Opinion ID: 3149548
Heading Depth: 2
Heading Rank: 2

Heading: Emotional Distress of Mrs. Rye

Text: Because Mrs. Rye has alleged that she suffers from emotional distress as a “parasitic” consequence of her Rh-sensitization, she has not presented a stand-alone claim for negligent infliction of emotional distress and, under our law, is not required to prove the existence of emotional damages through expert medical testimony. See Estate of Amos v. Vanderbilt Univ., 62 S.W.3d 133, 136-37 (Tenn. 2001). Nevertheless, in order to succeed on this theory of damages, she must establish that she has “suffered a serious mental injury resulting from the [Defendants‟] conduct.” Rogers v. Louisville Land Co., 367 S.W.3d 196, 206 (Tenn. 2012). Our case law suggests that she may do so by presenting evidence of “unpleasant mental reactions such as . . . anger, chagrin, disappointment, and worry,” along with “[e]vidence regarding the duration and intensity” of these symptoms, or by presenting “[o]ther evidence that the [Defendants‟] conduct caused [her] to suffer significant impairment in . . . her daily functioning.” Id. at 20910.15 Contrary to the assertion by the majority, such evidence may be established by the 14 The factual differences in these cases, as pointed out by the majority in an attempt to undermine their applicability to the Ryes‟ circumstances, are completely irrelevant to the legal conclusion reached by each of these jurisdictions—that Rh-sensitization is an existing physical injury in and of itself, which gives rise to a cause of action at the time a physician fails to administer the necessary RhoGAM injection, irrespective of (although not exclusive to) any future harm that may be caused to the mother or the fetus. 15 Other “nonexclusive factors” that may be considered in a claim for emotional distress include “[e]vidence of physiological manifestations of emotional distress” and “[e]vidence that the [claimant] - 13 - Ryes‟ own testimony and does not require proof that Mrs. Rye “sought emotional or psychiatric counseling or mental health treatment from a psychiatrist, a psychologist, a counselor, or anyone else.” Cf. id. at 210; see also Miller v. Willbanks, 8 S.W.3d 607, 615 (Tenn. 1999).16 The deposition testimony of Mr. and Mrs. Rye fully supports the existence of Mrs. Rye‟s damages in the form of emotional distress and, in consequence, this issue should survive summary judgment, whether under the Byrd/Hannan standard or that adopted for the federal courts in Celotex. Mrs. Rye testified that immediately upon learning of her sensitized condition, which was clearly caused by the Defendants‟ conduct, she was simply “scared . . . to death.” She described her painful reaction when one of her daughters, who had overheard the conversation with Mrs. Rye‟s physician, informed her grandmother that “mommy can‟t have any more babies or they‟ll die.” Throughout her deposition, Mrs. Rye repeatedly described the level of her “concern” and “anxiety” upon learning of the serious risks to herself and her future children. She contended that she and her husband worry about the effects of Rh-sensitization “every single day,” a condition that has affected her ability to have more children, as both she and her husband had planned throughout their marriage. As practicing Catholics, the Ryes cannot use any form of birth control for contraceptive purposes; in consequence, they must refrain altogether from sexual relations during ovulation because of the risks involved. Mrs. Rye described her relationship with her husband as “completely different” now that she is Rhsensitized. She attested to daily anxiety, spelling out in some detail their concerns in the context of their religious beliefs, and their meetings with their priest. All of this evidence establishes a factual basis for an award of damages based on Mrs. Rye‟s emotional distress. Under the Byrd/Hannan standard for summary judgment, the Defendants have failed to either negate Mrs. Rye‟s claim of emotional distress or otherwise establish that Mrs. Rye will be unable to prove her damages. Moreover, even by the federal standard, the Ryes‟ testimony creates a genuine issue of material fact as to whether Mrs. Rye suffered compensable emotional distress. See Rogers, 367 S.W.3d at 209-10. Her Rhsensitization has adversely affected her fundamental right to bear and raise children. See sought medical treatment, was diagnosed with a medical or psychiatric disorder . . . , and/or was prescribed medication.” Id. at 210. “In certain instances, the extreme and outrageous character of the defendant‟s conduct is itself important evidence of serious mental injury.” Id. 16 Even if this were a requirement for proving an emotional distress claim, the Ryes both testified that they had sought advice and counseling from their priest, who surely would qualify as “anyone else” providing support services. - 14 - Eisenstadt v. Baird, 405 U.S. 438, 453 (1972) (describing “the decision whether to bear or beget a child” as “fundamental”); Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535, 541 (1942) (“Marriage and procreation are fundamental to the very existence and survival of the [human] race.”). None of the Ryes‟ concerns would exist but