Court Opinion

ID: 9691137
Source: CourtListenerOpinion
Date Created: 2023-08-24 20:13:19.790248+00
Date Added: 2024-06-11T18:19:11.461889
License: Public Domain

Kelly, J..
(concurring in part and dissenting in part). I agree with part II of the majority opinion. The trial court did not abuse its discretion in finding that plaintiffs’ first amended complaint inadequately notified defendants that plaintiffs sought damages for pulmonary injuries. Moreover, the trial court did not abuse its discretion in denying plaintiffs’ motion to amend because of its late date. However, I respectfully dissent with respect to part I of the majority opinion. I would recognize a cause of action for the loss of an opportunity to avoid physical harm less than death.
Generally, in an action alleging medical malpractice, the plaintiff has the burden of proving four elements: (1) the applicable standard of care, (2) the defendant’s breach of that standard, (3) an injury, and (4) proximate causation between the breach and the injury. MCL 600.2912a; MSA 27A.2912(1); Locke v Pachtman, 446 Mich 216, 222; 521 NW2d 786 (1994). Proximate cause requires proof of two separate ele*668ments: (1) cause in fact and (2) legal cause. Skinner v Square D Co, 445 Mich 153, 162-163; 516 NW2d 475 (1994); Moning v Alfono, 400 Mich 425, 437; 254 NW2d 759 (1977). Generally, to establish the cause-in-fact element, a plaintiff must show that, but for the defendant’s action, the injury would not have occurred. Skinner, supra at 163.
The lost opportunity doctrine, adopted by this Court for wrongful death cases in Falcon v Memorial Hosp,1 provides an exception to the general rule of proving causation in medical malpractice actions. According to the doctrine, damages are recoverable for the lost opportunity to survive, even though the opportunity was less than fifty percent. Id. at 461 (Levin, J.). A plaintiff must show only that there is a substantial possibility that the defendant’s negligence caused the injury. Id. at 469.
Several reasons have been advanced for adoption of the doctrine. First, because medicine is an inexact science, questions regarding causation are not easily answered, especially where a physician’s failure to act is alleged to be responsible for the harm. Falcon, supra at 455 (Levin, J.). Fundamental fairness dictates that the uncertainty be imposed on the tortfeasor, not on the patient. As one commentator has stated:
But for the defendant’s tortious conduct, it would not have been necessary to grapple with the imponderables of chance. Fate would have run its course. A defendant’s tort not only destroys a “raffle ticket,” in so doing it destroys any chance of ever knowing how that ticket would have fared in the drawing. [King, Causation, valuation, and chance in personal injury torts involving preexisting con*669ditions and future consequences, 90 Yale L J 1353, 1378 (1981).]
Second, the doctor-patient relationship should be taken into account. Patients retain physicians not only to cure disease or heal injury, but also to maximize their chance of recovery and to assuage their pain and suffering. Falcon, supra at 459 (Levin, J.). The lost opportunity doctrine helps ensure that physicians are liable for negligence or gross negligence that deprives their patients of less than an even chance of obtaining a better result.
Third, as the Court of Appeals stated, where the chance of recovery is fifty percent or less, the traditional rule undermines the loss allocations and deterrent functions of tort law.
If the lost opportunity doctrine is limited to cases only involving death, potentially flagrant examples of malpractice could go uncompensated in cases in which the same negligent failure to diagnose or treat results in a lost opportunity to avoid egregious harm, i.e., paralysis or coma. Thus, the deterrent and loss-allocation functions of tort law would be undermined if defendants could escape liability for the effects of negligent conduct that cause demonstrable losses. [210 Mich App 231, 237; 533 NW2d 334 (1995).]
It is of real concern that the application of traditional concepts of proximate cause may unjustly deny legal recourse to patients injured by a physician’s negligence.
The majority acknowledges the importance of the deterrent and loss-allocation functions of tort law. However, it refuses to jettison the element of causation in order to gain the lost opportunity’s deterrent effect. In Falcon, Justice Levin remarked that causa*670tion principles are not discarded where the injury is viewed as the lost chance rather than the ultimate harm. A plaintiff must still establish more-probable-than-npt causation. It must be proven that, more probably than not, the defendant reduced the opportunity of avoiding harm. Falcon, supra at 462.
The Ohio Supreme Court recently discarded what it proclaimed “the traditionally harsh view” and adopted the loss-of-chance theory. Roberts v Ohio Permanente Medical Group, Inc, 76 Ohio St 3d 483, 488; 668 NE2d 480 (1996).2 It reasoned:
A patient who seeks medical assistance from a professional caregiver has the right to expect proper care and should be compensated for any injury caused by the caregiver’s negligence which has reduced his or her chance of survival. Over the years, medical technology has improved and advances have been made in the treatment of many areas of medicine, including cancer. However, these medical strides are meaningless unless early detection is practiced diligently by those in the health care field. Thus, a health care provider should not be insulated from liability where there is expert medical testimony showing that he or she reduced the patient’s chances of survival. Unfortunately, under the traditional view, this is precisely the outcome. The innocent patient is the loser while the health care provider escapes liability despite his or her negligence.
The policy reasons behind the lost opportunity doctrine apply equally to fatal and nonfatal cases. Patients seek treatment from doctors for maladies other than potentially fatal diseases.3 In both fatal and *671nonfatal cases, the patient seeks to improve the opportunity of “avoiding, ameliorating, or reducing physical harm and pain and suffering.” Falcon, supra at 461 (Levin, J.).
