Opinion ID: 172567
Heading Depth: 2
Heading Rank: 1

Heading: Personal-Injury Claims

Text: In Colorado, as elsewhere, a party seeking recovery in tort must demonstrate that the defendant's conduct caused the alleged injury. See Vigil v. Franklin, 103 P.3d 322, 325 (Colo.2004). The general rule for causation is that the plaintiff must prove that the alleged injury would not have occurred but for the defendant's negligent conduct. Kaiser Found. Health Plan v. Sharp, 741 P.2d 714, 719 (Colo.1987). Plaintiffs do not dispute that proposition but argue that when there are potential multiple or concurring causes for an injury, Colorado applies a substantial factor test for causation, not the more stringent but-for test. Aplt. Br. at 50. Under the substantial-factor test, Plaintiffs contend, an actor's conduct can be deemed causal `where it is of sufficient significance in producing the harm as to lead reasonable persons to regard it as a cause and to attach responsibility.' Id. at 52 (quoting Sharp v. Kaiser Found. Health Plan, 710 P.2d 1153, 1155 (Colo.Ct.App. 1985), aff'd on other grounds, 741 P.2d 714 (Colo.1987)). [1] Because the illnesses at issue in this case (cancer and thyroid disease) can have multiple causes, Plaintiffs conclude that this more permissive substantial-factor test applies. The legal issues regarding causation that arise when a disease has multiple possible causes are subtle. Plaintiffs' statement of the substantial-factor test reflects the difficulty of the issues; it relies on certain language from the Restatement (Second) of Torts but misstates the law by overlooking other language. To better understand the proper test, it is helpful to review the more precise, and clearer, treatment of multiple possible causes in the Proposed Final Draft of the Restatement (Third) of Torts: Liability for Physical Harm. [2] We then compare that treatment to the treatment in the Restatement (Second) and see that the ultimate legal standards in the two Restatements are essentially identical for our purposes. Roughly speaking (we will become more precise as we discuss the underlying concepts), under the Restatements a Plaintiff could recover from Defendants only if either (1) Uravan radiation was a but-for cause of the Plaintiff's ailments or (2) that radiation (either alone or with other factors) would have caused the ailments. Because Colorado law has been consistent with the treatment of causation in the Restatements, we presume that it, too, would impose this requirement for recovery. We therefore reject Plaintiffs' version of the substantial-factor test. To explain how we have arrived at this conclusion, we turn to an extended discussion of general principles. Applying those principles to this case, we then affirm the summary judgment.
The term substantial factor appears in the treatment of causation in the Restatement (Second) of Torts (as well as its predecessor, the original Restatement of Torts). It has been abandoned, however, in the Restatement (Third) of Torts because of the misunderstanding that it has engendered. See id. § 26 cmt. j. Causation under the Restatement (Third) has two components. First, the tortious conduct must be the factual cause of the physical harm to the plaintiff. See id. §§ 26, 27. Ordinarily, a cause is a factual cause only if it is a but-for cause, see id. § 26, although there is a potential exception, which we will discuss shortly, when there are multiple causes, see id. § 27. Second, the harm must be among the harms that result from the risks that made the actor's conduct tortious. Id. § 29. Traditionally, this second component has been referred to as proximate cause, a term that has baffled law students (to say nothing of jurors, lawyers, and judges) for generations; but the Restatement (Third) has wisely redescribed the subject matter as scope of liability. See id. Ch. 6, Special Note on Proximate Cause; id. § 29 cmt. b. We need not dwell on this topicthe focus of our attention is on factual causebut an illustration in the Restatement (Third) conveys what is necessary to show that an injury factually caused by the defendant is within the scope of liability: Richard, a hunter, finishes his day in the field and stops at a friend's house while walking home. His friend's nine-year-old daughter, Kim, greets Richard, who hands his loaded shotgun to her as he enters the house. Kim drops the shotgun, which lands on her toe, breaking it. Although Richard was negligent for giving Kim his shotgun, the risk that made Richard negligent was that Kim might shoot someone with the gun, not that she would drop it and hurt herself (the gun was neither especially heavy nor unwieldy). Kim's broken toe is outside the scope of Richard's liability, even though Richard's tortious conduct was a factual cause of Kim's harm. Id. cmt. b, illus. 