Opinion ID: 839177
Heading Depth: 1
Heading Rank: 1

Heading: the origins of the loss-of-opportunity doctrine

Text: The history of the loss-of-opportunity doctrine is highly relevant to the interpretation of MCL 600.2912a(2) because this Court's adoption of the doctrine evidently prompted the Legislature to add that provision. In Falcon v. Mem. Hosp., 436 Mich. 443, 462 N.W.2d 44 (1990), this Court first recognized the loss-of-opportunity doctrine. [1] Falcon involved a wrongful-death claim brought on behalf of a woman who had suffered an amniotic embolism during childbirth. As in all negligence cases, the plaintiff was required to show causation to establish a valid medical-malpractice claim. Falcon discussed various causation theories. Some courts have required a plaintiff to establish that it is more probable, measured as more than fifty percent, that, but for such negligence, the patient would not have suffered the physical harm. Id. at 449, 462 N.W.2d 44 (Levin, J.). Falcon termed this the more probable than not standard. Id. at 451, 462 N.W.2d 44. Under this standard, a plaintiff who establishes that the patient would have had more than a fifty percent opportunity of not suffering physical harm had the defendant not acted negligently, recovers one hundred percent of the damages. Id. at 450, 462 N.W.2d 44. The plaintiff in Falcon could not have maintained a wrongful-death action under the more-probable-than-not standardthe decedent only had a 37.5 percent chance of surviving even without the alleged malpractice, so it was not more probable than not that the physician's malpractice caused the decedent's death. Id. at 460, 462 N.W.2d 44. While the plaintiff in Falcon could not recover for the injury of her granddaughter's wrongful death, we ruled that the plaintiff nevertheless had a different cause of action available to her. Falcon adopted the approach taken by other courts that recognized  loss of an opportunity for a more favorable result, as distinguished from the unfavorable result, as compensable in medical malpractice actions. Id. at 461, 462 N.W.2d 44 (emphasis added). Under this approach, damages are recoverable for the loss of opportunity although the opportunity lost was less than even, and thus it was not more probable than not that the unfavorable result would or could have been avoided. Id. at 461-462, 462 N.W.2d 44. Thus, the Falcon decision explicitly recognized loss of an opportunity to avoid physical harm as a distinct injury. A plaintiff could bring a claim for loss of an opportunity to avoid death, even if she could not maintain a claim for the death itself because she could not establish causation for the death. Falcon's approach to calculating damages for a loss-of-opportunity claim also indicates that it treated the lost opportunity as a distinct injury, not simply a direct physical-harm injury that enjoyed a lower causation standard. Because the plaintiff's granddaughter in Falcon allegedly lost a 37.5 percent chance of survival, we concluded that the appropriate measure of damages would be 37.5 percent times the damages recoverable for wrongful death. . . . Id. at 471, 462 N.W.2d 44. Thus, generally speaking, `[t]he proper computation of damages would limit the damages recoverable to only that amount of reduced chance of recovery actually caused by the physician's negligent conduct.' Id. at 472 n. 47, 462 N.W.2d 44 (citation omitted). We consulted Mays v. United States, 608 F.Supp. 1476, 1482-1483 (D.Colo., 1985), for its method of computing damages attributable to the defendant. Falcon, 436 Mich. at 471-472, 462 N.W.2d 44 (Levin, J.). In Mays, malpractice had reduced the patient's opportunity to survive from 40 to 15 percent, so the court computed the damages by multiplying the opportunity lost (40 minus 15) by the net pecuniary loss to determine the damages for the harm caused by the defendant. Id. Calculating the damages this way permitted the plaintiff to recover damages only for the reduction in the patient's opportunity of survival. Id. at 472, 462 N.W.2d 44. This calculation isolates the value of the injury that can be causally linked to a defendant's negligencethe loss of an opportunity. The value of a loss-of-opportunity claim is measured by the extent of the loss; so, clearly, the injury being compensated is the loss of a particular amount of opportunity. By contrast, the measure of damages in a traditional claim for wrongful death or physical harm is, generally speaking, the value of damages attributable to the death or physical harm; as such, the injury being compensated is the death or physical harm. In sum, when Falcon adopted the loss-of-opportunity doctrine, it recognized that the injury of loss of an opportunity was distinct from the injury of suffering the associated physical harmwhich, in that case, was death. However, Falcon indicated that not all losses of opportunity were actionable; rather, a plaintiff must suffer the loss of a substantial opportunity for a better result. The cause of action accrues when harm and damages result from the loss of a substantial opportunity for a better result. Id. at 470 n. 43, 462 N.W.2d 44. We concluded that loss of a 37.5 percent opportunity of living constitutes a loss of a substantial opportunity of avoiding physical harm, but declined to decide what lesser percentage would constitute a substantial loss of opportunity in other circumstances. Id. at 470, 462 N.W.2d 44. Finally, Falcon emphasized that a loss-of-opportunity cause of action was not exempt from the more-probable-than-not standard of causation. Under this approach, the plaintiff must establish more-probable-than-not causation. He must prove, more probably than not, that the defendant reduced the opportunity of avoiding harm. Id. at 462, 462 N.W.2d 44. Unlike a claim for wrongful death or physical injury, the patient . . . need not show that it was probable, measured as more than fifty percent, that the course of the disease and treatment would have been different. Id. at 470 n. 43, 462 N.W.2d 44. Instead, [i]t is sufficient to show, more probably than not, that had there been a correct diagnosis, the patient would have had a substantial opportunity of avoiding the course of the disease and treatment that occurred. Id. Therefore, while a claim for loss of opportunity addresses a different injury than a cause of action for the physical injury itself, it is still subject to the same standard of proof of causation. Falcon's enunciation of the loss-of-opportunity doctrine is significant, because it apparently provoked the Legislature to amend MCL 600.2912a. In 1993, the Legislature amended that provision by adding a second subsection, which states: In an action alleging medical malpractice, the plaintiff has the burden of proving that he or she suffered an injury that more probably than not was proximately caused by the negligence of the defendant or defendants. In an action alleging medical malpractice, the plaintiff cannot recover for loss of an opportunity to survive or an opportunity to achieve a better result unless the opportunity was greater than 50%. [MCL 600.2912a(2).] The amendment was widely understood to be a direct reaction to the Falcon decision. As a majority of this Court noted, after Falcon adopted the lost opportunity doctrine, [o]ur Legislature immediately rejected Falcon and the lost opportunity doctrine. MCL 600.2912a(2). . . . Weymers v. Khera, 454 Mich. 639, 649, 563 N.W.2d 647 (1997). I agree that the amendment of MCL 600.2912a(2) was a reaction to Falcon, but I would not characterize it as a rejection of the lostopportunity doctrine entirely. It merely established the threshold for loss-of-opportunity claims.