Court Opinion

ID: 9741704
Source: CourtListenerOpinion
Date Created: 2023-08-26 21:00:49.7252+00
Date Added: 2024-06-11T07:24:25.583554
License: Public Domain

SULLIVAN, Judge,
concurring in part and dissenting in part
The majority observes, correctly I believe, that the Indiana Supreme Court in Mayhue v. Sparkman (1995) Ind., 653 N.E.2d 1384 held the following: (1) That Indiana adopts Restatement (Second) of ToRts § 323 with regard to medical malpractice claims; (2) That in such instances, we no longer look to traditional proximate cause analysis requiring denial of recovery unless the injury or harm claimed would not have occurred “but for” the defendant’s negligence; (3) That given a pre-existing condition which more probably than not would have caused the resultant harm, e.g. death, a claimant may nevertheless recover if the defendant’s negligence was a “substantial factor in producing the harm.” 653 N.E.2d at 1388 (citing McKellips v. St. Francis Hospital, Inc. (1987) Okl. 741 P.2d 467, 475);13 and (4) That a plaintiff may i-ecover even if the chances of survival or recovery, absent defendant’s negligence, were less than 50%.14
What Mayhue v. Sparkman, supra, did not hold, however, is that a medical malpractice defendant is liable for the total value of the lost life even though the natural preexisting cancerous condition was the ultimate causative factor, and even though the medical malpractice merely increased the risk of the ultimate occurrence or decreased the chances of recovery or survival. Further, it did not hold that a damage recovery in such situation must be an all-or-nothing recovery.
In stating that acceptance of “the § 323 approach does not require a separate loss of chance doctrine,” 653 N.E.2d at 1389 (emphasis in original), the court did not reject the concept that a plaintiffs recovery reflects the increased risk element. It did not say that loss of chance is to be disregarded. Rather, the Mayhue court seems to have been saying, as did McKellips, supra, that the doctrines of § 323 and pure loss of chance are alternatives to accomplish the same policy purpose as to the hurdle of traditional proximate cause; that it is not an either/or situation with respect to liability, but also that utilization of § 323 analysis does not depend upon creation of a separate free-standing loss of chance doctrine. In other words, the § 323 approach may stand upon its own base in that it embraces and includes the loss of chance or increased risk concepts.
Although the pure loss of chance doctrine does reason that the “harm” is not the death, but rather is the “reduction in the probability that the patient would recover or obtain better results if the defendant had not been negligent,” Mayhue v. Sparkman, supra, 653 N.E.2d at 1387, § 323 should not, in an effort to afford some recovery, treat the negligent physician as if his negligence were the sole *19cause of death. The facts at issue remain the same under either the loss of chance theory or the § 323 theory, and it is difficult to understand why the recoveries should be so dramatically different depending upon which doctrine is applied.15
McKellips v. St. Francis Hospital, Inc., supra, resolved the matter in a very logical and common sense manner. It adopted § 323 as “the preferable and most rational theory” (741 P.2d at 474) in the context of the proximate cause problem, but it also incorporated the loss of chance doctrine in its analysis of the recoverable damages.16 I see no procedural or substantive impediment to such reasoning.
Our Supreme Court, although it vacated the Court of Appeals opinion in granting transfer, did not in Mayhue, cast any negative implications upon the statement that:
“As to valuation, the chance of survival or of successful treatment, no matter how small, is a compensable interest for which the negligent defendant is liable. Damages for the lost chance are measured by the ‘percentage probability by which the defendant’s tortious conduct diminished the likelihood of achieving some more favorable result.’” Mayhue v. Sparkman (1994) Ind.App., 627 N.E.2d 1354, 1359 (citations omitted).
The Supreme Court did not state that such valuation, even if valid as to application of pure lost chance, would not be acceptable in the setting of a § 323 analysis.
The validity of apportionment is also acknowledged by Professors Prosser and Kee-ton as deduced in the following comment from Andel, Medical Malpractice: The Right to Recover for the Loss of a Chance of Survival, 12 Pepperdine Law Rev. 973, 988-989 (1985):
“According to Prosser and Keeton, the ‘substantial factor’ rule replaces the ‘but for’ rule in traditional proximate cause analysis and is a much better rule where multiple causation has played an important part in producing the harm. In such cases, responsibility should be imposed upon all causes of the harm_” (emphasis supplied).
In any event, the McKellips, supra, approach to apportionment of damages is preferable to the all or nothing approach adopted by the majority in the case before us.
The Mayhue court, itself acknowledged, at least by inference, that there is no impediment to having our juries apportion damages in multiple causation cases. Although proximate cause complications are sought to be resolved by application of § 323, the court gave our fact-finding system credit for having the ability to meet the task of apportionment. The Court stated that adoption of the § 323 analysis “ is most consistent with Indiana law, particularly our strong faith in the ability of the jury to decide such complex questions.” 653 N.E.2d at 1389.
This confidence is expressed by other scholarly treatments of the subject. In Shoenberger, Medical Malpractice InjuryCausation and Valuation of the Loss of Chance to Survive, 6 Journal of Legal Medicine 51, 82-83 (1985), Professor Shoenberger notes:
“If we are willing to trust juries to attempt to allocate responsibility in a comparative negligence state according to percentages, it appears anomalous to have difficulty *20with permitting the jury to perform exactly that same function in a value of a [§ 323] case.”
In summation, I concur that under § 323, a plaintiff may recover damages from a negligent physician, whose negligence is a substantial factor in increasing the risk of death, even though the patient would have died of natural causes without any negligence on the part of the defendant. I further concur that such recovery may lie even though the patient’s chances of recovery or survival were as little as 10%, absent negligence on the part of the physician, so long as the plaintiff establishes by the evidence that the defendant’s negligence was a substantial factor in increasing the risk. I do not, however, concur in the holding that if the jury finds
liability, they must award full damages against the physician as if there had been no contributing cause. Rather, I would hold that the jury should be instructed to apportion any damages for the malpractice liability based upon the McKellips formula or some similar formula, so long as the defendant has produced expert evidence with respect to the percentages involved, i.e. the percentage of increased risk or diminished chance of survival.17

