Title: LISA ROBERTS V MECOSTA COUNTY GENERAL HOSPITAL
Citation: N/A
Docket Number: 122338
State: Michigan
Issuer: Michigan Supreme Court
Date: July 21, 2004

_______________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Michigan Supreme Court 
Lansing, Michigan 
Chief Justice:  
Justices: 
Maura D. Corrigan  
Michael F. Cavanagh 
Elizabeth A. Weaver 
Marilyn Kelly 
Opinion 
Clifford W. Taylor 
Robert P. Young, Jr. 
Stephen J. Markman 
FILED JULY 21, 2004 
LISA ROBERTS, 
Plaintiff-Appellee, 
v 
 
No. 122312 
MICHAEL ATKINS, M.D., 
Defendant-Appellant, 
and 
MECOSTA COUNTY GENERAL HOSPITAL, 
GAIL A. DESNOYERS, M.D., BARB 
DAVIS, and OBSTETRICS AND 
GYNECOLOGY OF BIG RAPIDS, P.C., 
formerly known as GUNTHER, DESNYOYERS 
& MEKARU,  
Defendants. 
LISA ROBERTS, 
Plaintiff-Appellee, 
v 
No. 122335 
GAIL A. DESNOYERS, M.D., BARB
DAVIS, OBSTETRICS AND GYNECOLOGY
OF BIG RAPIDS, P.C., formerly
known as GUNTHER, DESNOYERS &
MEKARU, 
Defendants-Appellants, 
 
 
 
 
 
_______________________________ 
 
 
 
 
 
 
 
 
_______________________________ 
 
 
 
 
and 
MICHAEL ATKINS, M.D., and
MECOSTA COUNTY HOSPITAL, 
Defendants. 
LISA ROBERTS, 
Plaintiff-Appellee, 
v 
No. 122338 
MECOSTA COUNTY GENERAL HOSPITAL, 
Defendant-Appellant, 
and 
GAIL A. DESNOYERS, M.D., MICHAEL
ATKINS, M.D., BARB DAVIS, and
OBSTETRICS AND GYNECLOGOY OF 
BIG RAPIDS, P.C., formerly known
as GUNTHER, DESNOYERS & MEKARU, 
Defendants. 
BEFORE THE ENTIRE BENCH 
YOUNG, J.  
INTRODUCTION 
This medical malpractice case is before us for the 
second time. 
In Roberts v Mecosta, 466 Mich 57; 642 NW2d 
663 (2002) (Roberts I), we held that the statute of 
limitations could not be tolled under MCL 600.5856(d) 
unless notice was given in compliance with all the 
provisions of MCL 600.2912b, and that § 2912b imposed no 
2  
 
 
 
requirement on defendants to object to the sufficiency of 
plaintiff’s notices of intent before the filing of the 
complaint. 
Because the Court of Appeals had not addressed 
the trial court’s conclusion that plaintiff’s notices of 
intent did not comply with § 2912b, we remanded the matter 
to that Court for further proceedings. 
On remand, the 
Court of Appeals held that plaintiff’s notices of intent 
strictly complied with the provisions of § 2912b. 
We conclude that plaintiff’s notices of intent are 
deficient in several respects and that, therefore, the 
statute of limitations was not tolled under § 5856(d). The 
unambiguous language of MCL 600.2912b(4) requires a medical 
malpractice plaintiff to include in her notice of intent a 
statement of (1) the factual basis for the claim, (2) the 
applicable standard of practice or care alleged by the 
claimant, (3) the manner in which it is claimed that the 
applicable standard of practice or care was breached, (4) 
the alleged action that should have been taken to comply 
with the alleged standard, (5) the manner in which it is 
claimed that the breach was the proximate cause of the 
injury claimed in the notice, and (6) the names of all 
professionals and facilities the claimant is notifying. 
Although the notices of intent in this case are not wholly 
deficient with regard to the above requirements, they are 
3  
 
 
  
 
 
 
nonetheless not in full compliance with § 2912b because 
they fail to properly set forth allegations regarding the 
standard of practice or care applicable to each named 
defendant, allegations regarding the manner in which it was 
claimed that defendants breached the applicable standards 
of practice or care, the alleged actions that defendants 
should 
have 
taken 
in 
order 
to 
satisfy 
the 
alleged 
standards, 
or 
allegations 
of 
the 
manner 
in 
which 
defendants’ breaches of the standards constituted the 
proximate cause of plaintiff’s injury. 
Because plaintiff did not fully comply with the 
unambiguous requirements of § 2912b(4), we reverse the 
decision of the Court of Appeals and we reinstate the 
judgments of the trial court granting defendants’ motions 
for summary disposition. 
I. FACTS AND PROCEDURAL HISTORY 
We set forth the following recitation of facts in our 
prior opinion: 
Plaintiff was pregnant and sought treatment
because she was experiencing severe pain in her 
abdomen. 
She was diagnosed as having suffered a
spontaneous abortion and a D & C [dilation and
curettage] was performed. Plaintiff alleges that
it was later discovered that she had actually
been suffering from an ectopic pregnancy, not a
spontaneous abortion, and that her left fallopian
tube had burst. 
Emergency surgery was performed
to 
remove 
plaintiff's 
left 
fallopian 
tube. 
4  
 
 
 
 
 
 
 
 
 
 
 
Plaintiff claims that as a result of the second 
operation, she can no longer bear children 
because her right fallopian tube had previously
been removed. 
Plaintiff 
decided 
to 
pursue 
a 
medical 
malpractice 
claim, 
alleging 
that 
defendants 
misdiagnosed 
her 
condition 
and 
subsequently
performed an unnecessary operation. 
Plaintiff served a notice of intent on 
defendant Mecosta County General Hospital on 
September 
19, 
1996, 
and 
on 
the 
remaining
defendants on September 23, 1996. 
Serving these
notices constituted plaintiff's attempt to (1)
meet 
the 
notice 
requirements 
for 
medical 
malpractice actions prescribed by MCL 600.2912b
and (2) toll the statute of limitations pursuant
to MCL 600.5856(d). 
After the waiting period required under MCL
600.2912b 
had 
passed, 
plaintiff 
filed 
her 
complaint. 
Thereafter, defendants filed motions
for summary disposition. 
Defendants argued,
inter alia, that plaintiff's claims were barred
by the statute of limitations because the notices
of intent failed to comply with the requirements
outlined in MCL 600.2912b(4). 
Specifically,
defendants 
asserted 
that 
plaintiff's 
notices 
failed to sufficiently state the standard of 
care, the manner in which the standard was 
breached, the action the defendants should have
taken, and the proximate cause of the injury.
Defendants advanced the position that, since the
notices 
were 
insufficient, 
the 
period 
of 
limitation was not tolled under MCL 600.5856(d)
and had therefore expired. 
The trial court 
granted the motions for summary disposition. 
The Court of Appeals reversed and remanded,
holding that defendants had waived their ability
to challenge plaintiff's failure to comply with
the notice requirements because they did not 
raise their objections before the time the 
complaint was filed . . . . [Roberts I, supra at 
59-61.] 
5  
 
 
 
 
  
 
                                                 
This Court reversed the decision of the Court of 
Appeals, holding that (1) the statute of limitations was 
not tolled unless notice was given in compliance with all 
the provisions of § 2912b, (2) that § 2912b imposed no duty 
on defendants to challenge any deficiencies in the notices 
of intent before the complaint was filed, and (3) that 
defendants were not required to assert the statute of 
limitations defense or to challenge the sufficiency of the 
notices of intent until after plaintiff filed suit. 
Roberts I, supra. 
We “express[ed] no opinion concerning 
plaintiff’s compliance or noncompliance with MCL 600.2912b, 
an issue that the Court of Appeals declined to answer.” 
Id. at 71 n 8. 
We remanded the matter to the Court of 
Appeals to address this issue. Id. at 71. 
On remand, the Court of Appeals held that plaintiff’s 
notices of intent strictly complied with the requirements 
of § 2912b.1  252 Mich App 664, 666; 653 NW2d 441 (2002). 
The panel opined that plaintiff’s notices of intent set 
forth a proper factual basis for her claim and a 
sufficient, even if not accurate, allegation as to the 
applicable standard of practice or care. 
Id. at 667-670. 
1 The panel declined to address plaintiff’s alternative
argument that her notices substantially complied with §
2912b(4) and that substantial compliance was sufficient. 
6  
 
