Case Name: Tyler LOUGH, a minor, by Carolyn LOUGH, his Guardian & Conservator, Appellant, v. ROLLA WOMEN'S CLINIC, INC., et al., Respondents
Court: Supreme Court of Missouri
Jurisdiction: Missouri
Decision Date: 1993-11-23
Citations: 866 S.W.2d 851
Docket Number: No. 75749
Parties: Tyler LOUGH, a minor, by Carolyn LOUGH, his Guardian & Conservator, Appellant, v. ROLLA WOMEN’S CLINIC, INC., et al., Respondents.
Judges: BENTON, THOMAS and PRICE, JJ., concur.
Reporter: South Western Reporter Second Series
Volume: 866
Pages: 851–860

Head Matter:
Tyler LOUGH, a minor, by Carolyn LOUGH, his Guardian & Conservator, Appellant, v. ROLLA WOMEN’S CLINIC, INC., et al., Respondents.
No. 75749.
Supreme Court of Missouri, En Banc.
Nov. 23, 1993.
Rehearing Denied Dec. 21, 1993.
David M. Remley, Donald P. Thomasson, Cape Girardeau, David L. Steelman, Rolla, for appellant.
Robert A. Wulff, Robert G. Brody, Patricia A. Manhart, St. Louis, Ronald R. McMillin, Kent L. Brown, Jefferson City, J. William Turley, Dan L. Birdsong, Charles Bennett, Rolla, for respondents.

Opinion:
HOLSTEIN, Judge.
Tyler Lough was born with multiple, irreversible, profound disabilities. According to a petition filed on his behalf, his condition is traceable to an error in reporting an Rh factor blood test performed on his mother in connection with a previous pregnancy in 1984. Concluding that no cause of action for preconception tort exists in this state, the trial court sustained motions for summary judgment. Following opinion by the Missouri Court of Appeals, Southern District, this Court granted transfer. Rule 83.03. The judgment is reversed.
I.
On appeal from a summary judgment, the record is viewed in a light most favorable to the nonmoving party, and that party is granted the benefit of all favorable inferences. ITT Commercial Finance Corp. v. Mid-America Marine Supply Corp., 854 S.W.2d 371, 376 (Mo. banc 1993). However, if the judgment of the trial court is sustainable on any grounds, it will not be overturned on appeal. Swink v. Swink, 367 S.W.2d 575, 578 (Mo.1963). The record is viewed with these principles in mind.
Tyler's mother has Rh negative blood. Tyler's older brother, Justin, born in 1984, has Rh positive blood. During delivery of Justin, some of his Rh positive blood entered his mother's bloodstream. The reaction of his mother's body was that her immune system became sensitized to Rh positive blood. Mrs. Lough's immune system dealt with the Rh positive blood as an invading substance and, following the delivery of Justin, her system developed antibodies to attack Rh positive blood in the future in a manner like the body's response to a vaccine. Tyler has Rh positive blood. Mrs. Lough learned of this problem in the fifth month of her pregnancy with Tyler, during November of 1986. During that pregnancy, antibodies in her system attacked Tyler's Rh positive blood. This condition is diagnosed as erythroblastosis fet-alis, or EBF. Because Tyler's system was constantly under attack from a time commencing shortly after his conception until he was delivered, he sustained devastating pulmonary, cardiovascular and neurological damage.
The drug RhoGAM is designed specifically to prevent what occurred to Tyler. Administered within 72 hours of a woman giving birth to a child with an Rh factor different from hers, RhoGAM suppresses the mother's immune system response, preventing the sensitization that harmed Tyler.
The mother in this case was given prenatal treatment by Drs. Fortin and White at the Rolla Women's Clinic during both pregnancies. Blood was drawn at the clinic and sent to the Phelps Regional Medical Center for analysis during the earlier pregnancy. Kathy Jadwin, a lab technician, did the blood analysis. She claims to have correctly identified the blood as Rh negative but misrecord-ed it as Rh positive. This report was returned to the clinic. As a result, RhoGAM was not administered after Justin was born. It is claimed that Kathy Jad win was an employee of Phelps County Regional Medical Center and was an agent of Drs. H. Neal Brannemann, Delaine Wiench, and Richert Goyette, and Pathology Lab Consultants, Inc. All defendants filed motions for summary judgment, which were sustained. This appeal followed.
