Opinion ID: 1991184
Heading Depth: 2
Heading Rank: 1

Heading: The lost or diminished chance doctrine

Text: We first address the lost or diminished chance doctrine adopted by the Court of Appeals as a basis for its reversal. In challenging the Court of Appeals' decision, Dr. Kemper points out that this doctrine has never been adopted by Kentucky courts. Further, he argues it is neither a natural extension of current Kentucky law, nor should it be adopted as a matter of public policy. At the trial, the jury was required to make the traditional finding in malpractice cases. The instruction, in pertinent part, asked: Do you believe from the evidence that Dr. Kemper failed to use the degree of care imposed upon him by this Instruction, and that such failure was a substantial factor in causing the injury to Lori Gordon about which you have heard evidence? The instructions requested by the Gordons are at the heart of the lost or diminished chance issue. First, the Gordons requested that the jury make a finding as to whether the breach of the doctor's duty was a substantial factor in causing Lori to lose a measurable chance of surviving her cancer[.] Alternatively, the Gordons asked that the jury decide whether the breach of the doctor's duty was a substantial factor in delaying Lori Gordon's diagnosis and treatment[.] The Gordons' proposed instructions, which were rejected by the trial court, essentially allowed the jury to compensate Lori for her lost or diminished chance of survival due to the late diagnosis. A significant difference exists between the two concepts. When applying the all or nothing principle  as was done in this case  the jury is required first to find that the doctor deviated from the standard of care appropriate for the case, and then find that such failure was a substantial factor in causing injury. Here, the injury was the death of Lori Gordon. Thus, under the all or nothing approach, the Gordons would have been required to prove within a reasonable probability that Lori would have recovered or survived absent the doctor's negligent conduct. Under the lost or diminished chance doctrine, the Gordons would not have been required to prove that the misdiagnosis was, in fact, a substantial factor in causing Lori's death. Rather, the Gordons would have only been required to show that it diminished Lori's chance for recovery or survival. In other words, under the all or nothing rule, the compensable injury in this case would be Lori's death resulting from the cancer. Under the lost or diminished chance doctrine, however, the compensable injury would be Lori's lost opportunity of recovery or survival from the cancer. The difference in these two doctrines is drastic. Under the traditional all or nothing rule, the Gordons would only recover if they could show within a reasonable probability that Dr. Kemper's failure to diagnose Lori's stomach cancer caused her death. Here, the jury found that it did not. Had the jury been given a lost or diminished chance instruction, however, the Gordons could have recovered on a proportional basis for any lost or diminished chance of survival found by the jury. If the jury had been allowed to find within a reasonable probability that had Lori's cancer been diagnosed on her first visit to Dr. Kemper her chance of recovery would have been 30%, but that at the actual time her cancer was finally discovered her chance of recovery had become only 5%, the Gordons would then have been entitled to recover 25% of the total damages resulting from Lori's death. Needless to say, wrongful death damages in cases like the one of Lori Gordon are usually quite substantial. Therefore, even a small percentage of damages can also be quite substantial. At this writing, a growing number of states have adopted the lost or diminished chance doctrine in malpractice lawsuits. [1] The Court of Appeals, in adopting this new tort concept, relies on this Court's decision in Davis v. Graviss, 672 S.W.2d 928 (Ky. 1984). [2] It interprets that case as recognizing the right to recovery for an increased risk of future harm and laying the groundwork for a natural progression into accepting the lost or diminished chance method of recovery. Thus, the Court of Appeals concluded, As the Supreme Court has already signaled its intent to permit recovery for an increased risk of future harm, we believe it would, likewise, be inclined to permit recovery for a lost chance of recovery/survival. See Gordon v. Kemper, No. 2002-CA-001983-MR at 13, 2005 WL 678535 (Ky.App. March 25, 2005). We find that the Court of Appeals has incorrectly interpreted the Davis case. In that case, the jury was allowed to consider the probability of future medical problems as it related to damages-not liability  for future mental suffering. In Davis , the plaintiff was the victim of a car accident that caused a permanent defect in the base of her skull, resulting in periodic leakage of cerebral fluid. Physicians presented her with two dreadful options. She could elect not to have surgery, but confront the possibility that future leakage of cerebral fluid would occur with devastating results; or she could have surgery with the possibility of terrifying results  even death. Psychiatric evidence established that this mental anguish was a probability, not a mere chance. This Court upheld the jury's award in favor of the plaintiff, concluding that an award for damages based on the plaintiff's fear was not speculative. As Justice Leibson succinctly stated, Thus the threshold question is the appellant's right to compensation for an injury causing an increased risk of future harm and for mental suffering and impairment of earning power resulting from the fear caused by the risk of future harm. Davis, 672 S.W.2d at 930. Such a holding does not serve as a precursor for this Court to accept the legal doctrine of lost or diminished chance. In Davis , future periodic brain leakage was a possibility, but the mental anguish was a probability resulting directly from her injuries and, therefore, compensable. Also, and perhaps most importantly, in Davis this Court was dealing with damages. Here, we are asked to extend its reasoning to liability. Both sides also refer to Walden v. Jones, 439 S.W.2d 571 (Ky.1969). Contrary to the suggestion of the Gordons, we find no support in that case for the lost or diminished chance doctrine. In fact, it seems