3. Returning to the concept of factual cause, § 26 states that [c]onduct is a factual cause of harm when the harm would not have occurred absent the conduct. As comment b to the section states, this standard is familiarly referred to as the `but-for' test. That test requires a counterfactual inquiry in which the court considers what would have occurred if the actor had not engaged in the tortious conduct. Id. cmt. e. If the harm complained of would have occurred notwithstanding the actor's conduct, then that conduct is not a but-for cause. See id. Section 27, however, recognizes that it is sometimes appropriate to impose liability even when the harm would have occurred without the defendant's act. This exceptional circumstance is narrowly defined to impose liability only when a tortfeasor's conduct, while not necessary for the outcome, would have been a factual cause if the other competing cause had not been operating. Id. § 27 cmt. a. The black letter of § 27 states: If multiple acts exist, each of which alone would have been a factual cause under § 26 of the physical harm at the same time, each act is regarded as a factual cause of the harm. Again, an illustration clarifies the concept: Rosaria and Vincenzo were independently camping in a heavily forested campground. Each one had a campfire, and each negligently failed to ensure that the fire was extinguished upon retiring for the night. Due to unusually dry forest conditions and a stiff wind, both campfires escaped their sites and began a forest fire. The two fires, burning out of control, joined together and engulfed Centurion Company's hunting lodge, destroying it. Either fire alone would have destroyed the lodge. Each of Rosaria's and Vincenzo's negligence is a factual cause of the destruction of Centurion's hunting lodge. Id. cmt. a, illus. 1. The formulation of the requirements for causation in the Restatement (Third) employs different nomenclature from that in the Restatement (Second), but it does not impose a stricter requirement for factual causation. We explain. Section 430 of the Restatement (Second) states that a negligent person is liable for another's harm only if the negligent conduct was a legal cause of the harm. Section 431 then introduces the notion of substantial factor, stating that negligent conduct is a legal cause of harm to another if ... his conduct is a substantial factor in bringing about the harm and no rule of law exempts him from liability. Section 433 sets forth considerations that are important in determining whether the actor's conduct is a substantial factor in bringing about harm to another. Those considerations are: (a) the number of other factors which contribute in producing the harm and the extent of the effect which they have in producing it; (b) whether the actor's conduct has created a force or series of forces which are in continuous and active operation up to the time of the harm, or has created a situation harmless unless acted upon by other forces for which the actor is not responsible; (c) lapse of time. Restatement (Second) of Torts § 433. Reading the black letter of §§ 430, 431, and 433, one could easily conclude that courts and juries have substantial leeway to depart from but-for causation in imposing liability. It would appear to be enough if the considerations listed in § 433 suggest that liability is appropriate. This is how Plaintiffs appear to understand the doctrine. But this conclusion cannot stand once one reads § 432, which imposes a requirement for liability that is at least as stringent as the factual-cause requirement in the Restatement (Third). Section 432(1) sets forth the general requirement of but-for causation; and § 432(2) recognizes what has become the exception in Restatement (Third) § 27 for multiple sufficient causes. Section 432 states: (1) Except as stated in Subsection (2), the actor's negligent conduct is not a substantial factor in bringing about harm to another if the harm would have been sustained even if the actor had not been negligent. (2) If two forces are actively operating, one because of the actor's negligence, the other not because of any misconduct on his part, and each of itself is sufficient to bring about the harm to another, the actor's negligence may be found to be a substantial factor in bringing it about. Thus, as we understand the substantial-factor requirement in the Restatement (Second), it adopts essentially the same standard for factual cause as the Restatement (Third). And that standard is different from what Plaintiffs advocate. What Plaintiffs would apparently use to determine whether conduct is a substantial factorthe conditions set forth in § 433are actually limitations on what conduct can qualify as a substantial factor. Once conduct satisfies one of the alternative requirements in § 432(1) and (2)which in the Restatement (Third) §§ 26, 27 are the alternative grounds for being a factual causeit must still qualify under § 433 if it is to be considered a substantial