In the context of this case, "preconception tort" refers to negligent conduct which occurred prior to the plaintiffs conception. The conduct in this case was that of Kathy Jadwin misrecording Mrs. Lough's blood type.
II.
No Missouri court has addressed the question of whether preconception torts are actionable. Most jurisdictions that have addressed the question have permitted preconception tort actions. Among those permitting preconception tort actions are Jorgensen v. Meade Johnson Laboratories, Inc., 483 F.2d 237 (10th Cir.1973) (construing Oklahoma law); Bergstreser v. Mitchell, 577 F.2d 22 (8th Cir.1978) (construing Missouri law); Renslow v. Mennonite Hospital, 67 Ill.2d 348, 10 Ill.Dec. 484, 367 N.E.2d 1250 (1977); Monuska v. Postle, 175 Mich.App. 269, 437 N.W.2d 367 (1989); Hegyes v. Unjian Entp., Inc., 234 Cal.App.3d 1103, 286 Cal.Rptr. 85 (2nd Dist.1991); and Walker v. Rinck, 604 N.E.2d 591 (Ind.1992). Cases in which a claim for preconception tort was denied include Albala v. City of New York, 54 N.Y.2d 269, 445 N.Y.S.2d 108, 429 N.E.2d 786 (1981); Grover v. Eli Lilly & Co., 63 Ohio St.3d 756, 591 N.E.2d 696 (1992); and McAuley v. Wills, 251 Ga. 3, 303 S.E.2d 258 (1983).
Renslow v. Mennonite Hospital recognized a cause of action in a case similar to this one. There an improper Rh blood transfusion was given to a mother by the defendant several years prior to the plaintiffs birth. The court in Renslow questioned whether there could be areas of foreseeable harm in which no duty arises. The court concluded there may be situations in which a duty for a particular preconception tort might not be imposed. The example given there was, "Successive generations of plaintiffs complaining against a single defendant for a harm caused by genetic damage done an ancestor in a nuclear accident." 10 Ill.Dec. at 489, 367 N.E.2d at 1255. However, the court concluded that such situation is clearly distinguishable and that the damage in a case involving EBF was, by its nature, not self-perpetuating nor is the plaintiff remote. Indeed, the very reason for the RhoGAM treatment is to benefit later conceived children of the mother, while injury to those children in the absence of proper treatment is highly predictable. 10 Ill.Dec. at 487, 367 N.E.2d at 1253.
In addition to Renslow, every court addressing the specific issue presented here has consistently allowed an action for recovery by a child born with EBF following a defendant's failure to administer RhoGAM to an Rh negative woman who has given birth to an Rh positive child. Empire Casualty v. St. Paul Fire and Marine Ins. Co., 764 P.2d 1191 (Co.1988), and Walker v. Rinck, supra.
The most draconian of rules among those cases denying a claim for a preconception tort is found in New York. Albala v. City of New York, supra Based on a perceived inability to judicially establish perimeters on a duty owed to unconceived children and the fear that doctors will face a choice between the best treatment for the patient mother and protecting future offspring of the patient, New York has adopted a rule criticized by Prosser as a "blanket no-duty rule." Prosser and Keator on Torts, § 55 at 369 (5th ed. 1984). This position was reaffirmed most recently in Enright v. Eli Lilly & Co., 77 N.Y.2d 377, 568 N.Y.S.2d 550, 570 N.E.2d 198 (1991). The courts of no other state have adopted that extreme view.
The other two preconception tort cases noted above denying the claims based their decisions on familiar principles of foreseeability. In Grover v. Eli Lilly & Co. the Ohio Supreme Court held that an injury to a child of a mother exposed to a drug while the mother was in útero was not foreseeable, and no cause of action existed. 591 N.E.2d at 700. In McAuley v. Wills, supra, a wrongful death action was brought against a driver whose negligence paralyzed a woman. She later conceived a child but, due to her paralysis, the child was traumatized during birth and died a few hours after delivery. The Georgia Supreme Court reasoned that although a duty is owed to the uneonceived child, the mother's delivery of the child in a manner inconsistent with paraplegia was an intervening cause, making the child's death an unforeseeable consequence. 303 S.E.2d at 260. Both Ohio and Georgia would likely recognize a preconception tort where there is no intervening cause and the treatment of the mother is specifically designed to benefit later conceived children.