 
 
 
 
  
 
                                                 
 
 
The panel further concluded that, by reference to the 
recitations of the factual basis for the claim, the notices 
of intent set forth the manner in which it was claimed that 
the applicable standards of care were breached, the alleged 
actions that should have been taken, and the manner in 
which it was alleged that the breaches of the standards of 
care were the proximate cause of plaintiff’s injury. 
The 
panel likewise concluded that the notices properly set 
forth the names of all health professionals and facilities 
that plaintiff notified in relation to the claim. 
II. STANDARD OF REVIEW 
This 
case 
involves 
questions 
of 
statutory 
interpretation, which are reviewed de novo. 
Roberts I, 
supra at 62. 
We review the trial court’s grant of summary 
disposition de novo. Id. 
III. ANALYSIS 
A. RELEVANT STATUTES
 
MCL 600.2912b(1)2 precludes a medical malpractice 
claimant from commencing suit against a health professional 
2 MCL 600.2912b(1) provides: 
Except 
as 
otherwise 
provided 
in 
this 
section, a person shall not commence an action 
alleging medical malpractice against a health 
(continued…) 
7  
 
 
 
   
                                                 
or health facility unless written notice is provided to 
that 
professional 
or 
facility 
before 
the 
action 
is 
commenced. 
After providing the written notice, the 
claimant is required to wait for the applicable notice 
period to pass before filing suit.3 
The 
two-year 
period 
of 
limitation 
for 
medical 
malpractice actions is tolled during the notice period 
“after the date notice is given in compliance with section 
2912b.” 
MCL 600.5856(d) (emphasis supplied). 
Thus, in 
order to toll the limitation period under § 5856(d), the 
claimant is required to comply with all the requirements of 
§ 2912b. Roberts I, supra at 64. 
(continued…)
professional or health facility unless the person
has given the health professional or health 
facility written notice under this section not
less 
than 
182 
days 
before 
the 
action 
is 
commenced. [Emphasis supplied.] 
3 The claimant generally may not commence an action for
182 days after providing the notice of intent. 
Exceptions
to this general rule are set forth in MCL 600.2912b(3)
(providing that under certain circumstances the 182-day
notice period is shortened to 91 days), MCL 600.2912b(8)
(providing that the claimant may file an action after 154
days if no response to the notice is received as 
contemplated by MCL 600.2912b[7]), and MCL 600.2912b(9)
(permitting the claimant to file the action immediately if,
at any time during the applicable notice period, the 
professional or facility named in the notice informs the
claimant in writing that the professional or facility does
not intend to settle the claim within the applicable notice
period). 
8  
 
 
  
 
 
 
 
 
 
 
 
 
 
MCL 600.2912b(4) enumerates the specific topics that 
the claimant is required to address in the written notice 
of intent: 
The notice given to a health professional or
health facility under this section shall contain 
a statement of at least all of the following: 
(a) The factual basis for the claim. 
(b) The applicable standard of practice or
care alleged by the claimant. 
(c) The manner in which it is claimed that 
the applicable standard of practice or care was
breached by the health professional or health
facility. 
(d) The alleged action that should have been
taken to achieve compliance with the alleged
standard of practice or care. 
(e) The manner in which it is alleged the
breach of the standard of practice or care was
the proximate cause of the injury claimed in the
notice. 
(f) The names of all health professionals
and health facilities the claimant is notifying
under this section in relation to the claim. 
[Emphasis supplied.] 
It is against this unambiguous statutory backdrop that we 
must determine the adequacy of plaintiff’s notices of 
intent. 
B. PLAINTIFF’S NOTICES OF INTENT DO NOT COMPLY WITH § 2912b(4) 
Plaintiff provided the following notice of intent to 
defendant Mecosta County General Hospital: 
9  
 
 
 
 
 
 
 
 
 
1. 
FACTUAL BASIS FOR CLAIM 
This 
is 
a 
claim 
for 
negligence 
which 
occurred on October 4, 1994, at Mecosta County 
General Hospital. 
It is claimed that on said 
date 
while 
pregnant 
with 
her 
first 
child,
Claimant presented herself to Mecosta County
General Hospital complaining of severe pain. 
At 
that time a diagnosis of a spontaneous abortion
was made and a D and C was performed. 
Claimant 
was sent home at that time. 
Over the course of the next few days
Claimant 
continued 
to 
experience 
pain 
and 
cramping and, on October 7, 1994, was again seen
at Mecosta County General Hospital. Claimant was 
told that the pain she was experiencing was 
cramps from the D and C she had done and was sent
home. 
Claimant returned to the hospital on October
8, 1994, wherein it was discovered that Claimant
had not had a spontaneous abortion but had an
ectopic pregnancy in her left tube which had
burst. 
Emergency surgery was performed at that
time and her left tube was removed. 
Claimant 
had 
her 
right 
tube 
removed 
approximately ten years ago and, as a result of
the negligence set forth above, she is now unable
to have children. 
2. 
THE APPLICABLE STANDARD OF PRACTICE OR CARE 
ALLEGED 
Claimant 
contends 
that 
the 
applicable
standard of care required that Mecosta County
General Hospital provide the claimant with the
services of competent, qualified and licensed 
staff of physicians, residents, interns, nurses
and other employees to properly care for her,
render competent advice and assistance in the
care and treatment of her case and to render same 
in accordance with the applicable standard of
care. 
10  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
                                                 
3. 
THE MANNER IN WHICH IT IS CONTENDED THAT THE 
APPLICABLE STANDARD OF CARE WAS BREACHED 
See paragraph 2 above.[4] 
4. 
THE ACTION THAT SHOULD HAVE BEEN TAKEN TO 
ACHIEVE COMPLIANCE WITH THE STANDARD OF PRACTICE 
OR CARE 
See paragraph 2 above. 
5. 
THE MANNER IN WHICH THE BREACH WAS THE 
PROXIMATE CAUSE OF CLAIMED INJURY 
See paragraph 2 above. 
6. 
NAMES OF HEALTH PROFESSIONALS, ENTITIES, AND
FACILITIES NOTIFIED 
Mecosta County General Hospital and all 
agents 
and 
employees, 
actual 
or 
ostensible,
thereof. 
Plaintiff subsequently provided the following notice 
of intent to the remaining defendants (Obstetrics & 
Gynecology 
of 
Big 
Rapids, 
P.C.; 
Gail 
DesNoyers, 
an 
obstetrician, 
and 
Barb 
Davis, 
P.A.C., 
a 
physician’s 
assistant, 
both 
of 
whom 
were 
affiliated 
with 
the 
professional corporation; and Michael Atkins, M.D., a 
physician who treated plaintiff at the hospital’s emergency 
room): 
4 Plaintiff contends that the references to “paragraph
2” in the notice are typographical errors, and that they
should be viewed as referring to paragraph 1. 
11  
 
 
 
 
 
 
 
 
 
