Opinion ID: 600483
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Heading: whether kansas law recognizes a cause of action for loss

Text: OF CHANCE OF RECOVERY 8 In Roberson v. Counselman, 235 Kan. 1006, 686 P.2d 149 (1984), the Kansas Supreme Court recognized a cause of action for loss of chance to survive. There the plaintiff brought a medical malpractice action against a chiropractor, alleging he was professionally negligent in failing to recognize his patient was experiencing symptoms consistent with acute heart disease and in failing to refer the patient to a medical doctor. The chiropractor's negligence, the plaintiff argued, substantially reduced deceased's chance of surviving the heart attack which took his life within hours after he had received chiropractic treatment. Id. 686 P.2d at 150. One of the plaintiff's experts testified if the decedent had received in-hospital treatment for the heart attack, he had a nineteen percent chance of dying. Without proper treatment, his chance of dying was twenty-five percent. Thus, the failure to receive medical treatment reduced his chances of survival from eighty-one to seventy-five percent. Another expert maintained the failure to receive proper treatment reduced his chances of survival from forty to zero percent. The Kansas District Court concluded the evidence on causation was insufficient to constitute a submissible jury question. 9 On appeal to the Kansas Supreme Court, the sole issue was whether the plaintiff offered sufficient evidence of causation. First, the Court explained Kansas applies the substantial factor test of causation. Under this test a plaintiff must show  'it is more likely than not that the conduct of the defendant was a substantial factor in bringing about the harm.'  Id. at 152 (quoting Restatement (Second) of Torts § 433B, cmts. a and b (1965)). Then, after reviewing several loss of chance to survive cases from other jurisdictions, the Court held: 10 The question of causation in cases involving negligent treatment of a potentially fatal condition ... is generally a matter to be determined by the finder of fact where the evidence has established the patient had an appreciable chance to survive if given proper treatment. In making the determination, the finder of fact should take into account both the patient's chances of survival if properly treated and the extent to which the patient's chances of survival have been reduced by the claimed negligence. 11 Id. at 159. Based on the expert testimony, the Roberson Court concluded the plaintiff presented sufficient evidence to preclude summary judgment and [w]hether the negligence of defendant was a substantial factor in Mr. Roberson's death is a matter for determination by a jury. Id. at 160. The Court illuminated its reasoning: 12 There are sound reasons of public policy involved in reaching this result. The reasoning of the district court ..., in essence, declares open season on critically ill or injured persons as care providers would be free of liability for even the grossest malpractice if the patient had only a fifty-fifty chance of surviving the disease or injury even with proper treatment. Under such rationale a segment of society often least able to exercise independent judgment would be at the mercy of those professionals on whom it must rely for life-saving health care. 13 Id. 14 Since Roberson, only the Kansas Court of Appeals has considered a loss of chance cause of action. In Donnini v. Ouano, 15 Kan.App.2d 517, 810 P.2d 1163, 1165-66 (1991), 2 the decedent's wife and estate brought a medical malpractice suit against his physician based on the failure to detect kidney cancer. Plaintiffs alleged two alternative theories at trial: (1) the doctor's negligence was the probable cause of the decedent's injuries and death, and (2) the doctor's negligence deprived the decedent of a substantial possibility of recovery from the cancer. Id. 810 P.2d at 1166. After a second trial on liability, the jury found the decedent's chances for survival with proper care, were fifty-five percent but were zero with the care actually given. 15 The Court of Appeals held the jury's finding the decedent had a fifty-five percent chance of survival had he received proper medical care indicated the jury found the doctor's negligence was the cause in fact of the decedent's death. Based on this finding, the court concluded the jury found negligence under traditional survival/wrongful death law not 'loss of chance,'  although both theories went to the jury. Id. at 1167. The Donnini court explained: 16 The loss of chance rule is an exception to the normal requirement of proving causation. In Roberson v. Counselman, 235 Kan. 1006, 686 P.2d 149 (1984), the court recognized the loss of chance cause of action applies when a doctor's negligence eliminates or substantially reduces a patient's chance of survival. 