For example, a plaintiff’s claim would fail if a syringe or other diseasetransmitting agent is discarded before being tested. Therefore, some jurisdictions 

require plaintiffs to show only a “medically sound channel of transmission” of a 

disease. Madrid, 122 N.M. at 278. This allows recovery for reasonable fears of 

exposure even when evidence is lost or unavailable. It also limits claims when fear of 

contracting a disease is not based on any scientifically recognized means of 

transmission.

Alternatively, jurisdictions that apply a “reasonableness of fear” test focus on 

whether a plaintiff’s fear of contracting a disease was “reasonable.” Williamson v.

Waldman, 150 N.J. 232, 242, 696 A.2d 14 (1997). A reasonableness test supports 

general tort principles of deterrence and compensation by making recovery easier. 

These jurisdictions often include an additional requirement to limit meritless claims. 
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

18

For example, New York courts consider one or more of the following factors to 

determine whether a plaintiff’s fear of developing AIDS is reasonable: the channel of 

transmission, whether HIV was present when the transmission occurred, and the 

results of an HIV antibody test. Brown v. N.Y.C. Health & Hosps. Corp., 648 

N.Y.S.2d 880, 886, 225 A.D.2d 36 (1996). New Jersey defines “reasonable” to 

coincide “with then-current, accurate, and generally available public information 

about the causes and transmission of [the disease].” Williamson, 150 N.J. at 249. 

Other courts consider emotional distress reasonable only if it occurs within “the 

window of anxiety.” Williamson, 150 N.J. at 250; Faya, 329 Md. at 456. This is the 

period between when a person learns of the exposure and when they know or should 

know that they are not infected. This limits damages to a circumscribed window, 

even if a plaintiff refuses testing or suffers anxiety in spite of a negative test result.

MultiCare points out that the majority of jurisdictions adopted the “actual 

exposure” requirement. However, most of the cases surveyed arose in the context of 

an NIED claim. Because NIED claims often have a physical impact requirement, 

many courts favor the “actual exposure” test because it contains an objective element 

analogous to the NIED physical impact test. See Carroll v. Sisters of Saint Francis 

Health Servs., Inc., 868 S.W.2d 585, 594 (Tenn. 1993) (adopting actual exposure 

requirement because it is consistent with the “existent injury” requirement for NIED 

claims); see also Madrid 122 N.M. 269 (declining to adopt the actual exposure test in 
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

19

part because New Mexico no longer requires proof of physical manifestation of injury 

in NIED claims). This case arises under chapter 7.70 RCW and not NIED. 

Therefore, a physical impact requirement is unnecessary.

We reject the cautious “actual exposure” test favored in NIED cases. However, a 

pure “reasonableness” standard lacks guardrails and could lead to excessive liability if

the public lacks information about a disease. Therefore, the test we adopt must link 

reasonableness to a scientific understanding of how a particular disease is spread and 

who is at risk of infection. Additionally, plaintiffs should be able to recover emotional

distress damages only for the period between discovery of the potential exposure and 

when it is clear that they have not been infected.

Therefore, this court adopts a new test for legal causation for chapter 7.70 

RCW claims that involve fear of disease transmission. Plaintiffs must establish (1) an 

objectively reasonable fear of having contracted a disease (2) through a medically 

recognized means of transmission (3) and damages that occur within the window of 

anxiety. This test weeds out frivolous litigation and accounts for public 

misinformation while still holding tortfeasors responsible for the consequences of their 

negligence.

Applying the test to this case, we hold that the General Treatment Class has 

established legal causation in their chapter 7.70 RCW claim. The General Treatment 

Class has shown that class members reasonably feared contracting hepatitis C when 
M.N. & G.T. v MultiCare Health System, Inc.

No. 101537-2

20

they learned of the alleged negligence. They have also demonstrated a medically 

recognized means of transmission: intravenous injections of potentially contaminated 

drugs. Under this test, the General Treatment Class does not need to prove the 

injections they received were actually infected with a disease. Finally, the General 

Treatment Class may recover damages only for the window of anxiety, which is the 

period between when a person learns of the exposure and when they know or should 

know that they are not infected.

CONCLUSION

We hold that the General Treatment Class properly brought this claim under 

chapter 7.70 RCW because their injuries arise as a result of heath care. We adopt a 

new test for legal causation in chapter 7.70 RCW claims involving fear of disease 

transmission. Plaintiffs must establish (1) an objectively reasonable fear of having 

contracted a disease (2) through a medically recognized means of transmission (3) and

damages that occur within the “window of anxiety.” The General Treatment Class has 

established legal causation for their chapter 7.70 RCW claim. We leave for the courts 

below to explore if and how this affects legal causation in any corporate negligence

claims that remain in this case.