. In McKellips, the court held that the jury must determine “whether the increase in risk under the circumstances was more likely than not a substantial factor in causing the harm.” 741 P.2d at 475 (emphasis supplied).

. Although the majority did not explicitly acknowledge it as a holding of Mayhue, it is clear from a reading of § 323 itself, that the focus of the Restatement rule is the increased risk of harm rather than whether the defendant's negligence was the proximate cause of the ultimate harm. In this regard, one may note that from case to case, the proximate cause analysis may differ in that some cases refer to the proximate cause thereby seeming to disregard the concept that there be multiple causes, all or some of which may be proximate causes. Other cases utilize the usual view that liability may result if the tortfeasor’s negligence is a proximate cause of the injury.

. It must be noted that the complaint of Cummings in the case before us included not only a claim for loss of consortium, as in Mayhue, and a survival action pursued as decedent’s personal representative but also a wrongful death action. Mayhue did not involve a wrongful death claim. It may well be that as to a wrongful death claim, the harm alleged is truly the death itself, as opposed to a claim under § 323 for an increased risk which was a substantial factor in the harm, i.e. the death. Therefore, as to the wrongful death aspect of this appeal, the majority is perhaps correct in holding that the harm is the death and that if plaintiff is to recover it must be for the death itself. Nevertheless, I do not perceive that isolation of the death from the increased risk element of § 323, precludes a valuation for purposes of recoverable damages of less than the full measure of damages that would be awarded were the defendant’s negligence the sole proximate cause of the death.

. The majority opinion here sets forth the procedure for calculation of damages as envisioned by McKellips v. Saint Francis Hospital, Inc., supra. 741 P.2d at 471, n. 4. See generally: King, Causation, Valuation, and Chance in Personal Injury Torts Involving Preexisting Conditions and Future Consequences, 90 Yale L.J. 1353 (1981).

. If death has not occurred, I venture no opinion as to the apportionability of percentages attributable to a lessening or increase of pain and suffering, medical expenses, quality of life etc. vis-a-vis a continuation of the pre-existing condition. Furthermore, I express no view with reference to die burden of proof as to apportionability, except to state that it may be appropriate to hold the defendant responsible for all damages except those which he can prove arose from the disease or condition. Scafidi v. Seiler (1990) 119 N.J. 93, 574 A.2d 398.