Court Opinion

ID: 9706388
Source: CourtListenerOpinion
Date Created: 2023-08-26 01:42:27.999143+00
Date Added: 2024-06-11T18:22:22.276756
License: Public Domain

Dissenting Opinion by
Justice NOBLE.
Respectfully, I dissent.
Since the early 1980s, Professor Joseph H. King, Jr., has propounded the alternate theory of recovery in appropriate tort cases known as the loss-of-a-chance theory, or simply lost chance, but in a simplified form from the complicated legal debate then occurring about causation questions. See Joseph H. King, Jr., Causation, Valuation, and Chance in Personal Injury ToRs Involving Preexisting Conditions and Future Consequences, 90 Yale L.J. 1851 (1981); Joseph H. King, Jr., “Reduction of Likelihood" Reformulation and Other Retrofitting of the Loss-of-a-Chance Doctrine, 28 U. Mem. L.Rev. 492 (1998) [hereinafter King, “Reduction of Likelihood ”]. The doctrine has most frequently been argued in medical malpractice cases where there has been a failure to diagnose a condition through either a complete failure or a misdiagnosis. The claimant argues that the physician’s negligence resulted in a lost chance or opportunity for a better result. Opponents of the theory argue that it is impossible to definitively say that a claimant would even have had a better chance absent the tort-feasor’s negligence. Given that most of medical negligence causation is proved by the testimony of experts, the opponents’ arguments seem specious.
In fact, the most common scenarios are similar to the facts of this case. A patient’s illness or condition is not diagnosed in time for the patient to receive treatment that has a chance of ameliorating or avoiding the end result of the untreated illness or condition. The medical proof is that at the point of failure to diagnose, the patient had a better chance of the best result from treatment. Obviously, this type of proof falls within the realm of expert testimony. Nonetheless, the patient has had a very real loss of a valuable opportunity that is easily understood at the human level. What patient would not feel he or she had been harmed by a physician’s negligent failure to diagnose when they are told that they had a chance for a better recovery at that point in time which was lost due to *159the negligence? How could a patient help but blame the physician for taking away that chance through his negligence?
“[W]hen a defendant tortiously destroys or reduces a victim’s prospects for achieving a more favorable outcome, the plaintiff should be compensated for that lost prospect. Damages should be based on the extent to which the defendant’s tortious conduct reduced the plaintiffs likelihood of receiving a better outcome.” King, “Reduction of Likelihood” 28 U. Mem. L. Rev at 492 (footnotes omitted). This should hold true whether the likelihood of avoiding or ameliorating injury is better than even or not.
Part of what makes courts wary of the lost chance doctrine is the unnecessary complication created by assuming that lost chance only applies if there is a 50% chance or less that a better outcome was lost due to the failure to diagnose. This is the wrong approach. The cause of action cannot intelligently be divided by looking at causation on a continuum where the jury finds the negligence of the physician to be a substantial factor, 51% or better, in causing the patient’s injury, but then tacking lost chance of a better recovery into that analysis by saying that anything 50% or less should be compensable because of the lost chance. This is mixing apples and oranges.
While I don’t completely agree with Professor Hill’s view of lost chance valuation, his view that the lost chance for a better recovery should be compensable makes sense if one considers that the lost chance doctrine is actually an alternative theory of injury when compared to the standard view of failure to diagnose causing a physical result in the patient. Under lost chance, the patient is not claiming he was injured by the physical result, but rather the injury is the loss of opportunity for a better result. In either case, the tortious conduct is the negligent failure to diagnose, but what that failure causes is different. For example, negligent failure to diagnose an ongoing heart attack could be reasonably viewed as a substantial factor in causing the patient’s death. However, if the jury found that it was not a substantial factor in causing the death because the severity of the heart attack he had would inevitably result in death, it still could be a substantial factor in reducing the patient’s chance for a better result if it had been diagnosed and treated before it became that severe. Proof could indicate that with early diagnosis, the patient would have had a percentage of chance for a better result somewhere between 1 to 100%. This lost chance is a valuable opportunity, the value of which is greater as the likelihood of a better result increases.
Perhaps the best way to view this alternative theory is to look at the instructions which should be given to the jury. The first instruction would describe the general duty of the physician to act within the proper standard of care, followed by an interrogatory as to whether he did so:
Instruction # 1
It was the duty of the defendant, Doctor X, to exercise the degree of care and skill of a reasonably competent physician acting under the same or similar circumstances in diagnosing the Plaintiffs (decedent’s) condition which resulted in her injury (death).
Interrogatory # 1
Do you believe, based on the evidence, that Dr. X failed to act with the degree of skill and care of a reasonably competent physician under the same or similar circumstances when he failed to diagnose the condition of the Plaintiff (decedent)?