 
1. 
FACTUAL BASIS FOR CLAIM 
This 
is 
a 
claim 
for 
negligence 
which 
occurred on October 4, 1994, at Obstetrics &
Gynecology of Big Rapids. 
It is claimed that on 
said date, while pregnant with her first child,
Claimant presented herself to Barb Davis, PAC,
Dr. Michael Atkins, and Dr. Gail DesNoyers
complaining 
of 
severe 
abdominal 
pain 
and 
bleeding. 
At that time a diagnosis of a 
spontaneous abortion was made and a D & C was
performed at Mecosta County General Hospital.
Claimant was sent home at that time, despite Dr.
DesNoyer’s [sic] knowledge of Claimant’s history
of a prior ectopic pregnancy. 
Over the course of the next few days,
Claimant 
continued 
to 
experience 
pain 
and 
cramping and, on October 7, 1994, was seen at
Mecosta County General Hospital by Dr. Michael
Atkins. 
Claimant was told that the pain she was
experiencing was cramps from the D & C she had
done and was sent home. 
Claimant returned to the hospital on October
8, 1994, wherein it was discovered that Claimant
had not had a spontaneous abortion but had an
ectopic pregnancy in her left tube which had
burst. 
Emergency surgery was performed at that
time and her left tube was removed. 
Claimant 
had 
her 
right 
tube 
removed 
approximately ten years ago and, as a result of
the negligence set forth above, she is now unable
to have any children. 
2. 
THE APPLICABLE STANDARD OF PRACTICE OR CARE 
ALLEGED 
Claimant 
contends 
that 
the 
applicable
standard of care required that Obstetrics & 
Gynecology of Big Rapids, Dr. Gail DesNoyers and
Barb Davis, PAC, provide the Claimant with the 
services of competent, qualified and licensed 
staff of physicians, residents, interns, nurses
and other employees to properly care for her,
render competent advice and assistance in the 
12  
 
 
 
  
 
 
 
 
 
 
 
care and treatment of her case and to render same 
in accordance with the applicable standard of
care. 
3. 
THE MANNER IN WHICH IT IS CONTENDED THAT THE 
APPLICABLE STANDARD OF PRACTICE OR CARE WAS 
BREACHED 
Claimant claims that Obstetrics & Gynecology
of Big Rapids, Dr. Gail DesNoyers and Barb Davis,
PAC, failed to provide her with the applicable 
standard 
of 
practice 
and 
care 
outlined 
in 
paragraph 2 above. 
4. 
THE ACTION THAT SHOULD HAVE BEEN TAKEN TO 
ACHIEVE COMPLIANCE WITH THE STANDARD OF PRACTICE 
OR CARE 
See paragraph 2 above. 
5. 
THE MANNER IN WHICH THE BREACH WAS THE 
PROXIMATE CAUSE OF CLAIMED INJURY 
See paragraph 2 above. 
6. 
NAMES OF HEALTH PROFESSIONALS, ENTITIES, AND
FACILITIES NOTIFIED 
Obstetrics & Gynecology of Big Rapids, Gail
DesNoyers, 
M.D., 
Michael 
Atkins, 
M.D., 
Barb 
Davis, PAC, and all agents and employees, actual
or ostensible, thereof. 
Plaintiff’s notices of intent primarily set forth 
facts demonstrating an unfavorable outcome——the fact that 
plaintiff had suffered an ectopic pregnancy and a ruptured 
“left tube” that was not diagnosed by defendants. Although 
the notices satisfy some of the requirements of § 2912b, 
they do not satisfy all of those requirements. 
Missing 
from the notices are (1) a statement of the particular 
13  
 
 
 
 
 
 
 
 
standard of practice or care applicable to each of the 
various defendants, (2) statements regarding the manner in 
which it was claimed that defendants breached the alleged 
standards of practice or care, (3) statements alleging the 
actions that should have been taken by defendants, and (4) 
statements regarding the manner in which defendants’ 
breaches of the standards of practice or care were alleged 
to have constituted the proximate cause of plaintiff’s 
injury. 
1. MCL 600.2912b(4)(a): FACTUAL BASIS 
We agree with the Court of Appeals that the notices of 
intent, which generally describe the events that led to 
plaintiff’s alleged injury, properly set out the factual 
basis for plaintiff’s claim. 
2. MCL 600.2912b(4)(b): STANDARD OF PRACTICE OR CARE 
The Court of Appeals panel declined to find fault with 
plaintiff’s statements of the standard of care, noting that 
(1) “defendants direct us to no authority to establish that 
the stated standard of care is incorrect, nor do they 
direct us to what they believe is the proper standard of 
care,” and (2) “[t]he statute does not require that the 
claimant accurately or correctly state the standard of care 
nor does it declare the notice to be inadequate if the 
14  
 
 
 
 
                                                 
plaintiff is incorrect in stating the standard of care.” 
252 Mich App 670. 
With respect to the panel’s first point, it is 
plaintiff’s burden to establish compliance with § 2912b 
and, in turn, to establish entitlement to application of 
the notice tolling provision, § 5856(d). 
See Roberts I, 
supra at 64. 
With 
respect 
to 
the 
panel’s 
second 
point, 
we 
acknowledge that the notice of intent is provided at the 
earliest 
stage 
of 
a 
medical 
malpractice 
proceeding. 
Indeed, the notice must be provided before the action can 
even be commenced. 
At the notice stage, discovery as 
contemplated in our court rules, MCR 2.300 et seq., has not 
been commenced, and it is likely that the claimant has not 
yet been provided access to the records of the professional 
or facility named in the notice.5
 It is therefore 
reasonably anticipatable that plaintiff’s averments as to 
the applicable standard may prove to be “inaccurate” or 
erroneous following formal discovery; moreover, it is 
probable that the alleged standard of care will be disputed 
5 See MCL 600.2812b(5) (requiring the professional or
facility receiving notice to allow the claimant access to
all medical records related to the claim that are in the 
control of the professional or facility within 56 days
after receipt of the notice). 
15  
 
 
   
                                                 
 
 
by the defendants.6
 In light of these circumstances, the 
claimant 
is 
not 
required 
to 
craft 
her 
notice 
with 
omniscience.7
 However, what is required is that the 
claimant make a good-faith effort to aver the specific 
standard of care that she is claiming to be applicable to 
each particular professional or facility that is named in 
the notice.8 
6 Indeed, the applicable standard of practice or care
is often a hotly disputed matter in a medical malpractice
action, and opposing expert witnesses are likely to 
disagree regarding the particular standard to which a 
defendant should be held. 
7 The statute requires only that the claimant set forth
particular allegations and claims regarding the applicable
standard of care, breach, etc. 
Accordingly, while the
claimant must set forth allegations in good faith, in a
manner that is responsive to the specific queries posed by
the statute, and with enough detail to allow the potential
defendants to understand the claimed basis of the impending
malpractice action, the claimant is not required ultimately
to prove that her statements are “correct” in the legal
sense. 
8 The phrase “standard of practice or care” is a term
of art in the malpractice context, and the unique standard
applicable to a particular defendant is an element of a
medical malpractice claim that must be alleged and proven.
Cox v Flint Bd of Hosp Mgrs, 467 Mich 1, 10; 651 NW2d 356
(2002). 
The applicable standard is governed either by
statute (see, for example, MCL 600.2912a[1], which sets
forth the particular proofs that a malpractice plaintiff 
must present with respect to a defendant’s “standard of
practice or care,” depending on whether the defendant is a
general practitioner or a specialist) or, in the absence of
a statutory standard, by the common law. 
Cox, supra at 5,
20. 
The standard of practice or care that is applicable,
for example, to a surgeon would likely differ in a given
(continued…) 
16  
 
 
 
                                                 
 Here, 
several 
different 
medical 
caregivers 
were 
alleged to have engaged in medical malpractice. 
Yet, 
rather than stating an alleged standard of practice or care 
for 
each 
of 
the 
various 
defendants——a 
hospital, 
a 
professional corporation, an obstetrician, a physician’s 
assistant, and an emergency room physician——plaintiff’s 
notices of intent allege an identical statement applicable 
to all defendants9 in response to § 2912b(4)(b): 
[T]he applicable standard of care required
that [the hospital, the P.C., Desnoyers, and 
Davis] provide the Claimant with the services of
competent, 
qualified 
and 
licensed 
staff 
of 
physicians, residents, interns, nurses and other
employees to properly care for her, render 
competent advice and assistance in the care and
treatment of her case and to render same in 
accordance with the applicable standard of care. 
With respect to the hospital and the professional 
corporation, this statement does not allege a standard 
applicable specifically to a hospital or professional 
corporation as opposed to any other healthcare professional 
or facility. 
Moreover, this statement fails to indicate 
whether plaintiff was alleging that these defendants were 
(continued…) 
set of circumstances from the standard applicable to an 
OB/GYN or to a nurse.  
9 Notably, no statement of an alleged standard of
practice or care is provided with respect to defendant
Atkins, the emergency room doctor. 
17 
 