The majority fails to explain why the doctrine is proper if death occurs, but not if a lesser injury is involved. It cites Texas and South Carolina Supreme Court cases in support of the argument that traditional notions of causation should not be discarded. Kramer v Lewisville Memorial Hosp, 858 SW2d 397 (Tex, 1993); Jones v Owings, 318 SC 72; 456 SE2d 371 (1995). However, both cases focused on whether the lost opportunity doctrine should apply where death is the ultimate result. They did not discuss whether, once the lost opportunity doctrine applies, it should be limited to death cases.
Other jurisdictions have adopted a cause of action for the loss of an opportunity to avoid physical harm less than death. In Aasheim v Humberger,4 the plaintiff consulted medically with the defendant physician regarding problems in her left knee. The defendant failed to order x-rays. The plaintiff was diagnosed with chondromalacia. After the condition of her knee did not improve, she was referred to another physician for arthroscopic surgery. Preoperative x-ray films revealed a giant cell tumor in the left knee. Physicians had to remove the infection along with all the bone and soft tissue in the knee area. She was given a prosthetic knee.
*672The plaintiff filed suit for failure to order diagnostic films. She alleged that the error caused her to lose the chance to have less radical surgery and preserve her natural knee. The Montana Supreme Court stated:
We feel that including “loss of chance” within causality recognizes the realities inherent in medical negligence litigation. People who seek medical treatment are diseased or injured. Failure to diagnose or properly treat denies the opportunity to recover. Including this lost opportunity within the causality embrace gives recognition to a real loss consequence of medical failure. [Aasheim, supra at 133.]
In Ehlinger v Sipes,5 parents brought an action against a physician for injuries arising from the premature birth of their twins. They alleged that failure to diagnose multiple pregnancies was a substantial factor causing the injuries. The physician argued that, to satisfy their burden on the causation issue, the plaintiffs had to show that, with proper diagnosis and appropriate treatment, more probably than not (1) the twins would not have suffered their injuries, or (2) the injuries would have been less severe. The Wisconsin Supreme Court rejected the argument, stating:
We disagree that to establish causation the Ehlingers must show that proper diagnosis and treatment would have been successful. We conclude that in a case of this nature, where the causal relationship between the defendant’s alleged negligence and the plaintiff’s harm can only be inferred by surmising as to what the plaintiff’s condition would have been had the defendant exercised ordinary care, to satisfy his or her burden of production on causa- • tion, the plaintiff need only show that the omitted treatment was intended to prevent the very type of harm which resulted, that the plaintiff would have submitted to the *673treatment, and that it is more probable than not the treatment could have lessened or avoided the plaintiff’s injury had it been rendered. It then is for the trier of fact to determine whether the defendant’s negligence was a substantial factor in causing the plaintiff’s harm. [Id. at 13-14 (emphasis in original).]
In Delaney v Cade6 the Kansas Supreme Court considered recognizing a cause of action for the loss of a chance of a better recovery as contrasted with the lost chance to survive. After reviewing the policy arguments relating to the lost chance doctrine, the court found that the lost chance of a better recovery stated a legitimate cause of action. It stated:
We have found no authority or rational argument which would apply the loss of chance theory solely to survival actions or to loss of a better recovery actions and not to both. As noted by plaintiff in her brief: “There is certainly nothing in that [Roberson] rationale to justify leaving the season open on persons who suffer paralysis, organ loss, or other serious injury short of death while protecting only those who do not survive the negligence.”
We acknowledge that the vast majority of cases we have reviewed involved death of the patient and a loss of chance of survival. We also recognize that the apportionment of damages may be more difficult in a loss of a better recovery case than in the cases resulting in death. However, the fact that most cases have involved death of the patient and that damages may be difficult to resolve in a loss of a better recovery case should not be grounds to refuse to recognize the doctrine when medical malpractice has substantially reduced a person’s chance of a better recovery. [Id. at 210.]
The court acknowledged that several jurisdictions have refused to recognize the loss of chance doctrine *674in either type of case. However, it found no jurisdiction which applied the theory in one type of case and denied it in the other. The court found that most jurisdictions, like Kansas, had simply not had occasion to address the doctrine in both situations.
I agree with the reasoning of the Kansas Supreme Court. Considering the policy arguments underlying the lost opportunity doctrine, there is no rational basis for distinguishing between death cases and cases in which physician negligence has limited recovery. Consequently, I would extend the reasoning of our decision in Falcon to nonfatal cases.

 436 Mich 443; 462 NW2d 44 (1990).

 In doing so, the Ohio court overruled its previous contrary position taken in Cooper v Sisters of Charity of Cincinnati, Inc, 27 Ohio St 2d 242; 272 NE2d 97 (1971).

 In Aasheim v Humberger, 215 Mont 127; 695 P2d 824 (1985), the plaintiff alleged that the defendant’s negligence resulted in the plaintiff *671losing a chance at less radical surgery and a chance to preserve her natural knee.

 Aasheim, n 3 supra.

 155 Wis 2d 1; 454 NW2d 754 (1990).

 255 Kan 199; 873 P2d 175 (1994).