Yes_No_
*160If the jury finds that the physician did not violate his duty of care, then the inquiry is over.
However, if the jury finds that the physician has violated his duty of care, then the stage is set for alternative theories of injury. First, inquiry should be made as to whether the failure to diagnose was a substantial factor in causing the patient’s physical injury:
Interrogatory # 2
Do you believe, based on the evidence, that Dr. X’s failure to diagnose the Plaintiffs (decedent’s) condition was a substantial factor in causing her injury (death)?
Yes_No_
If the jury answers yes to this query, then under present causation analysis, the all or nothing approach, the doctor is liable for the injury or death and the jury will assess compensation under the standard damage instruction. If the jury answers no, then it should proceed to a lost chance causation interrogatory:
Interrogatory # 3
If you did not find for the Plaintiff (decedent’s estate) under Interrogatory #2, do you believe, based on the evidence, that Dr. X’s failure to diagnose the Plaintiff (decedent) was a substantial factor in reducing the Plaintiffs (decedent’s) chance of a better result?
Yes_No_
At this point, if the jury answers no, then they have found for the physician on both injury theories, and the case is concluded. If the jury answers in the affirmative, then they should be asked to evaluate the degree or percentage of lost chance and determine damages. Lost opportunity for a better result can be any percentage between one and one hundred. This encompasses a total loss of chance down through any lesser degree of opportunity lost. This is the most difficult part of this theory, because many factors can influence the percent of chance for a better result available to any given patient. However, this is not an impossible task, and can be based on scientific knowledge and the experience of an expert witness. It is the expert who will do the math, and present a statement of percentage of lost chance for a better result to the jury, subject to cross-examination, but the jury will determine the compensable percentage:
Interrogatory # 4
What percentage for the loss of a chance do you attribute to Dr. X’s failure to diagnose the Plaintiffs (decedent’s) condition?
_%
The jury should then be asked to place a value on that lost chance for a better result, through a separate damage instruction:
Instruction # 2
You have found that the defendant, Dr. X, did not act with the degree of care and skill of a reasonably competent physician under the same or similar circumstances in failing to diagnose the Plaintiffs (decedent’s) condition and that failure to diagnose was a substantial factor in reducing the Plaintiffs (decedent’s) chance of a better result. You must now determine what amount of money, if any, would reasonably compensate the Plaintiff (decedent’s estate) for her percentage of loss of a chance for a better result, which you found in Interrogatory # 4, considering that you have found that the defendant, Dr. X’s, failure to diagnose the Plaintiffs (decedent’s) condition did not cause the Plaintiffs (decedent’s) injury (death).
Interrogatory # 5
What amount of money would reasonably compensate the Plaintiff (dece*161dent’s estate) for her percentage of loss of a chance for a better result?
Mental and physical suffering, (including any such as she is reasonably certain to endure in the future (if applicable) for the loss of a chance) $.
Reasonable and necessary medical expenses for the loss of a chance ⅜.
Lost wages for the loss of a chance $.
Permanent impairment of her power to earn money for the loss of a chance $.
Total $.
The damages to be considered are essentially the same for either theory of injury. The above instructions demonstrate that the effect of negligently failing to diagnose a patient’s condition can result in more than one type of injury. While not physical, the loss of the chance for a better recovery is real, and it resonates with anyone who has ever been denied an opportunity for something important. Certainly, there can be no opportunity more important than that which might save one’s life or prevent debilitation from the failure to diagnose a condition. Every patient in this scenario doubtless feels that a tangible thing has been lost when they are denied their chance for a better result. And, there is no unfairness in this to the physician. Lost chance is never reached by the trier of fact unless it also finds that a physician acted negligently toward his or her patient.
I further differ from the majority opinion in that I do not believe that this theory of injury will open the floodgates to unnecessary litigation, nor do I agree that this Court should look past the realities of what is lost by a negligent failure to diagnose to whether a potential financial burden “might be spread upon the shoulders of millions of people.... ” Being “troubled” about the cost of insurance or any other industry, or referencing universal health care when this country does not have it, moves into territory to which I do not believe an impartial Court should go. Even assuming this is an appropriate concern for the Court, it is not clear that the majority’s rule, with its all-or-nothing approach, does not result in larger damage awards, since a plaintiff need only show a better than 50% chance in order to recover the full measure of damages against the physician. Arguably, adoption of the lost chance rule would result in more verdicts, but those would be balanced by lower damage awards.
Therefore, I would affirm the Court of Appeals, but for the reasons as stated above.
THOMAS C. SMITH, Special Justice, joins this dissenting opinion.