 
 
                                                 
vicariously or directly liable to her.10
 Although it 
appears from plaintiff’s complaint that she is claiming 
that the hospital and the professional corporation are 
vicariously liable for the negligence of their agents, the 
notices of intent implied that plaintiff alleged direct 
negligence against these defendants for negligently hiring 
or negligently granting staff privileges to the individual 
defendants. 
Thus, plaintiff’s notices neither alleged a 
standard 
specifically 
applicable 
to 
the 
defendant 
facilities, nor did they serve as adequate notice to these 
defendants that plaintiff planned to proceed under a 
vicarious liability theory at trial. 
The section of plaintiff’s alleged standard of care 
that appears to be relevant to individual defendants 
DesNoyers and Davis states that 
the applicable standard of care required that 
. . . 
[they] 
render 
competent 
advice 
and 
assistance in the care and treatment of her case 
and to render same in accordance with the 
applicable standard of care. 
Thus, in response to the statutory query, “What is the 
applicable standard or practice or care alleged by the 
10 See Cox, supra at 11 (“A hospital may be 1) directly
liable for malpractice, through claims of negligence in
supervision of staff physicians as well as selection and
retention of medical staff, or 2) vicariously liable for
the negligence of its agents.”). 
18  
 
 
 
 
       
 
                                                 
 
claimant?”, plaintiff has essentially answered in part: 
“The standard of care required that defendants adhere to 
the standard of care.” 
Obviously, this statement is 
tautological and unresponsive, and it cannot be viewed as 
minimally compliant with § 2912b(4)(b). 
The alleged 
standard also observes that defendants DesNoyers and Davis 
were required to “properly care for” plaintiff and to 
“render competent advice and assistance.” 
Such general 
averments, however, are not adequately responsive to the 
statutory 
requirement 
that 
the 
claimant 
allege 
an 
applicable standard of practice or care relevant to the 
defendant.11 
Again, plaintiff was not required to provide a 
statement of alleged standards of care or practice that 
11 The dissent argues that nowhere in § 2912b(4) does 
the Legislature require that a plaintiff allege a “standard
applicable specifically” to each defendant and, therefore,
neither should this Court. Post at 15-16. 
However, as
explained in n 8, the phrase “standard of practice or care”
is a term of art. 
Proof of the standard of care is 
required in every medical malpractice lawsuit, and the
Legislature has chosen to require a plaintiff to address
standard of care issues in the notice of intent. 
Under a 
proper understanding of this term, the standard applicable
to one defendant is not necessarily the same standard
applicable to another defendant. 
See Cox, supra at 10. 
Thus, we are attempting to do nothing more than interpret
the Legislature’s requirement in § 2912b(4)(b)—that a 
plaintiff provide a "statement" regarding the applicable
“standard of practice or care” alleged. 
19  
 
 
 
 
 
 
 
 
                                                 
 
might ultimately be proven, after discovery and trial, to 
be correct and accurate in every respect. 
However, 
plaintiff was required to make a good-faith averment of 
some particularized standard for each of the professionals 
and facilities named in the notices.12
 We conclude that 
plaintiffs’ notices fail to comply with § 2912b(4)(b) with 
respect to each defendant. 
3. MCL 600.2912b(4)(c): BREACH 
In response to § 2912b(4)(c), which requires a 
claimant to state “[t]he manner in which it is claimed that 
the applicable standard of practice or care was breached,” 
plaintiff’s notice to the hospital states “See paragraph 2 
12 We note that in some cases the burden of explication
under § 2912b(4)(b) will be minimal. 
For example,
allegations that a physician has extracted the wrong tooth,
amputated the wrong limb, or left a surgical instrument
embedded in a patient’s body cavity would give rise only to
a slight burden of articulation of the standard of care 
under § 2912b(4)(b). 
Under such circumstances it would be 
obvious to a casual observer that the standard of care 
would require the physician to extract the correct tooth,
amputate the correct limb, or properly account for all
surgical instruments. 
However, in the instant case,
plaintiff’s allegations are based on an alleged failure to
diagnose an ectopic pregnancy and nothing more. 
Whether 
the failure to diagnose this condition constituted a breach
of the standard of care, in contrast to the above examples,
is 
not 
obvious 
from 
the 
face 
of 
the 
allegations.
Accordingly, plaintiff was required to provide a more 
exacting statement of the standard of care and of the
manner in which it was breached. 
20  
 
 
 
 
 
 
                                                 
above.” 
The notice provided to the remaining defendants13 
states: 
Claimant claims that Obstetrics & Gynecology
of Big Rapids, Dr. Gail DesNoyers and Barb Davis,
PAC, failed to provide her with the applicable 
standard 
of 
practice 
and 
care 
outlined 
in 
paragraph 2 above. 
The Court of Appeals panel held that the notices 
complied with § 2912b(4)(c): 
If we look only to the statements in 
paragraphs two and three of the notices, they
arguably 
do 
not 
comply 
with 
the 
statute,
particularly 
with 
respect 
to 
the 
individual 
defendants. 
However, nothing in the statute 
requires that the notice of intent be in a 
particular format or that each of the six 
statutory 
items 
be 
separately 
listed 
or 
identified. 
If we examine the respective first
paragraphs of the notices (the factual basis for
the claim), we do find a statement of the manner
in 
which 
plaintiff 
claims 
the 
standard 
of 
practice or care was breached. Specifically, the
notices clearly state that the medical personnel
incorrectly 
diagnosed 
a 
spontaneous 
abortion 
rather than an ectopic pregnancy, resulting in
the loss of plaintiff's only remaining fallopian
tube, thus rendering her sterile. 
[252 Mich App
672.] 
We agree that nothing in § 2912b(4) requires that the 
notice be in any particular format. 
The statute does, 
however, clearly require the claimant to provide “a 
13 As with the statement of the applicable standard of
care, the notice contains absolutely no statement with 
respect to a breach of the standard of care by defendant
Atkins. 
21  
 
 
 
 
   
                                                 
 
statement” 
of 
each 
of 
the 
enumerated 
categories 
of 
information, and we disagree with the panel’s conclusion 
that the required information need not be “separately . . . 
identified.” 
Certainly, the statement must identify, in a 
readily ascertainable manner, the specific information 
mandated by § 2912b(4). 
The 
notices 
fail 
to 
identify 
how 
the 
various 
defendants breached the applicable standards of care. 
Here, the hospital’s notice of intent refers to paragraph 
2, in which the alleged standard of practice or care is set 
out. The notice of intent applicable to the remaining 
defendants 
states 
that 
defendants, 
defendant 
Atkins 
excluded, 
“failed 
to 
provide 
[plaintiff] 
with 
the 
applicable standard of practice and care.” 
In both 
instances, plaintiff has stated, in essence: “Defendants 
breached the standard of care by breaching the standard of 
care.” 
Such a circular and unresponsive assertion is not 
minimally 
compliant 
with 
the 
statutory 
mandate 
that 
plaintiff provide a statement of the manner in which 
defendants breached the applicable standards of care.14 
14 At oral argument, plaintiff’s counsel conceded that 
plaintiff’s notice merely stated, in essence, that “the
manner in which [the standard of care] was breached is the
fact that it was breached,” and counsel took the untenable
(continued…) 
22  
 
 
 
 
                                                 