clearly to be a rejection by this Court of that principle. In Walden , the plaintiff alleged his paralysis was the result of a misdiagnosis that was later discovered. However, medical testimony at trial established that the plaintiff might have had a chance of recovery had he been properly diagnosed originally, but that he probably would not have recovered even absent the alleged negligence. Finding insufficient evidence to raise a jury issue of proximate causation, the trial court directed a verdict in favor of the defendants. This Court affirmed, stating that it did not accept the argument that any chance of recovery, no matter how remote, entitles the plaintiff in a malpractice suit to have the issue of proximate cause submitted to the jury. Walden, 439 S.W.2d at 575. In the case of Richard v. Adair Hosp. Found. Corp., 566 S.W.2d 791 (Ky.App. 1978), however, the medical testimony linking the alleged negligence to the lost chance of recovery was much stronger than in Walden . In Richard , an infant suffering from pneumonia was twice turned away from the emergency room based on the negligent determination that no emergency existed. The child later died as a result of the pneumonia. The medical testimony at trial established that the infant's chances of recovery would have been substantially greater had she been treated during one of the first two visits to the emergency room. The Court of Appeals determined that summary judgment in favor of the defendant was prematurely granted. At first blush, the Richard opinion seems to allow compensation for the infant's lost chance of survival, based on the testimony that she might have lived if properly diagnosed. However, a careful reading reveals that damages could be awarded only if the jury determined that the hospital's negligence caused the infant's death: We feel that the proper disposition of this case is dependent upon the determination of whether appellee was negligent in twice refusing hospital admission to the infant, based upon the child's condition when admission was requested, when an unmistakable emergency situation may have existed. Richard, 566 S.W.2d at 793. The Richard opinion is silent as to whether the infant's estate could be compensated for the lost chance of survival itself, as the Gordons request in this case. We are fully appreciative of the Gordons' point that the standard of proof in the lost or diminished chance doctrine would still be anchored in the requirement of probabilities. It is argued that a plaintiff would still be required to show, within a reasonable probability, that the negligence caused the loss of the chance of survival. However, a close look at the semantics of this argument makes it clear that this amounts to a concept chasing its own tail. When the dew leaves the rose, it is still a rose. The reasonable probability of a chance of survival is still just a possibility. We further take issue with the Court of Appeals' determination that public policy reasons support the recognition of lost or diminished chance of recovery as a distinct and compensable injury in tort law. Even as we write this opinion, our society is wallowing near the water line with the burdensome and astronomical economic costs of universal healthcare and medical services. Rising malpractice insurance premiums for physicians are undoubtedly a part of that financial burden. Medical science and technology are advancing at a dizzying and sometimes seemingly miraculous rate. Our expectations as recipients of these modern day blessings ride upon the tail of this comet. We must acknowledge, however, that in spite of seemingly miraculous cures and mind-boggling technology that allow us to both examine and evaluate the human body, the diagnosis must still be seen by human eyes, analyzed by human minds, and treatment offered by human hands. That is why there remains great wisdom in ensuring that our laws offer redress for those wronged by medical malpractice based on reasonable probabilities and substantial cause, not on chance or mere possibility. Perfection is not part of human nature, and rarely does wisdom say one thing and nature another  wings for angels and feet for men. We are troubled by the potential financial burden that might be spread upon the shoulders of millions of people if we adopt this new concept of lost or diminished chance of recovery. Further, we see many difficulties in adopting the lost or diminished chance doctrine. For instance, what is a late diagnosis? Does a diagnosis missed this week, but made next week, rise to the level of diminished chance? A whole new and expensive industry of experts could conceivably be marched through our courts, providing evidence for juries that an MRI misread on Monday, but accurately discerned on Friday, perhaps gives rise to an infinitesimal loss of a chance to recover. Yet, under this doctrine, even a small percentage of the value of a human life could generate substantial recovery and place burdensome costs on healthcare providers. This additional financial load would be passed along to every man, woman, and child in this Commonwealth. We find it difficult to improve upon the words of the Vermont court which, in rejecting the principle of lost or diminished chance, stated: Although some of the arguments in favor of the loss of chance doctrine are appealing, we are mindful that it represents a significant departure from the traditional meaning of causation in tort law.... [T]he decision to expand the definition of causation and thus the potential liability of the medical profession in Vermont involves significant and far-reaching policy concerns more properly left to the Legislature, where hearings may be held, data collected, and competing interests heard before a wise decision is reached. (Internal citations omitted.) See Smith v. Parrott, 175 Vt. 375, 833 A.2d 843, 848 (2003). In short, this Court declines to expand tort liability by judicial legislation in a matter of such far reaching consequence to our citizens. Therefore, we reverse that portion of the decision of the Court of Appeals adopting the doctrine of lost or diminished chance for tort recovery in medical malpractice cases. Having thus resolved the issue of the lost or diminished chance doctrine, we need not reach the merits of Dr. Kemper's argument that the adoption of the doctrine would violate § 241 of the Kentucky Constitution.