Opinion ID: 1201607
Heading Depth: 2
Heading Rank: 3

Heading: Medical Monitoring Costs

Text: In the context of a toxic exposure action, a claim for medical monitoring seeks to recover the cost of future periodic medical examinations intended to facilitate early detection and treatment of disease caused by a plaintiff's exposure to toxic substances. ( Ayers v. Jackson Tp. (1987) 106 N.J. 557 [525 A.2d 287, 308, 76 A.L.R.4th 571] [hereafter Ayers ].) We shall now undertake to decide whether and under what circumstances a toxic exposure plaintiff may recover medical monitoring damages in a negligence action. The trial court awarded medical monitoring damages to plaintiffs, determining that [s]ince plaintiffs must now live with an increased vulnerability to serious disease it is axiomatic that they should receive periodic medical monitoring in order to determine at the earliest possible time the onset of disease. The Court of Appeal reversed. Citing Civil Code section 3283, [23] the court concluded that such an award must be based upon either a present physical injury or a threat of a future injury that is more likely than not to occur, and that neither had been demonstrated here. Firestone and amici curiae urge us to affirm the Court of Appeal judgment in this regard. Essentially, Firestone, amici curiae, and the Court of Appeal assume that the reasonableness of medical intervention, and hence compensability, is dependent upon the sufficiency of proof that the occurrence of the disease is reasonably certain. Firestone points to various cases in other jurisdictions that share similar views. (E.g., Ball v. Joy Manufacturing Co. (S.D.W. Va. 1990) 755 F. Supp. 1344, 1372 [denying medical monitoring damages where plaintiff had not suffered present demonstrable injury]; Villari v Terminix International, Inc. (E.D.Pa. 1987) 663 F. Supp. 727, 735 [observing that, under Pennsylvania law, plaintiff seeking costs of medical surveillance as element of damages must demonstrate some physical injury].) We are not convinced by these decisions and find the Court of Appeal's analysis in Miranda v. Shell Oil Co. (1993) 17 Cal. App.4th 1651 [15 Cal. Rptr.2d 569] (hereafter Miranda ) persuasive. In Miranda, the court observed that [t]he cost of anticipated medical care reasonably certain to be required in the future has long been held to be a proper item of recoverable damages under [Civil Code section 3333]. [24] ( Buswell v. City and County of San Francisco (1948) 89 Cal. App.2d 123, 133 [200 P.2d 115].) In our view, expenditures for prospective medical testing and evaluation, which would be unnecessary if the particular plaintiff had not been wrongfully exposed to pollutants, are a correlative detriment within section 3333. (See [ In re Paoli R.R. Yard PCB Litigation (3d Cir.1990) 916 F.2d 829, 852]; and Coover v. Painless Parker, Dentist (1930) 105 Cal. App. 110, 115 [286 P. 1048].) Thus, such a plaintiff may collect damages from the tortfeasor measured by the `reasonable medical and other expenses' to be incurred for monitoring. (Rest.2d Torts, § 924; see [citations].) We have found no authority which limits the applicability of Civil Code section 3333 to those situations where physical injury is evident. Civil Code section 3282 defines `detriment' as `a loss or harm suffered in person or property.' `Harm,' under the Restatement Second of Torts means `the existence of loss or detriment in fact of any kind to a person....' (Rest.2d Torts, § 7, subd. (2), italics added.) The Restatement distinguishes `physical harm' by classifying it as `the physical impairment of the human body, or of land or chattels.' ([ Id., ] § 7, subds. (2) and (3).) According to the Restatement's analysis, a plaintiff is entitled to recover damages from the tortfeasor for all `harm'  as opposed to `physical harm'  `past, present and prospective, legally caused by the tort.' ([ Id., ] § 910; see also [ id., ] § 7, com. d.; & [ id., ] § 917. ( Miranda, supra, 17 Cal. App.4th at pp. 1656-1657.) In holding that recovery of medical monitoring damages is not contingent upon a showing of a present physical injury or upon proof that injury is reasonably certain to occur in the future, the Miranda court aligned itself with a number of other courts that have considered the issue. (E.g., Ayers, supra, 525 A.2d 287, 312-313; In re Paoli R.R. Yard PCB Litigation (3d Cir.1990) 