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

Heading: Loss of Chance as an Independent Injury

Text: Causation and injury are sometimes described together as the collective third element of a medical malpractice claim. See Mayhue, 653 N.E.2d at 1386-87 (reciting that, in order to prevail in a medical malpractice cause of action, a plaintiff must establish: (1) the physician owed a duty to the plaintiff; (2) the physician breached that duty; (3) the breach proximately caused the plaintiff's injuries). Causation and injury are distinct, however, and we are confronted with this distinction here. We think that loss of chance is better understood as a description of the injury than as either a term for a separate cause of action or a surrogate for the causation element of a negligence claim. If a plaintiff seeks recovery specifically for what the plaintiff alleges the doctor to have caused, i.e., a decrease in the patient's probability of recovery, rather than for the ultimate outcome, causation is no longer debatable. Rather, the problem becomes one of identification and valuation or quantification of that injury. We view the issue presented by JoAnn's claim as whether a plaintiff may recover for an increased risk of harm, here a decreased life expectancy, caused by a doctor's negligence, before the ultimate consequences are known. Because in this case the ultimate injury is death, the increased risk of that result is a decrease in life expectancy. Although loss of chance could also be applied as a label for this injury, we do not view recognizing this injury as a deviation from traditional tort principles. Rather, in this context it is nothing more than valuation of an item of damages that is routinely valued in other contexts. Scheid and Orthopaedics have conceded, for purposes of summary judgment, that they had a duty toward plaintiff and that they breached that duty. They do not concede that the breach caused a compensable injury, but they have, at this summary judgment stage, not yet contested that their negligence caused JoAnn's chance of long-term survival of cancer to be reduced. They contend only that Indiana does not recognize a reduction in the long-term probability of survival as a compensable injury. In Dayton Walther Corp. v. Caldwell, 273 Ind. 191, 198-99, 402 N.E.2d 1252, 1256 (1980), this Court held that the trial court did not err in overruling an objection to evidence of the increased risk of meningitis and epilepsy caused by the defendant's negligence. We concluded that: To hold otherwise would virtually wipe out any appraisal by an expert medical witness as to an estimate of permanent future impairments. Id. Scheid and Orthopaedics attempt to distinguish Caldwell, noting that, in Caldwell, the plaintiff had, as of trial, already suffered one bout of meningitis. Meningitis was one of the two ultimate potential effects, and even as to meningitis the ultimate consequences were not yet known. Caldwell thus foreshadowed recognition of compensation for increased risk of yet unknown but serious consequences. A number of jurisdictions allow recovery for negligence that has increased the risk of harm, even where the full ramifications of the defendant's actions are not yet known. See Cudone v. Gehret, 821 F.Supp. 266, 270-71 (D.Del.1993) (Delaware would allow jury instruction regarding recovery for increased risk of harm where doctor's alleged malpractice in failing to timely diagnose breast cancer more than doubled possibility of recurrence of breast cancer); James v. United States, 483 F.Supp. 581, 587 (N.D.Cal.1980) (in lung cancer case, awarding damages for the loss of the opportunity for earlier and possibly more effective treatment in spite of current remission); Boryla v. Pash, 960 P.2d 123, 127 (Colo.1998) (directed verdict in favor of the defendant was error in view of evidence that a three-month delay in diagnosing breast cancer could have increased plaintiff's risk of a recurrence); Petriello v. Kalman, 215 Conn. 377, 576 A.2d 474, 484-85 (1990) (upholding instruction on compensation for increased likelihood that plaintiff would suffer bowel obstruction); Moattar v. Foxhall Surgical Assocs., 694 A.2d 435, 439-40 (D.C.1997) (plaintiff could presently recover for all future economic injuries when cancer was more probable than not to recur and cause her death). More specifically, many jurisdictions have recognized a decrease in life expectancy as a cognizable injury. See Anderson, 669 A.2d at 78 (recovery for shortened