We are also unable to discern in the paragraphs 
setting forth the factual basis for the claim any statement 
of the manner in which the standards of care were breached. 
The notices indicate that plaintiff complained of severe 
pain, was diagnosed with a miscarriage, underwent a 
dilation and curettage procedure, was sent home, returned 
to the hospital four days later, was diagnosed with an 
ectopic pregnancy, and underwent surgery to remove her 
“left 
tube.” 
Although 
these 
are 
certainly 
tragic 
circumstances, the facts as set forth in the notices simply 
do not serve to notify defendants of the manner in which 
they breached their respective standard of care. 
The 
notices do not aver how plaintiff alleged her treatment by 
any defendant was deficient. 
There is no allegation, for 
(continued…)
position 
that 
this 
is 
all 
that 
is 
required 
by 
§
2912b(4)(c). 
Such a construction renders the statutory
notice requirement completely nugatory. 
Moreover, it does
not fulfill the statutory purposes of notifying potential
malpractice defendants of the basis of the claims against
them. 
Counsel’s construction of § 2912b(4)(c) is analogous
to the following hypothetical example: 
A parent sees that
a priceless lamp in his living room is broken. 
The parent
asks his child, “How did the lamp become broken?” 
The 
child replies, “The lamp is broken.” The repetition of the
fact that the lamp is broken is unresponsive to the 
question that was asked. Similarly, plaintiffs’ notices of
intent answer the question, “How was the standard of care
breached?” with the response, “The standard of care was
breached.” 
23  
 
 
 
 
                                                 
 
example, that any of the defendants failed to perform 
critical tests, incorrectly diagnosed her condition, or 
failed to refer her to a specialist in keeping with the 
appropriate standard of care. 
Although, perhaps, an 
inference 
arises 
from 
the 
recitation 
of 
facts 
that 
plaintiff was alleging that one or more of the defendants 
should have earlier diagnosed an ectopic pregnancy, such an 
“inference” is not sufficient to meet the statutory 
requirement that plaintiff provide a statement of the 
manner in which each defendant breached the applicable 
standard of care.15 
15Plaintiff’s notices of intent state that defendants 
engaged in “negligence” and, thus, it may said that 
plaintiff specifically alleged in her notices that a 
“breach” of the standard of care occurred. 
However, it is
not sufficient under § 2912b(4)(c) to merely assert that a
breach occurred, because that section requires that a 
notice more precisely contain a statement regarding the
manner in which the breach is alleged to have occurred. 
Despite enacting a statute that requires a plaintiff
in general terms to provide her contentions regarding six
aspects of her claim of medical malpractice, the dissent’s
view is that the Legislature created a nullity and that a
plaintiff satisfies her obligation under this statute by 
essentially declaring, “I went to the doctor and something
bad happened.” 
Contrary to the dissent’s assertion that
the majority has required a “high degree of specificity”——
neither a term nor a concept found in our opinion——what we
have required is what the statute expressly requires: A
good-faith effort on the part of a plaintiff to answer the
statutory questions, including the manner in which the
(continued…) 
24  
 
 
 
 
 
 
 
 
                                                 
4. MCL 600.2912b(4)(d): ACTION THAT SHOULD HAVE BEEN TAKEN 
In response to § 2912b(4)(d), which mandates a 
statement of “[t]he alleged action that should have been 
taken to achieve compliance with the alleged standard of 
practice or care,” plaintiff’s notices merely refer the 
reader to “paragraph 2” (which, on appeal, plaintiff claims 
should have read “paragraph 1”). 
The Court of Appeals 
panel held that the recitations of facts in the notices 
were sufficient to meet this requirement: 
Clearly, when reading the notices as a 
whole, plaintiff alleges that the action that
should have been taken was to have timely
diagnosed the ectopic pregnancy so that it could
have been treated without the loss of plaintiff’s
left fallopian tube. [252 Mich App 672.] 
Once again, we disagree. 
Plaintiff has failed to identify 
any particular action that any defendant should have taken 
in order to achieve compliance with the standard of care. 
Defendants are left to guess not only which aspect of 
plaintiff’s treatment was deficient, but what plaintiff 
alleges defendants should have done differently. 
5. MCL 600.2912b(4)(e): PROXIMATE CAUSE 
Plaintiff’s notices of intent fail to satisfy the 
requirement of § 2912b(4)(e) that the notice contain a 
(continued…) 
plaintiff claims that the applicable standard of care was 
breached.  
25  
 
 
 
                                                 
 
statement of “[t]he manner in which it is alleged the 
breach of the standard of practice or care was the 
proximate cause of the injury claimed in the notice.” 
The 
Court of Appeals held that 
plaintiff clearly states that the misdiagnosis
resulted in having to have emergency surgery four
days later to remove her only remaining fallopian
tube as a result of the tube bursting from the
undiagnosed ectopic pregnancy, thus rendering her
sterile. 
This is clearly a statement of the
manner in which it is alleged that the breach of
the standard of practice or care proximately
caused the injury. [253 Mich App 673.] 
We disagree with the assertion that plaintiff “clearly 
state[d]” that a misdiagnosis by any of the defendants 
resulted in her fallopian tube bursting and in her ensuing 
sterility. 
Nowhere in the notices does plaintiff state 
that any of the defendants misdiagnosed her condition; nor 
do the notices state any consequences stemming from a 
misdiagnosis. Indeed, the reader is left to wonder whether 
plaintiff is alleging that a diagnosis of ectopic pregnancy 
could have been made in time to avoid the rupture of her 
“tube,” or whether she is alleging that her tube ruptured 
as a direct result of her treatment by defendants DesNoyers 
and Davis on October 4, 1996.16
 With no specific 
16 Plaintiff’s notices of intent state that “as a 
result of [defendants’] negligence . . . , [plaintiff] is
(continued…) 
26  
 
 
 
 
 
 
 
                                                 
 
allegations regarding the conduct of any of the named 
defendants, the notices are insufficient to meet the 
particularized requirements of § 2912b(4)(e).17 
6. MCL 600.2912b(4)(f): HEALTH PROFESSIONALS AND FACILITIES 
Finally, we agree with the Court of Appeals that the 
notices of intent, which list “Mecosta County General 
Hospital 
and 
all 
agents 
and 
employees, 
actual 
or 
ostensible, thereof” as well as “Obstetrics & Gynecology of 
Big Rapids, Gail DesNoyers, M.D., Michael Atkins, M.D., 
(continued…)
now unable to have any children.” 
At first blush, this
may appear to satisfy the proximate causation requirement
of § 2912b(4)(e). However, it is not sufficient under this
provision 
to 
merely 
state 
that 
defendants' 
alleged
negligence caused an injury. 
Rather, § 2912b(4)(e) 
requires that a notice of intent more precisely contain a
statement as to the manner in which it is alleged that the
breach was a proximate cause of the injury. 
17 The dissent urges, on the basis of legislative
history, that the Legislature’s purpose in enacting § 2912b
was to encourage settlement discussions. 
Post at 8. 
This 
use of legislative history is questionable. 
See In re 
Certified 
Question 
(Kenneth 
Henes 
Special 
Projects
Procurement, Marketing, & Consulting Corp v Continental
Biomass Industries, Inc), 468 Mich 109, 114-118 (2003).
However, assuming that the Legislature’s primary purpose
was to facilitate settlement, it is clear from the decision
to depart from the generally applicable notice pleading
environment created by our court rules that the Legislature
believed more particularized statements were required in
the context of medical malpractice litigation. 
Indeed, if
settlement 
is 
a 
primary 
objective 
of 
§ 
2912b, 
the 
heightened particularity required by the statute fosters
this 
goal 
by 
providing 
a 
defendant 
with 
a 
clear 
understanding of the plaintiff’s allegations. 
27  
 
 
 
 
   
Barb Davis, PAC, and all agents and employees, actual or 
ostensible, thereof,” contain a proper statement of the 
names of all defendant health professionals and facilities. 
IV. CONCLUSION 
Under MCL 600.2912b(4), a medical malpractice claimant 
is required to provide potential defendants with notice 
that includes a “statement” of each of the statutorily 
enumerated categories of information. 
Although it is 
reasonable to expect that some of the particulars of the 
information supplied by the claimant will evolve as 
discovery and litigation proceed, the claimant is required 
to make good-faith averments that provide details that are 
responsive to the information sought by the statute and 
that are as particularized as is consistent with the early 
notice stage of the proceedings. 
The information in the 
notice of intent must be set forth with that degree of 
specificity which will put the potential defendants on 
notice as to the nature of the claim against them. This is 
not an onerous task: all the claimant must do is specify 
what it is that she is claiming under each of the 
enumerated categories in § 2912b(4). 
Although there is no 
one method or format in which a claimant must set forth the 
required information, that information must, nevertheless, 
28  
 