The Court of Appeals’ decision is reversed as to the General Treatment Class’s

chapter 7.70 RCW claim. The case is remanded to the Court of Appeals for 

proceedings consistent with this opinion. 
M.N. & G.T. v MultiCare Health Systems, Inc.

No. 101537-2

21

 _______________________________

WE CONCUR:

Hazelrigg, J.P.T.
No. 101537-2 

GONZÁLEZ, C.J. (dissenting)—The plaintiffs before us went to Good 

Samaritan Hospital for emergency care. While they were there, a nurse exposed

some of her patients to a deadly disease. Once a cluster of hepatitis outbreaks was 

detected, the hospital and public health workers made the responsible choice to 

inform all those who might be at risk and to offer them free blood tests. 

As results came in, it became clear that only the nurse’s own patients were at 

risk. But these plaintiffs, who were not the nurse’s patients, had to live for months 

not knowing if they had been exposed, if they would need difficult and expensive 

treatment, if they posed a risk to their loved ones, or if their lives would be cut 

short. That is an undeniable injury. 

But not all injuries have remedies at law. Whether these plaintiffs do is 

governed by chapter 7.70 RCW. In that act, the legislature has limited 

compensable injuries resulting from health care to three categories. RCW 
M.N. & G.T. v MultiCare Health System, Inc. No. 101537-2 (González, C.J.,

dissenting)

2

7.70.030. The only category that possibly applies here is the failure to meet the 

standard of care. RCW 7.70.030(1).

1

 

None of the plaintiffs before us were treated, exposed, or infected by the 

nurse. They were never at risk from her. The plaintiffs’ real injury was their 

temporary fear that they were injured. While that fear is understandable, it is not 

an injury for which chapter 7.70 RCW gives a remedy. 

Plaintiffs who got blood tests may have suffered a compensable injury under 

chapter 7.70 RCW. Blood tests are inconvenient, highly invasive, and can cause 

pain and anxiety. But even if a voluntary blood test under these circumstances 

could be considered an injury, whether that injury is potentially compensable turns 

on whether the hospital’s failure to meet the standard of care was a legal cause of 

the plaintiffs’ injuries. Arguably, the hiring, training, and supervision of the nurse 

did not meet the standard of care and was a cause in fact of the blood test. But to 

be actionable, the hospital’s failure to meet the standard of care must also be a 

legal cause of any injury. Schooley v. Pinch’s Deli Mkt., Inc., 134 Wn.2d 468, 478, 

951 P.2d 749 (1998) (citing King v. City of Seattle, 84 Wn.2d 239, 249, 525 P.2d 

228 (1974)). 

1

Under chapter 7.70 RCW, plaintiffs may also seek recovery for unfulfilled promises that an 

injury would not occur or injuries resulting from health care delivered without consent. RCW 

7.70.030(2), (3). These categories are not before us. 
M.N. & G.T. v MultiCare Health System, Inc. No. 101537-2 (González, C.J.,

dissenting)

3

 “Legal cause ‘is grounded in policy determinations as to how far the 

consequences of a defendant’s acts should extend.’” N.L. v. Bethel Sch. Dist., 186 

Wn.2d 422, 437, 378 P.3d 162 (2016) (quoting Crowe v. Gaston, 134 Wn.2d 509, 

518, 951 P.2d 1118 (1998)). Even if the hospital was negligent, the blood test was

the direct result of the hospital taking responsible action. The Tacoma-Pierce 

County Public Health Department describes the hospital’s actions as the “model 

response to a potential outbreak of communicable disease. Had [the hospital] 

refused to send the notices at issue here, public health would have suffered.” Br. 

of Amicus Curiae Tacoma-Pierce County Pub. Health Dep’t at 5. The hospital’s 

actions also followed public policies embraced by the Washington State 

Legislature and our evidence rules. See RCW 5.64.010(1) (“In any civil action 

against a health care provider for personal injuries which is based upon alleged 

professional negligence . . . evidence of furnishing or offering or promising to pay 

medical, hospital, or similar expenses occasioned by an injury is not admissible.”); 

ER 407 (subsequent remedial measures not evidence of negligence or culpable 

conduct). Given these strong policies in favor of disclosure and remedial action, 

under the statute, the hospital’s actions were not the proximate cause of an injury 

for which the law gives a remedy. 
M.N. & G.T. v MultiCare Health System, Inc. No. 101537-2 (González, C.J.,

dissenting)

4

I would affirm the courts below. Accordingly, I respectfully dissent.