for the failure of the Defendants to have administered a routine RhoGAM injection during Mrs. Rye‟s third pregnancy. Under either summary judgment standard, the evidence must be viewed in a light most favorable to the claims of the non-moving party, with all reasonable inferences drawn in favor of those claims. Celotex Corp., 477 U.S. at 330-31 & n.2 (Brennan, J., dissenting); Staples v. CBL & Assocs., Inc., 15 S.W.3d 83, 89 (Tenn. 2000). In my view, a reasonable juror could easily conclude that Mrs. Rye has suffered genuine and profound emotional distress. By granting summary judgment, however, my colleagues have precluded any consideration of the merits of this claim. C. Future Medical Expenses Related to Future Pregnancies In Tennessee, a claimant may recover damages for future medical expenses related to a present injury if “the future effects [are] shown to be reasonably certain and not a mere likelihood or possibility.” Potts v. Celotex Corp., 796 S.W.2d 678, 681 (Tenn. 1990). This means that “before a [claimant] may recover for potential injuries, there must be a reasonable degree of medical certainty that the [claimant] will develop a disease in the future as a result of an injury.” Id. The terms “reasonably certain” and “reasonable degree of medical certainty” “require[] the [claimant] to prove that he or she will, more probably than not, need . . . medical services in the future.” Singh v. Larry Fowler Trucking, Inc., 390 S.W.3d 280, 287 (Tenn. Ct. App. 2012) (emphasis added) (quoting Henley v. Amacher, No. M1999-02799-COA-R3-CV, 2002 WL 100402, at  (Tenn. Ct. App. Jan. 28, 2002)). While the amount of future damages is necessarily “speculative and imprecise” to some degree, “this imprecision is not grounds for excluding” evidence of the existence of future medical expenses that may be incurred. Overstreet v. Shoney‟s, Inc., 4 S.W.3d 694, 704 (Tenn. Ct. App. 1999). In this instance, the Defendants have supported their motion for summary judgment with the affidavit and deposition of their expert witness, Dr. Thomas G. Stovall, who testified “within a reasonable degree of medical certainty that it is more likely than not that an Rh-sensitized individual will never sustain any injuries or damages whatsoever.” Dr. Stovall further testified that “[t]he risks of any future injuries to [Mrs. Rye] or to a child in a future pregnancy, if such a child is conceived, are so remote that it cannot be stated with any reasonable degree of medical certainty that such injuries would in fact occur.” In response, the Ryes submitted the affidavit and deposition of their expert witness, Dr. Joseph Bruner, who testified that “[c]ontrary to the opinions of Dr. Stovall, it is my opinion that it is more probable than not that unborn children of Mr. and Mrs. Rye will experience complications,” including the “severe consequences” of Rhsensitization such as a ruptured liver or spleen, excessive bleeding, permanent brain - 15 - damage, anemia, heart problems, and even fetal death. According to Dr. Bruner, if the child of an Rh-sensitized mother survives the pregnancy, it can develop “deafness, speech problems, cerebral palsy, or mental retardation.” Dr. Bruner further testified that “it is more probable than not that Mrs. Rye‟s next pregnancy will involve a baby with moderate to severe disease in utero.” More specifically, Dr. Bruner explained that “[w]ith [Mrs. Rye‟s] next R[h] incompatible pregnancy, . . . she will produce antibodies that will cross the placenta, and they will attach to the fetal red blood cells. And these red blood cells will be destroyed, and the fetus will experience some degree of anemia.” (Emphasis added.) Finally, when asked by defense counsel during the deposition if he could “say that any of these things . . . are more likely than not going to occur to [Mrs. Rye] in the future,” Dr. Bruner responded as follows: [Dr. Bruner:] It‟s more likely than not that she will become pregnant with another sensitized pregnancy. .... [Defense counsel:] And . . . more likely than not, it‟s going to be a child whose blood is not compatible with [Mrs. Rye‟s] R[h-sensitized] status. You‟re saying that‟s more likely than not, more than a 50 percent chance of that? [Dr. Bruner:] That‟s correct. .... So more likely than not, she will become pregnant again . . . . More likely than not, the fetus will be affected in at least one or more future pregnancies . . . . Over all, there‟s a 70 percent chance her pregnancy will be affected. .... It‟s more likely than not that she will become pregnant again. If she becomes pregnant again, based on what we know today, there‟s a 70 percent risk that the baby will be incompatible. It‟s more likely than not that baby will have moderate to severe disease and require invasive procedures. .... - 16 - Okay. So it‟s more likely than not, she‟ll become pregnant. It‟s more likely than not, the baby will be incompatible. It‟s more likely than not, the disease will be moderate to severe . . . . My colleagues conclude that the Defendants are entitled to summary judgment on this issue because Mrs. Rye‟s “future medical expenses depend entirely upon contingencies that have not occurred and may never occur.” Again, this is not the standard for the