 
 
 
be specifically identified in an ascertainable manner 
within the notice. 
The notices of intent supplied by plaintiff to 
defendants in this case fail to comply with the statutory 
mandate. 
Among 
the 
defendants 
are 
two 
different 
facilities, an obstetrician, an emergency room physician, 
and a physician’s assistant, yet no attempt was made to 
identify a specific standard of practice or care applicable 
to any particular defendant. 
Rather than indicating the 
manner in which the (improperly alleged) standards of care 
were breached by defendants, the notices simply indicate 
that the standards were, in fact, breached. Nowhere in the 
notices does plaintiff state what actions the various 
defendants should have taken to comply with the appropriate 
standards of practice or care, or how defendants’ conduct 
constituted the proximate cause of plaintiff’s claimed 
injury. 
Although the factual recitations in the notices 
indicate that plaintiff suffered an adverse medical result, 
this result is not connected in any meaningful way with the 
conduct of any defendant. 
Accordingly, plaintiff did not 
fulfill her obligation under § 2912b, and the statute of 
limitations was not tolled during the notice period. 
We 
therefore reverse the judgment of the Court of Appeals and 
29  
 
 
reinstate the judgments of the trial court granting summary 
disposition to defendants. 
Robert P. Young, Jr.
Maura D. Corrigan
Clifford W. Taylor
Stephen J. Markman 
30  
 
 
 
 
 
 
 
 
 
 
 
 
 
_______________________________ 
 
 
 
 
 
 
 
S T A T E O F M I C H I G A N  
SUPREME COURT  
LISA ROBERTS, 
Plaintiff-Appellee, 
v 
No. 122312 
MICHAEL ATKINS, M.D., 
Defendant-Appellant, 
and 
MECOSTA COUNTY GENERAL HOSPITAL,
GAIL A. DESNOYERS, M.D., BARB
DAVIS, and OBSTETRICS AND
GYNECOLOGY OF BIG RAPIDS, P.C.,
formerly known as GUNTHER, DESNYOYERS
& MEKARU, 
Defendants. 
LISA ROBERTS, 
Plaintiff-Appellee, 
v 
No. 122335 
GAIL A. DESNOYERS, M.D., BARB
DAVIS, OBSTETRICS AND GYNECOLOGY
OF BIG RAPIDS, P.C., formerly
known as GUNTHER, DESNOYERS &
MEKARU, 
Defendants-Appellants, 
and 
MICHAEL ATKINS, M.D., and
MECOSTA COUNTY HOSPITAL,
Defendants. 
 
 
_______________________________ 
 
 
 
 
 
 
 
 
_______________________________ 
 
 
 
 
 
v 
LISA ROBERTS, 
Plaintiff-Appellee, 
No. 122338 
MECOSTA COUNTY GENERAL HOSPITAL, 
Defendant-Appellant, 
and 
GAIL A. DESNOYERS, M.D., MICHAEL
ATKINS, M.D., BARB DAVIS, and
OBSTETRICS AND GYNECOLOGY OF 
BIG RAPIDS, P.C., formerly known
as GUNTHER, DESNOYERS & MEKARU, 
Defendants. 
KELLY, J. (dissenting). 
INTRODUCTION 
We 
granted 
leave 
to 
appeal 
to 
determine 
what 
constitutes 
an 
adequate 
notice 
of 
intent 
under 
MCL 
600.2912b(4) preparatory to the filing of a medical 
malpractice complaint. 
The majority concludes that the 
statute requires a high degree of specificity at the notice 
stage of a potential lawsuit. 
I respectfully disagree. 
Requiring such a level of 
specificity is inconsistent with the statute's words and 
purpose. 
I would hold that the notice of intent must 
provide sufficient information about a claim that a 
2  
 
 
 
 
 
 
 
 
 
defendant may ascertain and investigate its basis and 
determine whether to discuss settlement. 
After reviewing 
the notices of intent that plaintiff provided in this case, 
I conclude that they satisfy the statute’s requirements. 
Therefore, I would affirm the decision of the Court of 
Appeals. 
FACTS AND PROCEDURAL HISTORY 
Early in her pregnancy, plaintiff experienced severe 
abdominal pain and bleeding. 
The defendant physicians 
diagnosed a spontaneous abortion, performed a dilation and 
curettage procedure, and sent plaintiff home to recover. 
Plaintiff’s pain persisted. 
Three days later, it 
worsened and she sought care at the defendant hospital. 
The emergency room doctor, defendant Atkins, diagnosed 
cramps and released plaintiff. 
Later that night, plaintiff returned to the defendant 
hospital. It was determined that she had had an ectopic 
pregnancy that had ruptured her left fallopian tube. 
The 
defendant physicians removed plaintiff’s left fallopian 
tube. Because her right fallopian tube had been removed 
several years earlier, the operation rendered her sterile. 
Plaintiff brought suit for medical malpractice. 
She 
claimed that the physicians' misdiagnoses led to her 
sterility. 
3  
 
 
 
                                                 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Plaintiff’s counsel sent to the defendant hospital an 
initial notice of intent to sue, as required by MCL 
600.2912b(4).1
 Counsel amended the notice approximately a 
month later, added other defendants who are agents or 
1MCL 600.2912b provides in part: 
(4) 
The 
notice 
given 
to 
a 
health 
professional 
or 
health 
facility 
under 
this 
section shall contain a statement of at least all 
of the following: 
(a) The factual basis for the claim. 
(b) The applicable standard of practice or
care alleged by the claimant. 
(c) The manner in which it is claimed that 
the applicable standard of practice or care was
breached by the health professional or health
facility. 
(d) The alleged action that should have been
taken to achieve compliance with the alleged
standard of practice or care. 
(e) The manner in which it is alleged the
breach of the standard of practice or care was
the proximate cause of the injury claimed in the
notice. 
(f) The names of all health professionals
and health facilities the claimant is notifying
under this section in relation to the claim. 
4  
 
 
 
 
 
 
 
employees of the hospital, and sent the amended notice to 
them. 
Ultimately, plaintiff brought suit and defendants 
moved for summary disposition. They asserted that the 
notices of intent failed to comply with MCL 600.2912b(4), 
and because by then the statutory period of limitations had 
expired, plaintiff’s claims were barred. 
The trial court 
granted the motion. 
The Court of Appeals vacated the 
decision and remanded the case. 240 Mich App 175; 610 NW2d 
285 (2000). It held that defendants had waived their right 
to challenge the sufficiency of the notices. 
This Court granted leave to appeal. 
A majority found 
that a challenge to the sufficiency of the notices had not 
been waived. 
It then remanded the case to the Court of 
Appeals to consider whether plaintiff had complied with the 
statute’s notice requirements. Roberts v Mecosta Co Gen 
Hosp, 466 Mich 57; 642 NW2d 663 (2002) (Roberts I). 
On 
remand, the Court of Appeals held that the plaintiff had 
complied with the requirements. 
Roberts v Mecosta Co Gen 
Hosp (On Remand), 252 Mich App 664; 653 NW2d 441 (2002). 
We again granted leave to appeal. 468 Mich 869 (2003). 
STANDARD OF REVIEW 
We review summary disposition judgments de novo. 
Harvey v Michigan, 469 Mich 1, 6; 664 NW2d 767 (2003). We 
5  
 
 
 
 
 