factor. (The counterpart to § 433 in the Restatement (Third) is § 36, which states that [w]hen an actor's negligent conduct constitutes only a trivial contribution to a causal set that is a factual cause of physical harm under § 27, the harm is not within the scope of liability. An actor's trivial contribution thus would still be a factual cause, but the actor would not be liable because the harm was outside the scope of liability. It should be noted that § 36, unlike Restatement (Second) § 433, applies only to one of multiple sufficient causes, not to a but-for factual cause. [3] ) There are two further nuances regarding factual cause that need to be explained: the notion of causal sets and the meaning of the term sufficient cause. The notion of a causal set is a helpful innovation in the Restatement (Third). A number of factors (often innocent) generally must coexist for a tortfeasor's conduct to result in injury to the plaintiff. Even when the defendant drives his car into the plaintiff's car, no injury would have resulted if the plaintiff had not entered her car and driven to the accident site. That there are many factors does not mean that the defendant's conduct was not a cause. As comment c to § 26 of the Restatement (Third) explains: A useful model for understanding factual causation is to conceive of a set made up of each of the necessary conditions for plaintiff's harm. Absent any one of the elements of the set, the plaintiff's harm would not have occurred. Thus, there will always be multiple (some say, infinite) factual causes of a harm, although most will not be of significance for tort law and many will be unidentified. That there are a large number of causes of an event does not mean that everything is a cause of an event. The vast majority of acts, omissions, and other factors play no role in causing any discrete event. This causal-set model does not imply any chronological relationship among the causal elements involved, although all causes must precede the plaintiff's harm. An actor's tortious conduct may occur well before the other person suffers harm and require a number of subsequent events to produce the harm. Thus, a gas valve negligently constructed may not fail for many years. Toxic substances may be sold without adequate warnings but not produce harm for decades. Conversely, the tortious conduct may occur after a number of other necessary events have already occurred but close in time to the occurrence of harm. Nor does this model imply any relationship among the causal elements; causal elements may operate independently, as when a property owner neglects a patch of ice on a sidewalk and a careless pedestrian fails to notice the condition, producing a fall. When § 27 of the Restatement (Third) speaks of multiple sufficient causes, it could more precisely speak of multiple sufficient causal sets.  See id. § 27 cmt. f. For example, the evidence at trial may show (1) that conditions A, B, C, D, E, and F were present; (2) that if only A, B, and C had been present, the injury would probably have occurred; and (3) that if only D, E, and F had been present, the injury would probably have occurred. If F is the defendant's misconduct, then F was not a but-for cause of the injury; even without F, the injury would have occurred (all it took was A, B, and C). But since D, E, and F would also have caused the injury, F is a component of a second causal set. F must, of course, be a necessary component of the second causal set to be a factual cause of the injury. See id. That is, F would not be a factual cause if D and E alone would have been enough to cause the injury; F must be a but for component of at least one causal set for liability to attach. Moreover, multiple causal sets may share some components. If A, B, and C would probably have caused the injury (with each of A, B, and C being necessary) and so would have A, B, and D, the tortfeasor who committed D would be liable. The Restatement (Third) provides the following example: Able, Baker, and Charlie, acting independently but simultaneously, each negligently lean on Paul's car, which is parked at a scenic overlook at the edge of a mountain. Their combined force results in the car rolling over the edge of a diminutive curbstone and plummeting down the mountain to its destruction. The force exerted by each of Able, Baker, and Charlie would have been insufficient to propel Paul's car past the curbstone, but the combined force of any two of them is sufficient. Able, Baker, and Charlie are each a factual cause of the destruction of Paul's car. Id. § 26 cmt. f, illus. 