review of evidence at the summary judgment stage. See Staples, 15 S.W.3d at 89 (“[At the summary judgment stage,] [c]ourts must view the evidence in the light most favorable to the nonmoving party and must also draw all reasonable inferences in the nonmoving party‟s favor.”). Our case law requires only that the claimant introduce expert testimony that future damages will “more probably than not” occur. Singh, 390 S.W.3d at 287. Because the Ryes have expert proof that Mrs. Rye‟s Rh-sensitization is more likely than not to result in future medical expenses, the Defendants have neither affirmatively negated an element of the Ryes‟ claim nor otherwise demonstrated that Mrs. Rye will be unable to prove future damages at trial.17 Even under the federal standard for summary judgment, the Defendants have not shown that the Ryes‟ evidence is insufficient to prove the existence of future harm to Mrs. Rye during any future pregnancies. As stated, the jurisdictions recognizing a claim based on Rh-sensitization agree that the injury accrues at the time a RhoGAM injection should have been administered, even when the amount of future damages is uncertain. See Dahl v. St. John‟s Hosp., No. 89-1784, 1990 WL 96045, at  & n.3 (Wis. Ct. App. Apr. 24, 1990) (holding that the plaintiff‟s injury and cause of action accrued at the time of the defendant‟s alleged “failure to administer a RhoGAM injection within approximately three days of the first child‟s birth[, which] began the process of Rh factor sensitization that impaired [the plaintiff‟s] ability to have healthy children in the future”); accord Ford v. Guaranty Nat‟l Ins. Co., No. 1:93CV213-S-D, 1997 WL 786767, at  (N.D. Miss. Nov. 26, 1997); Kenyon, 688 P.2d at 967; Simmons v. Riverside Methodist Hosp., 336 N.E.2d 460, 461, 464 (Ohio Ct. App. 1975). Because an Rh-sensitized claimant who fails to file suit until a future pregnancy actually causes complications would likely be barred by the statute of limitations, these other jurisdictions have recognized that the suit must be filed as soon as 17 Contrary to the assertion by the majority, I have not “harvested from the record only those facts supporting [my] favored result.” A thorough review of the deposition testimony and affidavits by the competing medical experts, when properly viewed in the light most favorable to the Ryes, leads to only one plausible conclusion—the Defendants have not disproven the opinion of Mrs. Rye‟s expert that she is more likely than not, as a result of her Rh-sensitized condition, to incur medical expenses related to a future pregnancy. - 17 - the claimant learns that the medical provider failed to administer the necessary RhoGAM injection. See, e.g., Dahl, 1990 WL 96045, at -5 (recognizing that despite “the inequity and potentially significant social effects of a decision that requires litigation of claims before the ultimate damage is known,” the plaintiff‟s “claim . . . existed . . . when the RhoGAM was not administered,” and “[a] claim for damages for future complications is recognized at law if the jury can adequately assess the probability of future damages”). This Court should follow the lead of the other states and recognize the viability of this claim. If Mrs. Rye does become pregnant in the future and suffers the very complications Dr. Bruner has identified as more than likely to occur, those responsible for her injury will escape accountability by virtue of our one-year statute of limitations in health care liability actions. Under these circumstances, I cannot agree that summary judgment is appropriate on this issue. D. Future Medical Expenses Related to Future Blood Transfusions Unlike Mrs. Rye‟s claim for medical expenses related to future pregnancies, the existence of future expenses related to any future blood transfusions is too remote and uncertain to survive summary judgment. In support of their motion for summary judgment, the Defendants offered the affidavit of their expert witness, Dr. Stovall, who opined “within a reasonable degree of medical certainty that it is more likely than not that an Rh-sensitized individual will never sustain any injuries or damages whatsoever.” In response, the Ryes offered the affidavit and deposition testimony of their expert, Dr. Bruner, who stated only that Mrs. Rye was at an “increased risk of life-threatening problems” if she were to be involved in some “medical emergency” that would “require[] an urgent or emergent blood transfusion as a life-saving procedure.” Testimony by Dr. Bruner that Mrs. Rye‟s condition “is likely to be life threatening in an emergency situation in which blood transfusions are required” does not establish the degree of probability required to support a claim for future damages. See Singh, 390 S.W.3d at 287. In fact, Dr. Bruner conceded that he could not testify that Mrs. Rye would more probably than not require a blood transfusion in the future. Thus, the Defendants have affirmatively negated the Ryes‟ claim that future medical expenses related to blood transfusions are reasonably certain to occur, and the Ryes have been unable to respond with any evidence establishing the existence of a genuine issue for trial. I agree, therefore, that summary judgment, under either