916 F.2d 829, 852 [hereafter In re Paoli ]; Burns v. Jaquays Mining Corp. (1987) 156 Ariz. 375 [752 P.2d 28, 33].) Consistent with these other decisions, the court determined that such recovery was not available solely upon proof of an exposure to toxic chemicals; rather, there must be a further showing that the need for monitoring is a reasonably certain consequence of the exposure, based upon a consideration of at least the following five factors: (1) the significance and extent of the plaintiff's exposure to the chemicals; (2) the relative toxicity of the chemicals; (3) the seriousness of the diseases for which plaintiff is at an increased risk; (4) the relative increase in the plaintiff's chances of developing a disease as a result of the exposure, when compared to (a) plaintiff's chances of developing the disease had he or she not been exposed, and (b) the chances of members of the public at large of developing the disease; and (5) the clinical value of early detection and diagnosis. ( Miranda, supra, 17 Cal. App.4th at pp. 1657-1658, citing Ayers, supra, 525 A.2d at p. 312.) [25] (15) Like the court in Miranda, supra, 17 Cal. App.4th 1651, and Ayers, supra, 525 A.2d 287, we conclude that a reasonably certain need for medical monitoring is an item of damage for which compensation should be allowed. Recognition that a defendant's conduct has created the need for future medical monitoring does not create a new tort. It is simply a compensable item of damage when liability is established under traditional tort theories of recovery. That medical monitoring may be called for as a result of a defendant's tortious conduct, even in the absence of actual physical injury, was compellingly demonstrated in the case of Friends For All Children, Inc. v. Lockheed Aircraft Corp. (D.C. Cir.1984) 746 F.2d 816 [241 App.D.C. 83, 46 A.L.R.4th 1113] [hereafter Friends For All Children ]. There, suit was instituted on behalf of 149 Vietnamese orphaned children who survived a plane crash during the evacuation of Vietnam in 1975. The complaint alleged that because of decompression, as well as the impact of the crash, the children suffered from a neurological disorder generically classified as minimal brain dysfunction. In that case, the Court of Appeals affirmed the imposition of liability on Lockheed for diagnostic examination expenses because the crash proximately caused the need for a comprehensive diagnostic examination. (746 F.2d at pp. 825-826.) In doing so, the court rejected the argument that the need for diagnostic examination was not a compensable injury, and, as did the court in Miranda, supra, 17 Cal. App.4th at page 1657, cited with approval the Restatement's definition of injury as `the invasion of any legally protected interest of another.' (746 F.2d at p. 826, citing Rest.2d Torts, § 7.) Consequently, the court in Friends For All Children, supra, 746 F.2d at page 826, held that a reasonable need for medical examinations was itself compensable, without proof of other injury: It is difficult to dispute that an individual has an interest in avoiding expensive diagnostic examinations just as he or she has an interest in avoiding physical injury. When a defendant negligently invades this interest, the injury to which is neither speculative nor resistant to proof, it is elementary that the defendant should make the plaintiff whole by paying for the examinations. (Fn. omitted.) [26] It bears emphasizing that allowing compensation for medical monitoring costs does not require courts to speculate about the probability of future injury. It merely requires courts to ascertain the probability that the far less costly remedy of medical supervision is appropriate. ( In re Paoli, supra, 916 F.2d at p. 852.) Indeed, [s]cience may well counsel medical intervention with respect to a known health risk long before it reaches the point where the law would regard its occurrence as `reasonably certain.' [Citation.] ( Miranda, supra, 17 Cal. App.4th at p. 1658.) We are therefore persuaded that recovery of medical monitoring damages should not be dependent upon a showing that a particular cancer or disease is reasonably certain to occur in the future. Finally, as Miranda, supra, 17 Cal. App.4th 1651, and other cases have stressed, recovery of medical monitoring costs is supported by a number of sound public policy considerations. First, there