3. A real-world example would be a typical asbestosis lawsuit. A person suffering from asbestosis may have been exposed to asbestos from a number of sources (say, four), and the total exposure may have been more than enough to cause asbestosis. It may well be (1) that asbestosis would probably have arisen even without exposure of the victim to Source A, so Source A is not a but-for cause; and (2) that Source A by itself would not have caused asbestosis. But Source A may be a factual cause if it was a necessary component of a causal set that included, say, two of the other sources and the three together would probably have caused asbestosis. See, e.g., Spaur v. Owens-Corning Fiberglas Corp., 510 N.W.2d 854, 858 (Iowa 1994); Eagle-Picher v. Balbos, 326 Md. 179, 604 A.2d 445, 459 (1992); Restatement (Third) of Torts § 27 Reporters' Note cmt. g. [4] Finally, we attempt to dispel some confusion that may arise from use of the word sufficient in the provisions of the Restatement (Second) and the Restatement (Third) that provide an alternative to but-for causation in limited circumstances. Restatement (Second) § 432(2) employs the phrase forces ... sufficient to bring about harm to another and Restatement (Third) § 27 is entitled Multiple Sufficient Causes. The use of the word sufficient in both Restatements does not mean that either of them would impose liability for conduct that is not a but-for cause if only the conduct could have caused the injury. Rather, it is necessary for the plaintiff to show that the conduct (or the causal set of which it is a necessary part) would in fact have caused the injury. As we all know, in the modern world of many hazardous substances, there may be many possible causes of a particular cancer. Each could be said to be sufficient to cause a specific person's cancer. But one who suffers that cancer does not have a cause of action based on each such substance to which he was exposed, regardless of how unlikely it is that the cancer resulted from that exposure. Only a substance that would have actually (that is, probably) caused the cancer can be a factual cause without being a but-for cause. This is clear in the black letter of Restatement (Third) § 27, which states: If multiple acts exist, each of which alone would have been a factual cause under § 26 of the physical harm at the same time, each act is regarded as a factual cause of the harm. Id. (emphasis added). And the illustrations to the section confirm this reading. We have already quoted the illustrations involving two fires, each of which alone would have destroyed the lodge, id. cmt. a, illus. 1, and involving three persons leaning on a car, the combined force of any two of [whom] is sufficient [to propel the car], id. cmt. f, illus. 3. We leave to a footnote a third illustration, the one most pertinent to the case before us, which requires proof that a drug would have caused the birth defect that could also have been caused by an unrelated genetic condition. Id. cmt. e, illus. 2. It is not enough that the drug could have caused the defect, as might be inferred from use of the term sufficient cause. [5] The Restatement (Second) is not as clear as the Restatement (Third) in excluding conduct that merely could have caused the injury, but the sole illustration to the point in Restatement (Second) § 432 is essentially the same as the concurrent-fires illustration in Restatement (Third) § 27. In any event, the very notion of two (or more) causes (or causal sets), neither of which is a but-for cause, necessarily assumes that each of the causes would have caused the injury. Say there are two such causes, A and B. The reason that A is not a but-for cause is that the injury would probably have occurred even if A had not been present. But that is merely another way of saying that even in the absence of A, B probably would have caused the injury; it would not be enough (to prevent A from being a but-for cause) that B may have caused the injury on its own but probably would not have. [6] To sum up, as we understand the Restatement (Second) and the Restatement (Third), a defendant cannot be liable to the plaintiff unless its conduct is either (a) a but-for cause of the plaintiff's injury or (b) a necessary component of a causal set that (probably) would have caused the injury in the absence of other causes. In particular, conduct was not a substantial factor, within the meaning of the term in the Restatement (Second), in bringing about a plaintiff's injury unless it satisfied (a) or (b), and also was a sufficiently significant factor under the considerations set forth in Restatement (Second) § 433. Thus, Plaintiffs' substantial-factor argument misconceives the meaning of substantial factor in the Restatement (Second). To be sure, it is Colorado law that governs here, not the Restatements. The Colorado Supreme Court may have decided to disagree with the Restatements and adopt a different standard for causation. But we see no evidence of this. We have reviewed the Colorado opinions relied upon by Plaintiffs for their view of the substantial-factor standard. None expressly addresses multiple sufficient causes. All but one are fully consonant with our above analysis. The sole