 
 
also review questions of statutory interpretation de novo. 
Omelenchuk v City of Warren, 461 Mich 567, 571 n 10; 609 
NW2d 177 (2000). See also Roberts I at 62. 
STATUTORY CONSTRUCTION AND ANALYSIS 
The issue before us is whether plaintiff’s notices 
satisfied the requirements of MCL 600.2912b(4). 
Our duty 
is to determine what the Legislature intended. Omelenchuk 
at 576 n 19. 
We begin with the language of the statute, 
and if the intent of the Legislature is clearly expressed, 
no further construction is warranted. 
Helder v Sruba, 462 
Mich 92, 99; 611 NW2d 309 (2000). 
The statute by its terms requires that the notice 
contain a “statement” of at least six items: 
(1) the 
factual basis for the claim, (2) the alleged applicable 
standard of practice or care, (3) the alleged manner in 
which the applicable standard of practice or care was 
breached, (4) the alleged action that should have been 
taken to comply with the applicable standard of practice or 
care, (5) the manner in which the breach of the standard of 
care proximately caused the injury, and (6) the names of 
all health professionals and health facilities that the 
claimant is notifying under the statute. MCL 600.2912b(4). 
To ascertain what the Legislature intended by this 
statute, 
we 
first 
examine 
the 
meaning 
of 
the 
word 
6  
 
 
 
 
 
 
 
“statement.” 
The statute does not define “statement,” and 
a resort to a lay dictionary to ascertain the meaning 
communication 
or 
declaration 
in 
speech 
or 
intended 
is 
of 
limited 
usefulness. 
One 
dictionary 
provides: 
Statement, n 1. something stated. 2. a 
writing, setting forth facts, particulars, etc.
3. a single sentence or assertion: I disagree
with 
your 
last 
statement.
 [Random 
House 
Webster’s College Dictionary (1995).] 
A “statement” can be merely a general assertion or it can 
be a detailed description. 
Plaintiff argues that the statute requires the former, 
and defendants argue that it requires the latter. The word 
as it appears in the sentence is susceptible to both 
meanings. 
Thus, to determine what the statute intends, we 
examine its structure as a whole, and particularly, the 
text surrounding the word "statement." 
G C Timmis & Co v 
Guardian Alarm Co, 468 Mich 416, 420; 662 NW2d 710 (2003). 
In discerning the intended meaning, we consider also 
the 
Legislature's 
apparent 
purpose 
in 
enacting 
the 
provision. 
In re Wirsing, 456 Mich 467, 474; 573 NW2d 51 
(1998). 
We may even consider legislative history. 
Adrian 
School Dist v Michigan Pub School Employees Retirement Sys, 
458 Mich 326, 335; 582 NW2d 767 (1998). 
7  
 
 
 
 
 
The statute in question requires that claimants 
alleging medical malpractice send a notice of intent to sue 
to potential defendants at least 182 days before filing a 
complaint. MCL 600.2912b(1). Each potential party is then 
required to make available to the others medical records in 
his possession relating to the claim. MCL 600.2912b(5). 
Within 154 days after receiving the notice of intent, 
the defendants are required to respond to it stating (1) 
the factual basis for their defense to the claim, (2) the 
standard 
of 
practice 
or 
care 
that 
they 
allege 
is 
applicable, (3) the manner in which they claim to have 
complied with the standard of care, and (4) the reasons why 
they contend that they were not the proximate cause of the 
plaintiff’s alleged injury. MCL 600.2912b(7). 
The statute anticipates that the defendants will often 
challenge the alleged applicable standard of practice or 
care and the manner in which it was breached. 
Id. 
The 
statutory period of limitations is tolled during the 
waiting period after the notice of intent is sent. 
MCL 
600.5856(d). 
The 182-day waiting period before the filing 
of a complaint is immediately lifted if the defendants 
communicate in writing that they do not intend to settle 
the claim. MCL 600.2912b(9). 
8  
 
 
 
 
 
 
                                                 
 
The overall structure and the operation of the notice 
provision suggest that the Legislature intended the act to 
encourage settlement discussions.2
 The 182-day waiting 
period 
enables 
the 
parties 
to 
engage 
in 
settlement 
discussions before initiating a lawsuit, possibly avoiding 
litigation entirely. 
During this period, information is 
exchanged without regard to the formal rules of discovery. 
Moreover, the plaintiff is effectively immobilized 
while awaiting a response from the defendants. The waiting 
period is waived only if the defendants file written notice 
that they do not intend to settle the claim. 
At this stage in the dispute, it is unlikely that all 
anticipated experts and witnesses will have been identified 
and deposed. 
Theories of liability and defenses may not 
have been developed with precision. 
A higher level of 
specificity about a claim emerges from the information 
exchanged by the parties after the notice is sent. 
The statute works no unfairness on defendants. 
The 
potential defendants who receive the notice assuredly 
possess a high level of medical expertise. 
They do not 
require information of great specificity in order to begin 
2 This conclusion is buttressed by statements in the
statute’s Senate Legislative Analysis, SB 270, August 11,
1993, and House Legislative Analysis, HB 4403-4406, March
22, 2993. 
9  
 
 
 
 
 
 
 
 
 
investigating an impending lawsuit. 
Also, most of the 
records pertinent to a medical malpractice claim are likely 
to be under the control of the defendants. 
A general 
assertion of the basis for the claim and of the items 
required by the statute is sufficient to inform them about 
the claim and to encourage settlement discussions. 
Moreover, the provision does not require a “unique 
standard,” “specific” information, or a “particularized” 
statement as the majority asserts. Ante at 16 n 8, 21, 19. 
Had the Legislature intended extensive detail in the 
notice, it would have required it. 
Numerous 
other 
statutes 
specify 
“detailed,” 
“complete,” or “full” statements, or statements made “with 
specificity.” 
In the State Employees’ Retirement Act, for 
example, each member is required to file a “detailed 
statement” of his prior service as an employee. MCL 38.14. 
MCL 500.424(2) in the Insurance Code provides: 
In addition to subsection (1), an alien 
insurer shall make and execute under oath a 
report of its financial standing and of its 
deposit together with a full statement of its 
business in the United States for the year
preceding the statement pursuant to section 438.
[Emphasis added.] 
MCL 462.2(2) in the railroad commission act
requires the governor to provide a “complete
statement” of the charges against a railroad 
commissioner after removing the commissioner for 
10  
 
 
 
 
 
  
 
 
 
 
 
neglect of duty or malfeasance. MCL 333.22231(4)
states: 
(4) 
Before 
a 
final 
decision 
on 
an 
application is made, the bureau of the department
designated by the director as responsible for the
certificate 
of 
need 
program 
shall 
issue 
a 
proposed decision with specific findings of fact
in support of the proposed decision with regard
to each of the criteria listed in section 22225. 
The proposed decision also shall state with 
specificity the reasons and authority of the 
department 
for 
the 
proposed 
decision. 
The 
department shall transmit a copy of the proposed
decision to the applicant. [Emphasis added.] 
These provisions demonstrate that the Legislature 
knows what phrasing to use when it intends to require 
extensive detail. 
Because it did not explicitly mandate 
such specificity in this statute, we should refrain from 
adding it ourselves. 
In 
the 
past, 
the 
Court 
has 
avoided 
making 
a 
requirement that notices be detailed if they serve the 
object of the statute and do not prejudice the defendant. 
Hummel v Grand Rapids, 319 Mich 616, 625; 30 NW2d 372 
(1948). 
The decision in Omelenchuck recognized that 
tolling provisions should not be traps for the unwary and 
that, without proper notice, there can be no tolling. 
Given that medical malpractice actions are complex and 
fact-intensive, the Court is ill-advised to require a 
11  
 
 
 
 
 
 
 
 
 