is an important public health interest in fostering access to medical testing for individuals whose exposure to toxic chemicals creates an enhanced risk of disease, particularly in light of the value of early diagnosis and treatment for many cancer patients. ( Ayers, supra, 525 A.2d at p. 311; Miranda, supra, 17 Cal. App.4th at p. 1660.) Second, there is a deterrence value in recognizing medical surveillance claims  [a]llowing plaintiffs to recover the cost of this care deters irresponsible discharge of toxic chemicals by defendants.... ( In re Paoli, supra, 916 F.2d at p. 852; Miranda, supra, 17 Cal. App.4th at p. 1660; Ayers, supra, 525 A.2d at pp. 311-312; cf. Friends For All Children, supra, 746 F.2d at p. 825].) Third, [t]he availability of a substantial remedy before the consequences of the plaintiffs' exposure are manifest may also have the beneficial effect of preventing or mitigating serious future illnesses and thus reduce the overall costs to the responsible parties. ( Ayers, supra, 525 A.2d at p. 312; see Miranda, supra, 17 Cal. App.4th at p. 1660.) In this regard, the early detection of cancer may improve the prospects for cure, treatment, prolongation of life and minimization of pain and disability. Finally, societal notions of fairness and elemental justice are better served by allowing recovery of medical monitoring costs. That is, it would be inequitable for an individual wrongfully exposed to dangerous toxins, but unable to prove that cancer or disease is likely, to have to pay the expense of medical monitoring when such intervention is clearly reasonable and necessary. ( Ayers, supra, 525 A.2d at p. 312; see Miranda, supra, 17 Cal. App.4th at p. 1660.) In light of the foregoing, we believe the Miranda court's analysis appropriately recognizes that medical science may necessarily and properly intervene in the absence of physical injury where there is a significant but not necessarily likely risk of serious disease. Accordingly, consistent with Miranda, supra, 17 Cal. App.4th 1651, and the cases cited above, we hold that the cost of medical monitoring is a compensable item of damages where the proofs demonstrate, through reliable medical expert testimony, that the need for future monitoring is a reasonably certain consequence of a plaintiff's toxic exposure and that the recommended monitoring is reasonable. In determining the reasonableness and necessity of monitoring, the following factors are relevant: (1) the significance and extent of the plaintiff's exposure to chemicals; (2) the toxicity of the chemicals; (3) the relative increase in the chance of onset of disease in the exposed plaintiff as a result of the exposure, when compared to (a) the plaintiff's chances of developing the disease had he or she not been exposed, and (b) the chances of the members of the public at large of developing the disease; (4) the seriousness of the disease for which the plaintiff is at risk; and (5) the clinical value of early detection and diagnosis. Under this holding, it is for the trier of fact to decide, on the basis of competent medical testimony, whether and to what extent the particular plaintiff's exposure to toxic chemicals in a given situation justifies future periodic medical monitoring. We are confident that our holding will not, as Firestone and amici curiae warn, open the floodgates of litigation. The five factors provide substantial evidentiary burdens for toxic exposure plaintiffs and do not, as Firestone insists, allow medical monitoring damages to be based solely upon a showing of an increased but unquantified risk resulting from exposure to toxic chemicals. (16) Moreover, toxic exposure plaintiffs may recover only if the evidence establishes the necessity, as a direct consequence of the exposure in issue, for specific monitoring beyond that which an individual should pursue as a matter of general good sense and foresight. ( Miranda, supra, 17 Cal. App.4th at p. 1660.) [27] Thus there can be no recovery for preventative medical care and checkups to which members of the public at large should prudently submit. (17 Cal. App.4th at p. 1660.) Finally, contrary to the protestations of Firestone and amici curiae, medical monitoring costs are not speculative because they are based upon the specific dollar costs of reasonable and necessary periodic examinations. (See Ayers, supra, 525 A.2d at p. 313.) [28]