the Byrd/Hannan standard or the Celotex/federal standard, should be granted in favor of the Defendants on this issue. E. Emotional Distress of Mr. Rye Initially, I agree with the assessment by my colleagues and the Court of Appeals that “[t]he trial court properly concluded that Mr. Rye‟s claim for negligent infliction of emotional distress is a „stand alone‟ claim, requiring expert proof to prevail at trial.” Rye, 2014 WL 903142, at ; see Camper v. Minor, 915 S.W.2d 437, 446 (Tenn. 1996). - 18 - Recognizing that Mr. Rye has failed to identify any expert who would testify at trial that he has suffered a severe emotional injury, the majority concludes that summary judgment for the Defendants is appropriate because “Mr. Rye lacks proof of an essential element of his claim.” As indicated, the Court of Appeals reversed the trial court‟s grant of summary judgment on this issue, relying solely upon the interpretation of Hannan as expressed in the Target footnote. Rye, 2014 WL 903142, at -24; see also Boals, 2013 WL 5872225, at . In my view, even under the Byrd/Hannan standard, the Defendants are entitled to summary judgment because they have affirmatively demonstrated that Mr. Rye will be unable to prove his emotional distress claim at trial. This issue presents the perfect opportunity to clarify how the second prong of Hannan should work in practice. Applying an interpretation of Hannan as expressed by the Court of Appeals and the majority of this Court, summary judgment is not appropriate even where, as here, a claimant has failed to identify a requisite expert witness within the established discovery deadlines. In my view, however, the phrase “at trial,” as used in Hannan, was never intended to relieve claimants from the responsibility to comply with discovery deadlines. In this instance, the Defendants did well to obtain a scheduling order from the trial court which established “firm cut-off dates for completion of discovery and exchange of evidence.” Cornett, 77 Tenn. L. Rev. at 334 n.198. Expert proof is required to support a stand-alone claim for emotional distress, but Mr. Rye failed to identify, within the discovery deadlines set by the trial court, an expert witness who could corroborate the viability of his claim. In consequence, the Defendants have satisfied the second prong of the Hannan standard by showing at the summary judgment stage, after the discovery deadlines, that Mr. Rye cannot prove his claim at trial. See id.; see also McDaniel, 2009 WL 1211335, at -15 (explaining that the defendant was entitled to summary judgment because the plaintiffs had failed to identify a qualified expert witness within the time established by the trial court‟s scheduling order). Thus, while I would apply the standard articulated in Byrd, Hannan, and their progeny, rather than the newly adopted federal standard, I agree with the majority that on this issue, summary judgment should be granted in favor of the Defendants. F. Disruption of Family Planning Finally, I agree with the majority that Tennessee does not recognize a stand-alone claim for “disruption of family planning.” See Rye, 2014 WL 903142, at -16. As both the trial court and Court of Appeals correctly concluded, however, the Ryes should be allowed to present evidence of the disruption of their family plans as a part of the physical and emotional damages associated with Mrs. Rye‟s Rh-sensitization. As stated, the Ryes have alleged physical injuries in the form of Mrs. Rye‟s altered blood status and the “disruption of the normal functioning of [her] capability to conceive unimpaired, healthy children, free from an abnormally high risk of birth defects or premature fetal death.” They have also alleged emotional injuries in the form of Mrs. Rye‟s daily - 19 - concerns and anxiety about the significant impairment of her ability to engage in regular sexual activity with her husband or to conceive more children. As indicated, courts in other jurisdictions have recognized these theories of recovery for claimants who have become Rh-sensitized due to the negligence of a medical provider. In consequence, I would reinstate the ruling of the trial court on this issue and allow Mrs. Rye to present evidence at trial of the disruption of her family planning, but only as a part of her claim of physical and emotional damages. In summary, I believe that the Ryes should be able to proceed to trial on three of their claims: (1) whether Mrs. Rye‟s condition of Rh-sensitization has caused her harm in the form of a present physical injury; (2) whether Mrs. Rye‟s Rh-sensitization has caused her harm in the form of emotional distress; and (3) whether Mrs. Rye‟s Rh-sensitization is reasonably certain to cause her prospective harm related to future pregnancies. I would allow the Ryes to present evidence of the disruption of their family planning, but only as a part of their alleged physical and emotional damages. By granting summary judgment on these three issues, my colleagues have deprived the Ryes of any opportunity to have their claims resolved on the merits by a jury of their peers. In consequence, the Defendants responsible for failing to comply with the recognized standard of care in the profession cannot be held accountable.