                                                 
 
detailed 
Legislatur
blueprint 
for 
notices 
of 
intent 
where 
FACTUAL ANALYSIS 
e did not.3 Omelenchuck at 576, n 19. 
the 
With these considerations in mind, I examine the 
notices that plaintiff sent in this case to determine if 
they satisfy the statute. 
The September 19, 1996, notice of intent, amending the 
August 15, 1996, notice sent to the defendant hospital set 
out the following factual basis: 
This 
is 
a 
claim 
for 
negligence 
which 
occurred on October 4, 1994, at Mecosta County 
General Hospital. It is claimed that on said date
while pregnant with her first child, Claimant
presented 
herself 
to 
Mecosta 
County 
General 
Hospital complaining of severe pain. At that time
a diagnosis of a spontaneous abortion was made 
and a D and C was performed. Claimant was sent
home at that time. 
Over the course of the next few days
Claimant 
continued 
to 
experience 
pain 
and 
cramping and, on October 7, 1994, was again seen
at Mecosta County General Hospital. Claimant was
told that the pain she was experiencing was 
cramps from the D and C she had done and was sent
home. 
3 The complex nature of medical malpractice would deter
the Legislature from requiring a high degree of specificity
in notices of intent to sue. 
The Legislature is presumed
to be aware of existing law. 
This includes judicial
interpretations of statutes. 
See People v Schultz, 435
Mich 517, 543-544; 460 NW2d 505 (1990). 
That renders it 
more telling when the Legislature chose not to use the same
or similar words here as it used in other instances when it 
wished to require detail. 
12  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Claimant returned to the hospital on October
8, 1994, wherein it was discovered that Claimant
had not had a spontaneous abortion but had an
ectopic pregnancy in her left tube which had
burst. Emergency surgery was performed at that
time and her left tube was removed. 
Claimant 
had 
her 
right 
tube 
removed 
approximately ten years ago and, as a result of
the negligence set forth above, she is now unable
to have any children. 
The September 23, 1996, notice of intent sent to the 
remaining defendants gave the following factual basis: 
This 
is 
a 
claim 
for 
negligence 
which 
occurred on October 4, 1994, at Obstetrics &
Gynecology of Big Rapids. It is claimed that on
said date while pregnant with her first child, 
Claimant presented herself to Barb Davis, PAC,
Dr. Michael Atkins, and Dr. Gail DesNoyers
complaining 
of 
severe 
abdominal 
pain 
and 
bleeding. 
At 
that 
time 
a 
diagnosis 
of 
a 
spontaneous abortion was made and a D & C was
performed at Mecosta County General Hospital.
Claimant was sent home at that time, despite Dr.
DesNoyer's [sic] knowledge of Claimant's history
of a prior ectopic pregnancy. 
Over the course of the next few days,
Claimant 
continued 
to 
experience 
pain 
and 
cramping and, on October 7, 1994, was seen at
Mecosta County General Hospital by Dr. Michael
Atkins. Claimant was told that the pain she was
experiencing was cramps from the D & C she had
done and was sent home. 
Claimant returned to the hospital on October
8, 1994, wherein it was discovered that Claimant
had not had a spontaneous abortion but had an
ectopic pregnancy in her left tube which had 
burst. Emergency surgery was performed at that
time and her left tube was removed. 
Claimant 
had 
her 
right 
tube 
removed 
13  
 
 
 
 
 
 
 
 
 
 
approximately ten years ago and, as a result of
the negligence set forth above, she is now unable
to have any children. 
In these statements, plaintiff set out the factual 
circumstances, alleged an initial misdiagnosis, and stated 
the correct diagnosis. 
The September 19 notice articulated the applicable 
standard of care: 
Claimant 
contends 
that 
the 
applicable
standard of care required that Mecosta County
General Hospital provide the claimant with the
services of competent, qualified and licensed 
staff of physicians, residents, interns, nurses
and other employees to properly care for her,
render competent advice and assistance in the
care and treatment of her case and to render same 
in accordance with the applicable standards of
care. 
Similarly, the September 23 notice contained the following: 
Claimant 
contends 
that 
the 
applicable
standard of care required that Obstetrics & 
Gynecology of Big Rapids, Dr. Gail DesNoyers and
Barb Davis, PAC, provide the Claimant with the 
services of competent, qualified and licensed 
staff of physicians, residents, interns, nurses
and other employees to properly care for her,
render competent advice and assistance in the
care and treatment of her case and to render same 
in accordance with the applicable standards of
care. 
Our 
courts 
have 
long 
recognized 
that 
medical 
malpractice is generally the failure to exercise that 
degree of skill, care, and diligence exercised by members 
of 
the 
same 
medical 
profession. 
Dorris 
v 
Detroit 
14  
 
 
 
 
 
Osteopathic Hosp Corp, 460 Mich 26; 594 NW2d 455 (1999); 
Adkins v Annapolis Hospital, 116 Mich App 558, 564, 323 
NW2d 482 (1982), affirmed 420 Mich 87; 360 NW2d 150 (1984). 
Plaintiff’s notices state that the standard of care is to 
provide competent services. 
Because this is sufficiently 
close in meaning to exercising professional care, it meets 
the requirement of MCL 600.2912b(4)(b) to delineate the 
appropriate standard of care. 
Where the standard of care is stated generally, it is 
unsurprising 
that 
the 
same 
standard 
is 
specifically 
applicable to each defendant. 
The majority’s conclusion 
that the Legislature intended that there be the requirement 
of a unique “standard applicable specifically” to each 
defendant, ante at 19, is myopic. 
This requirement is not 
in the statute. Hence, it does not exist. 
To state the manner in which the alleged standard of 
care was breached under MCL 600.2912b(4)(c), the September 
19 notice to the defendant hospital refers to paragraph two 
of the notice. 
The September 23 notice contains the 
following statement: "Claimant claims that Obstetrics & 
Gynecology of Big Rapids, Dr. Gail DesNoyers and Barb 
Davis, PAC, failed to provide her with the applicable 
standard of practice and care outlined in paragraph 2 
above." 
It is manifest that plaintiff claims that the 
15  
 
 
 
 
 
 
 
 
   
                                                 
 
 
actions of the defendant physician did not fulfill the duty 
of care owed to plaintiff. 
Both notices refer to paragraph two of the respective 
notices to state the “[alleged] action that should have 
been taken to achieve compliance with the alleged standard 
of practice or care” and “the manner in which [it is 
alleged] the breach of the standard of practice or care was 
the proximate cause of the injury claimed in the notice.” 
MCL 600.2912b(4)(d), (e). 
When these paragraphs are read 
together with the first paragraphs, they state that the 
defendants 
should 
have 
correctly 
diagnosed 
plaintiff 
according to their professional duty. 
They assert that a 
correct diagnosis would have prevented the serious medical 
injury that plaintiff suffered. 
Finally, the notices name 
the defendants. MCL 600.2912b(4)(f). 
I agree with the Court of Appeals that these notices 
are not “picture[s] of clarity” or “the ‘perfect notice.’” 
252 Mich App 673. 
However, I would find them sufficient 
under the statute.4 
4 Ironically, this case highlights why the Legislature
did not require a detailed statement. 
A potential
defendant is under no obligation to challenge upon its
receipt the sufficiency of the notice of intent to sue.
Roberts I. 
The plaintiff, while awaiting the defendant’s
response, cannot be assured that the notice is legally
(continued…) 
16  
 
 
 
 
 
                                                 
CONCLUSION  
I would find that the Legislature intended that 
parties alleging medical malpractice under MCL 600.2912b(4) 
provide notice of intent to sue that includes a succinct 
statement of certain enumerated items. 
It did not intend 
that 
the 
statement 
contain 
extensive 
details. 
The 
statement simply must provide notice of a potential claim 
sufficient to allow potential defendants to ascertain the 
basis for the claim and enter into settlement discussions. 
The statements in the notices of intent to sue 
provided 
by 
plaintiff 
in 
this 
case 
satisfied 
the 
requirements of MCL 600.2912b(4). 
They addressed each of 
the statutorily enumerated items and provided adequate 
notice of plaintiff’s claims. Defendants were given enough 
information to investigate the basis for the claims and 
consider settlement. 
Defendants have not asserted that 
they misunderstood the notices; they have asserted merely 
that the notices were insufficient under the statute. 
(continued…)
sufficient. 
If its sufficiency should be challenged and
found to be deficient only after a lawsuit has been filed,
the period of limitations likely will have expired on the
claim. 
I believe that the Legislature did not intend to
impose particularized requirements on an injured party who
is effectively immobilized until either the defendant 
responds or the waiting period elapses. 
17  
 
 
 
 
 
 
For these reasons, I would affirm the decision of the 
Court of Appeals. 
Marilyn Kelly
Michael F. Cavanagh
Elizabeth A. Weaver 
18