The reason for not adopting a rule that would absolutely bar claims for preconception torts is demonstrated by the following hypothetical: Assume a balcony is negligently constructed. Two years later, a mother and her one-year-old child step onto the balcony and it gives way, causing serious injuries to both the mother and the child. It would be ludicrous to suggest that only the mother would have a cause of action against the builder but, because the infant was not conceived at the time of the negligent conduct, no duty of care existed toward the child. It is unjust and arbitrary to deny recovery to Tyler simply because he had not been conceived at the time of Kathy Jadwin's negligence.
The concern expressed in Albala, that liability will not be confined to manageable boundaries if preconception torts are permitted, is speculation. The respondents have not directed this Court to any indication that the states permitting preconception torts have been swallowed by the kind of apocalypse of liability actions envisioned by the Albala court. In addition, the concern that a physician might be called upon to make a treatment choice less favorable to his patient in an effort to avoid doing harm to future offspring of the patient does not exist in this case. As previously noted, Rh factor testing and RhoGAM treatment are done exclusively for the benefit of the children and benefit the mother only by removing the risk that sensitization poses to those children. There is no beneficial treatment to the mother that might be foregone if recovery is allowed in this case. See Walker v. Rinck, 604 N.E.2d at 595.
The basic question in this case is whether a duty exists. Any question of duty depends upon a calculus of policy considerations. These include "the social consensus that the interest is worthy of protection; the foreseeability of harm and the degree of certainty that the protected person suffered injury; moral blame society attaches to the conduct; the prevention of future harm; considerations of cost and ability to spread the risk of loss; the economic burden upon the actor and the community." Hyde v. City of Columbia, 637 S.W.2d 251, 257 (Mo.App. 1982). Foreseeability is the paramount factor in determining existence of a duty, but a relationship between the parties where one is acting for the benefit of another also plays a role. Hoover's Dairy, Inc., v. Mid-America Dairymen, Inc., 700 S.W.2d 426, 432 (Mo. banc 1985); Prosser and Keeton on Torts, § 42, p. 274 (5th ed. 1984). Each of the factors listed in Hyde and Hoover's Dairy militate in favor of the existence of a duty in this case.
Individual cases involving "preconception torts" can be sensibly analyzed under existing principles of tort law to determine if a duty exists in a particular case. Just as there is not a duty in every case when a plaintiff is alive at the time of some allegedly negligent conduct, there will not be a duty in every case where allegedly negligent conduct harms a plaintiff not yet conceived. It is sufficient to say that in this case, a duty exists.
The respondents make a series of other arguments in support of their claim that there is no duty. The first is that § 516.105, which establishes that the date of the negligent conduct commences the running of the statute of limitations, means that there is no duty. That section is intended to limit the time within which suit may be brought and says nothing about those to whom a duty is owed.
Respondents claim that because Missouri does not allow a cause of action for wrongful life, see Miller v. Duhart, 637 S.W.2d 183 (Mo.App.1982), Tyler's claim is invalidated. Wrongful life was rejected because wrongful life would require finding a right to have never been born and it would require the courts to measure how the plaintiff might have benefitted by having never existed. Respondents further argue that this Court's decision in Sullivan v. Carlisle, 851 S.W.2d 510 (Mo. banc 1993), weighs against preconception tort. That case denied a plaintiff ad litem the right to pursue a wrongful death action because a plaintiff ad litem was not a "person" entitled to recover under the wrongful death statute, nor was anyone else living who was qualified to sue. In Sullivan it was not an absence of duty but an absence of a person entitled to recover damages occasioned by the death. In addition, respondents cite Ramho v. Lawson, 799 S.W.2d 62 (Mo. banc 1990), holding no wrongful death cause of action may be maintained for a nonviable fetus. Whether a nonviable fetus is a "person" in the context of § 537.080, the wrongful death statute, simply has no bearing on the question of whether a duty was owed by the defendants in this case. These arguments are rejected.
III.