life expectancy due to increased risk of a recurrence of testicular cancer); Swain v. Curry, 595 So.2d 168, 172-73 (Fla.Dist.Ct.App.1992) (recovery for increased risk of cancer, decreased chance of survival, and reduction of life expectancy allegedly caused by defendant's failure to diagnose breast cancer in a timely manner); Knopfer v. Louisiana Patient's Compensation Fund, 527 So.2d 326, 329 (La.Ct.App.1988) (plaintiff's reduction in life expectancy justified jury award of $500,000 for misdiagnosis of moles as benign); Morrison v. Stallworth, 73 N.C.App. 196, 326 S.E.2d 387, 393 (1985) ([S]hortened life expectancy is a compensable element of damage.); Davison v. Rini, 115 Ohio App.3d 688, 686 N.E.2d 278, 283-84 (1996) (recognizing a shortened life expectancy as a cognizable injury where eighty-five percent chance of full recovery was reduced to twenty-five percent chance of surviving five years). But see Beeman v. Manville Corp. Asbestos Disease Compensation Fund, 496 N.W.2d 247, 256-57 (Iowa 1993) (maintaining that reduction in life expectancy itself is an element of damages only in South Carolina, which has adopted the English Rule that lost opportunity to live out one's full life is recoverable). Here, JoAnn has pointed to evidence that would support a finding of both present injury and increased risk of harm. We agree with the authorities that find these sufficient to maintain a cause of action for an increased risk of harm. JoAnn has characterized defendants' actions as having reduced her chance for long-term survival and extinguished the chance for successful removal of her tumor. The doctors testified that JoAnn's chances of complete recovery, sixty to eighty percent in June of 1993, had dropped to a ten to thirty percent chance of surviving five years by May of 1994. JoAnn has suffered physical injuries, including the growth of a cancerous tumor, the destruction of healthy lung tissue, and the collapse of a lung. [11] Scheid and Orthopaedics point to the fact that JoAnn does not ask for past medical expenses or for lost earnings. However, this has no bearing on whether or not she may maintain a separate cause of action for her decreased life expectancy. In some cases an intangible loss may be as great an injury as any that a plaintiff could suffer. JoAnn must live under constant fear that at any time she may suffer a recurrence of her lung cancer. If that occurs, her doctors have testified that she has no chance of survival. This is not too remote or speculative an injury to preclude recovery, and JoAnn should not be forced to wait until she has suffered a relapse to proceed with a cause of action for what is essentially a daily threat of impending death, or to wait until her husband, on her behalf, is left with a wrongful death claim. As already noted, given the occurrence-based statute of limitations for medical malpractice, these future claims may face substantial obstacles. Money is an inadequate substitute for a period of life, but it is the best a legal system can do. The alternative is to let a very real and very serious injury go uncompensated even if due to negligent treatment. Faced with that choice, we hold that JoAnn has stated a viable cause of action and presented evidence sufficient to defeat summary judgment. Specifically, within the parameters set forth here, we hold that JoAnn may maintain a cause of action in negligence for this increased risk of harm, which may be described as a decreased life expectancy or the diminished probability of long-term survival. Here, we also have an injury that often accompanies a delay in diagnosisthe invasion of healthy tissue by a tumor or other growth. Accordingly, this case does not present the issue whether a plaintiff must have incurred some physical injury as a result of the defendant's negligence in order to recover for an increased risk of harm. [12] Some courts have concluded, particularly in the loss of chance context, that the loss must be substantial before it is compensable. [13] We see no obvious method of quantifying that test. [14] Because we measure damages by probabilizing the injury, the likelihood that plaintiffs will bring claims for trivial reductions in chance of recovery seems small. If, in the future, we face a volume of insignificant claims, perhaps such a rule will become necessary. For now, we are content to rely on basic economics to deter resort to the courts to redress remote probabilities or insubstantial diminutions in the likelihood of recovery.