exception is the opinion by the Colorado Court of Appeals in Sharp, 710 P.2d at 1155. That decision held that the trial court had erred in requiring evidence of but-for causation because the plaintiff had been required to show only that the misdiagnosis of her heart condition was a substantial factor in causing her heart attack. In language ultimately derived from Restatement (Second) § 431 cmt. a, the court said, A defendant's conduct is a substantial factor where it is of sufficient significance in producing the harm as to lead reasonable persons to regard it as a cause and to attach responsibility. Sharp, 710 P.2d at 1155; see Restatement (Second) § 431 cmt. a (The word `substantial' is used to denote the fact that the defendant's conduct has such an effect in producing the harm as to lead reasonable men to regard it as a cause, using the word in the popular sense, in which there always lurks the idea of responsibility .... (emphasis added)). But the court apparently ignored Restatement (Second) § 432, discussed above, which states that conduct is not a substantial factor unless it is a but-for cause or one of multiple sufficient causes. In any event, the state Supreme Court took the case and affirmed on a different theory. See Sharp, 741 P.2d at 718, 720 (finding sufficient evidence of but-for causation and affirming court of appeals without reaching its `substantial factor' analysis). Our role here is to predict what the Colorado Supreme Court would adopt as the governing law. See TMJ Implants, Inc. v. Aetna, Inc., 498 F.3d 1175, 1180 (10th Cir.2007) (federal courts applying state law must predict what the state's highest court would do (internal quotation marks omitted)). Predicting another court's decision is necessarily an uncertain proposition. In our view, however, it would be too adventurous on our part to assume that Colorado would depart from the Restatements. We therefore hold that Defendants would be liable only upon proof of one of the following: (1) that exposure of a Plaintiff to Uravan radiation was a but-for cause of the Plaintiff's medical condition or (2) that such exposure to Uravan radiation was a necessary component of a causal set that would have caused the medical condition. We now examine whether Plaintiffs supplied such evidence.
Plaintiffs failed to raise in district court a genuine issue of fact regarding factual causation. That is, they failed to present to the court evidence, or even an argument, that Uravan radiation was either a but-for cause of any medical condition suffered by one of the Plaintiffs or that Uravan radiation was a necessary component of a causal set that would probably have caused one of those conditions. Plaintiffs presented five expert witnesses. Dr. Colin K. Hill, who was offered only as an expert with respect to the medical-monitoring Plaintiffs, testified regarding how radiation injures cells and begins the process that can lead to cancer and other ailments. Dr. A. James Ruttenber addressed only general causation, that is, whether radiation at Uravan had the capacity to cause the cancers and thyroid diseases that the Plaintiffs developed. See Neiberger v. Fed Ex Ground Package Sys., Inc., 566 F.3d 1184, 1191 (10th Cir. 2009) (discussing general and specific causation); Restatement (Third) of Torts § 28 cmt. c(3), c(4) (same). Dr. F. Owen Hoffman provided the raw data upon which the final two experts relied. He estimated the mean dose of radiation received by each Plaintiff from Uravan operations. And for the Plaintiffs claiming thyroid diseases, he estimated their radiation exposure from the detonation of atomic weapons at a testing site in Nevada (the Nevada Test Site or NTS) conducted between 1959 and 1970. In addition, for the cancer Plaintiffs (including the one who suffered thyroid cancer) he converted the Uravan dosage into a figure representing the Excess Risk of Diagnosed Cancer and an Assigned Share figure that can be used to compare the number of cancers expected in a population exposed to that level of radiation to the number that would be expected in an unexposed population. Aplt.App., Vol. X at 1869, 1872. To prove specific causation for each Plaintiffthat is, to prove that the Uravan radiation caused the specific ailment of which the Plaintiff complainedPlaintiffs relied on the remaining two experts: Drs. Inder J. Chopra and Robert Peter Gale. Dr. Chopra addressed the Plaintiffs with thyroid disease (including the one case of thyroid cancer) and Dr. Gale addressed the remaining Plaintiffs, all of whom had suffered cancer. Dr. Chopra prepared a report that assessed each thyroid Plaintiff and concluded that the Plaintiff's exposure to radiation from Uravan and NTS fallout was a substantial factor contributing to the Plaintiff's thyroid disease. See, e.g., id., Vol. IX at 1562. A substantial factor, he explained, is intended to mean that the exposures were one of the