17 .... 18 A cause of action in which the patient had a greater than 50 percent chance of surviving does not fall under the causation rule from Roberson. 19 Id. 810 P.2d at 1167, 1168. In such a case, traditional negligence causation rules apply. 20 Three federal district courts have considered the loss of chance cause of action under Kansas law. In Boody v. United States, 706 F.Supp. 1458, 1459 (D.Kan.1989), the plaintiff brought a medical malpractice action under the Federal Tort Claims Act on behalf of his deceased wife. He alleged a physician acted negligently in failing to properly read an x-ray and detect lung cancer at an early stage. The plaintiff's expert testified the decedent would have had a fifty-one percent chance of surviving five years if diagnosed at the time the defendant failed to detect cancer. A year later, when doctors discovered cancer, decedent had a very slight chance of surviving five years. Thus, the expert maintained, the doctor's actions significantly diminished the chance of surviving five years. The court applied Roberson's reduced standard of causation and held the defendant's negligence deprived decedent of an appreciable chance to survive. Id. at 1463. 3 21 The plaintiff in Borgren v. United States, 716 F.Supp. 1378, 1382 (D.Kan.1989), claimed her physicians negligently failed to diagnose the likelihood of breast cancer and to recommend a biopsy. The court found the doctor's negligence caused a three year delay in treatment and significantly decreased the plaintiff's chances of disease-free survival. Specifically, the court concluded plaintiff established, by a preponderance of the evidence, that she had lost a thirty to fifty-seven percent chance of ten year disease-free survival. Id. at 1383. The court awarded the plaintiff damages for pain, suffering, and loss of chance of survival. 22 Finally, in Denton v. United States, No. 87-2536-V, 1990 WL 98335, at  4 (D.Kan. July 3, 1990), a physician's negligence in failing to transfer the decedent to another medical facility and to consult a specialist caused the decedent to lose an eighty percent chance of survival. The court held this constituted an appreciable chance to survive and awarded damages on a percentage basis equal to the loss of chance. 23 The district court in Ms. Delaney's case, troubled by the implications of Roberson in all medical malpractice cases, chose to limit the loss of chance theory to actions involving loss of chance of survival. 756 F.Supp. at 1481-82. It stated: 24 The court does not believe Roberson was intended to dramatically change the long established requirement in all medical malpractice cases that the plaintiff demonstrate that the physician's deviation from the minimally accepted standards of the medical profession was more likely than not a substantial factor in causing the plaintiff's injuries. Without clearer indication from the Supreme Court of Kansas, this court is unwilling to extend Roberson and the loss of chance theory beyond survival actions. 25 Id. at 1484. 26 While Ms. Delaney concedes some courts have refused to recognize loss of chance, no court has determined loss of chance only applies in survival actions. Moreover, she asserts, the Roberson rationale extends to loss of chance of recovery cases. The Roberson Court's interest in not declaring open season on critically ill or injured patients and leaving them at the mercy of the health care professionals on whom they must rely applies with equal force to patients with a less than fifty percent chance of recovery. Finally, Ms. Delaney notes Roberson discussed two loss of chance cases in which the plaintiff survived. See Jones v. Montefiore Hosp., 494 Pa. 410, 431 A.2d 920, 922, 924 (1981) (plaintiff asserted physicians' and hospitals' negligence caused her to contract cancer and shortened her life; court held trial judge should have instructed jury to impose liability if defendants' conduct increased risk of harm and increased risk was substantial factor in bringing about harm that plaintiff actually suffered); Clark v. United States, 402 F.2d 950, 953-54 (4th Cir.1968) (plaintiff claimed physician's negligent conduct caused loss of a kidney). 27 Consequently, Ms. Delaney has moved to certify the question of whether Kansas recognizes a cause of action for loss of chance of recovery to the Kansas Supreme Court. 4 Because this question has not been addressed by the Kansas courts with sufficient clarity, we are uncomfortable attempting to decide the issue without its further guidance. Consistent with our judicial policy that matters of state law should first be decided by state courts, we grant the motion to certify. A separate order of certification will enter. 28