Respondents argue that even if a preconception tort exists, this one is barred by the statute of limitations found in § 516.-105, which states in part:
All actions against physicians, hospitals, . and any other entity providing health care services and all employees of any of the foregoing acting in the course and scope of their employment, for damages for malpractice, negligence, error or mistake related to health care shall be brought within two years from the date of the occurrence of the act of neglect complained of, except that a minor under the full age of ten years shall have until his twelfth birthday to bring such action....
Respondents argue that a minor must have been in existence at the time of the act of neglect to take advantage of the exception. While it is true that § 516.105 commences running of the two-year period at the time of the negligent conduct rather than the time of the injury, the statute, in equally clear and unequivocal terms, excludes actions by a minor under ten years of age from the two-year limit. Under the terms of the statute, Tyler, being under ten years of age, has until his twelfth birthday to bring this action. To hold otherwise requires reading words into the statute which are not there. Where no ambiguity exists, there is no room for construction. Jones v. Director of Revenue, 832 S.W.2d 516, 517 (Mo. banc 1992).
In Walker v. Rinck, supra, a statute of limitations under consideration provided that actions against health care providers must be brought within two years of the alleged misconduct. However, the statute further provided that "a minor child under the full age of six (6) years shall have until his eighth birthday in which to file." Ind.Code, § 16-9.5 — 3—1. The plaintiff in that case was conceived more than two years after the negligent conduct. The court held that even though stale claims may arise, the statute would be given effect as written. "It is for the legislature to change such a statute of limitation." 604 N.E.2d at 596. The statute in Indiana is indistinguishable from the one now under consideration. In Bergstreser v. Mitchell, supra, the United States Court of Appeals, construing § 516.105, concluded that a minor was entitled to the benefit of the exception, even though conceived more than two years after the negligent conduct. 577 F.2d at 26. Walker and Bergstreser are highly persuasive.
The defendants essentially make two arguments as to why the exception for minors is inapplicable. The first argument is that the exception is a tolling of the statute of limitations only during the minority of the child. The provision for children under ten years of age found in § 516.105 is not an ordinary tolling provision but a special statute of limitations applicable to claimants under the age of ten. Tolling statutes allow actions to be brought within the time limits otherwise al lowed by law "after [a] disability is removed." § 516.170. The exception found in § 516.105 is more accurately described as a proviso because it removes "special cases from the general enactment and provides for them specially." Sutherland Stat. Const. § 20.22 (4th ed. 1985). The legislature clearly made special provision for time limits on claims against health care providers by children under ten years of age. Nothing in the words of the statute indicates the two-year time limit is tolled only during minority.
The defendants' second argument is that the exception in § 516.105 must be ignored because it was declared unconstitutional to the extent it deprived a minor of a cause of action in Strahler v. St. Luke's Hospital, 706 S.W.2d 7 (Mo. banc 1986). Oddly, respondents seem to believe that the result of Strahler was to eliminate any exception. The precise holding was that the general two-year limitation was unconstitutional as applied to a person fifteen years old at the time of the negligent conduct who did not file suit until she was nineteen years of age. It was the application of the two-year limit to minors over the "ripe old age" of ten that offended article I, § 14 of our constitution. 706 S.W.2d at 10. Obviously, the result of Strahler was to expand, not contract, the exception to the two-year time limitation found in § 516.105. Because Tyler Lough is under ten years of age, the statute of limitation had not run when this action was filed.
IV.
There were other issues raised by some of the defendants in the motion for summary judgment, including the question of the agency of Jadwin for other defendants. Inasmuch as those issues were specifically not decided by the trial court, they need not be decided here.
The judgment is reversed and the cause remanded to the trial court for further proceedings consistent with this opinion.
BENTON, THOMAS and PRICE, JJ., concur.
GERALD M. SMITH, Special Judge, dissents in separate opinion filed.
COVINGTON, C.J., and LIMBAUGH, J., concur in opinion of GERALD M. SMITH, Special Judge.
ROBERTSON, J., not sitting.
. "Preconception tort" is somewhat of a misnomer. Implicit in the concept of tort is a wrongful act resulting in an invasion of right or an injury. In Judge Cardozo's shorthand, "Proof of negligence in the air, so to speak, will not do." Palsgraf v. Long Island R. Co., 248 N.Y. 339, 162 N.E. 99 (1928). Here the injury did not occur until after conception.
. All references to statutes are to RSMo 1986, unless specified otherwise.