variables that contributed to the observed health effect (thyroid disease). Id. at 1556. He defined substantial as an amount that is not trivial, id, concluding that if the contribution of any one source to [a Plaintiff's] total exposure to irradiation was 5% of the total, its contribution was substantial, Id. at 1557. Because at least 5% of the radiation exposure for each Plaintiff came from Uravan, the Uravan radiation was a substantial contributing factor. Dr. Chopra's report did not, however, state with respect to any Plaintiff that Uravan radiation was a but-for cause of the Plaintiff's thyroid disease or was a necessary component of a causal set that probably would have caused the Plaintiff to suffer the disease. For the Plaintiffs with cancer (other than thyroid cancer), Dr. Gale's report opined that to a reasonable medical probability exposure to ionizing radiations was a substantial factor contributing to each plaintiff developing cancer(s). Id. at 1642 (emphasis omitted). The report did not define substantial contributing factor, but it noted that, based on Dr. Hoffman's data, each of the Plaintiffs had an assigned share exceeding 10%, and he later submitted a declaration that this meant that there is greater than a 10% likelihood [that a] Plaintiff's cancer was contributed to by the additional radiation exposure from Defendants' uranium operations. Id. Vol. XII at 2075. As was true of Dr. Chopra, however, Dr. Gale did not opine that Uravan radiation was either a but-for cause of any Plaintiff's cancer or was a necessary component of a causal set that would have caused the cancer. Thus, the evidence relied on by Plaintiffs did not show that Uravan radiation was a factual cause of any of their ailments. In reaching this conclusion we are not being hypertechnical. The problem for Plaintiffs is not that their experts failed to utter some magic words, such as but for. Nor are we relying on any expertise of this court in analyzing the data and opinions from Plaintiffs' experts. We claim no such expertise. For all we know, the data would support but-for claims of some, or even all, Plaintiffs. The problem for Plaintiffs is that they did not make a timely argument that they had produced evidence of but-for causation, and they have never (not even in this court) contended that they have produced evidence that Uravan radiation was a necessary component of a causal set that probably would have caused the Plaintiffs' ailments. Our conclusion in this regard follows from an examination of how the issue was joined below. The Defendants' summary-judgment motion on the personal-injury claims was premised on the absence of but-for evidence. Defendants stressed that agents other than radiation can cause the Plaintiffs' ailments and that neither Dr. Chopra nor Dr. Gale had opined that those ailments would not have occurred `but for' [the Plaintiffs'] exposure to the radioactive substances attributable to Defendants' activities. Id. Vol. XI at 1928. In response, Plaintiffs argued that they need not establish but-for causation and that their expertsnamely Drs. Chopra and Galecreated a triable issue of fact by opining that exposure to radiation at Uravan substantially contributed to the development of each Plaintiff's disease. Id. Vol. XII at 1992, 1997-98. At a hearing on the matter the district court rejected Plaintiffs' substantially contributed standard and stated that Defendants were entitled to summary judgment because the Plaintiffs' experts ha[d] not offered the requisite opinion of `but for' causality. Id. Vol. XIII at 2208. A few seconds after stating that conclusion, the court asked whether there was [a]ny need for clarification or further explanation with regard to the ruling on this motion? Id. Plaintiffs' counsel responded No, your Honor. Id. Ten days later Plaintiffs filed a motion to alter or amend the judgment under Federal Rule of Civil Procedure 59(e). The motion asserted, for the first time, that their evidence could satisfy the but-for requirement (if one were erroneously imposed). But even then the specific arguments that Plaintiffs raised amounted to no more than the assertion that the substantial-factor test actually subsumes the `but for' test. Id. at 2357. They pointed to no evidence that their ailments would not have occurred in the absence of Uravan radiation. Moreover, a Rule 59(e) motion cannot be used to advance arguments that could have been raised in prior briefing. See Grynberg, 538 F.3d at 1354 (internal quotation marks omitted). Plaintiffs make better but-for arguments on appeal. [7] But they come too late. Based on the evidence and arguments properly before the district court, summary judgment on all personal-injury claims was appropriately granted. See Hutton Contracting Co. v. City of Coffeyville, 487 F.3d 772, 782 (10th Cir.2007) (Absent special circumstances, we will not reverse on a ground not raised below.).