Opinion ID: 853638
Heading Depth: 3
Heading Rank: 1

Heading: Issues Raised under the Rubric Loss of Chance

Text: Loss of chance, also often referred to as increased risk of harm is usually traced back to this frequently quoted passage from Hicks v. United States: When a defendant's negligent action or inaction has effectively terminated a person's chance of survival, it does not lie in the defendant's mouth to raise conjectures as to the measure of the chances that he has put beyond the possibility of realization. If there was any substantial possibility of survival and the defendant has destroyed it, he is answerable. 368 F.2d 626, 632 (4th Cir.1966) (quoted in Mayhue v. Sparkman, 653 N.E.2d 1384, 1387 (Ind.1995)). The term loss of chance has been applied to a number of related situations. These include: (1) an already ill patient suffers a complete elimination of an insubstantial or substantial probability of recovery from a life-threatening disease or condition [3] ; (2) a patient survives, but has suffered a reduced chance for a better result or for complete recovery [4] ; and (3) a person incurs an increased risk of future harm, but has no current illness or injury. [5] The first of these was addressed by this Court in Mayhue. See 653 N.E.2d at 1384. The Alexanders now present the second, which, like the first, typically arises in the context of a claim of negligent health care. The third commonly arises in connection with claims of exposure to toxic substances, where no adverse results have yet emerged. These cases pose a number of separate but sometimes interrelated issues. First, many courts initially address the issue as one of causation. Mayhue took the view that under traditional medical malpractice theory, when a patient's chance of recovering from a disease is already less than fifty percent, it can never be said that the doctor's malpractice was the proximate cause of the ultimate death. See id. at 1387. Accordingly, recovery under traditional tort standards of causation is barred under those circumstances. This approach views the injury as the ultimate adverse result of the disease, which may be death, but may also be other conditions (paralysis, blindness, etc.). Just as it is difficult to find causation where the harm is already more than likely to occur, it seems odd to speak of a causal relationship between a defendant's act or omission and an as yet unknown ultimate result. Although an act of malpractice may reduce a patient's chances for survival or for obtaining a better result, this is simply a statistical proposition based on the known experience of a group of persons thought to be similarly situated (in JoAnn's case, persons with four centimeter nodes in the lungs). In any given case, however, the plaintiff's ultimate injury either does or does not occur. Thus, if full recovery is awarded based on an appraisal of causation (or greater than fifty percent probability), the plaintiff who later beats the odds may be overcompensated for an injury that never ultimately emerges. Similarly, the plaintiff who has a less than fifty percent chance, but nonetheless does ultimately bear the full brunt of the disease, may be undercompensated. One way to deal with this problem is to permit multiple suits as different injuries develop, [6] but that approach has several shortcomings, including the generation of multiple litigation and the attendant costs of that litigation. [7] Delaying suit is another possibility, [8] but that fails altogether to compensate for the very real pain and distress that accompanies an uncertain but probable serious or fatal condition. [9] Delaying suit for medical malpractice in Indiana also has a distinct disadvantage. Given the occurrence-based limitations period for Indiana's medical malpractice claims and our holding that the Indiana Constitution prohibits barring only claims that have accrued but are unknowable, [10] a person in JoAnn's shoes may be forever barred if the claim cannot be presented until the disease recurs. These factors argue in favor of permitting the Alexanders to bring their claims now. If this is to be done, however, there are further complexities to address. First, there is disagreement as to the elements of recoverable damages. Some courts purporting to address loss of chance allow recovery only for medical expenses, lost earnings, or loss of consortium, see, e.g., Roberts v. Ohio Permanente Medical Group, Inc., 76 Ohio St.3d 483, 668 N.E.2d 480, 484-85 (1996) (in loss of chance cases, damages are recoverable for underlying injury or death). Others have explicitly allowed recovery for what the doctrine's name suggests: the loss of the chance itself, see United States v. Anderson, 669 A.2d 73, 76 (Del.1995) (citing cases). If a lost chance is to be compensable, its valuation also presents issues. Damages may be assessed for the full amount of the injury, if the full extent of the physical injury is already known. See Weymers v. Khera, 454 Mich. 639, 563 N.W.2d 647, 653 (1997) (citing cases from jurisdictions that assess full damages when plaintiff has established that defendant's negligence increased plaintiff's risk of harm). Other courts have attempted to assess the damages in proportion to the likelihood that the doctor's negligence caused (or will cause) an injury. See, e.g., McKellips v. Saint Francis Hosp., Inc., 741 P.2d 467, 475-76 (Okla.1987) (holding, where decedent's fatal heart attack was misdiagnosed as gastritis, that loss of chance damages must be limited to those proximately caused from a defendant's breach of duty). Finally, if damages are awardable for the increased risk of an injury that has not yet occurred, the court faces the difficult task of putting a dollar amount on an as yet unknown loss. The Alexanders' claim here presents that issue as to the ultimate recurrence of the cancer. They also assert current injury in the form of the cancer's metastasizing, and the anxiety generated by the prospect of future recurrence.