Court Opinion

ID: 9750057
Source: CourtListenerOpinion
Date Created: 2023-08-28 14:16:11.119056+00
Date Added: 2024-06-11T07:26:02.287244
License: Public Domain

HANDLER, J.,
concurring.
The decision of the Court in this case brings greater clarity to the concept of proximate cause in the context of a medical malpractice action in which the negligence of the defendant has increased the risk of harm to the plaintiff. Its decision on this point is an important and sensible refinement of our prior determinations. The Court also explains that for purposes of determining damages the increased risk of harm proximately caused by the malpractice of the defendant can be valued separately from the harm attributable to any preexistent condition, and holds that such damages should then be apportioned accordingly. This holding not only is instructive in terms of understanding compensatory damages, it also has important implications in terms of potential liability for torts that increase the risk of future harm.
In its treatment of causation, the Court builds on the authority of our decision in Evers v. Dollinger, 95 N.J. 399, 417, 471 A.2d 405 (1989). We there recognized that the increased risk of harm occasioned by a defendant’s malpractice was itself a relevant consideration in determining liability. The Court *115quotes with approval, ante at 104, 574 A.2d at 403, our holding in Evers that a
plaintiff should be permitted to demonstrate, within a reasonable degree of medical probability, that the seven months delay resulting from defendant’s failure to have made an accurate diagnosis and to have rendered proper treatment increased the risk of recurrence or of distant spread of plaintiff’s cancer, and that such increased risk was a substantial factor in producing the condition from which plaintiff currently suffers. [95 N.J. at 417, 471 A.2d 405.]
It also observes:
A clear majority of the courts that have considered proximate causation in the context of harm resulting from both a plaintiff’s preexistent condition, and a defendant’s negligent discharge of a duty related to that condition, have permitted the jury to consider whether defendant’s negligence increased the risk of harm and whether such increased risk was a substantial factor in producing the harm, (citations omitted) [Ante at 104, 574 A.2d at 403.]
The Court takes care to emphasize that its ruling is “limited to that class of cases in which a defendant’s negligence combines with a preexistent condition to cause harm.” Ante at 108, 574 A.2d at 406. It invokes the “substantial factor” test of causation, which calls for a determination “whether deviation, in the context of the preexistent condition, was sufficiently significant in relation to the eventual harm to satisfy the requirement of proximate cause.” Ante at 109, 574 A.2d at 406. This standard is consistent with what we held in Evers v. Dollinger, supra, and with what was implicated in Gaido v. Weiser, 115 N.J. 310, 558 A.2d 845 (1989). The latter case involved a claim relating to a patient suffering from a preexistent condition — he was mentally ill and suicidal — whose death by suicide was allegedly caused in part by the medical malpractice of the defendant. The Court, in affirming the judgment of the Appellate Division, impliedly acknowledged the soundness of the Evers standard of causation in this kind of malpractice case. That standard can be understood to entail the inquiry whether “the increased risk of suicide by [the patient] caused by [the defendant’s] failure to provide adequate medical treatment was itself a substantial factor that contributed to [the patient’s] suicide.” 115 N.J. at 314-15, 558 A.2d 845 (Handler, *116J., concurring). These views conform to and support those now expressed in the Court’s opinion.
In its consideration of compensatory damages, the Court builds on the authority of Fosgate v. Corona, 66 N.J. 268, 330 A.2d 355 (1974). It rules that damages in this kind of case— one involving malpractice that causes an increased risk of harm — should be limited by apportionment. It holds, in effect, that the malpractice defendant can and should be held liable in damages but only for the value of the increased risk of future or eventual harm that can be attributed to the conduct of the defendant; such a defendant should not be liable in damages for the harm itself when this can be attributed to other causes, i.e., a preexistent condition. For this proposition the Court quotes with approval Professor King, “the pre-eminent commentator,” King, Causation Valuation, and Chance in Personal Injury Torts Involving Preexisting Conditions and Future Consequences, 90 Yale L.J. 1353, 1360 (1981), ante at 111, 574 A.2d at 407, and also brings to our attention the cases and commentators that have endorsed “the soundness of the concept that plaintiff’s recovery in Evers-type cases should ordinarily be limited to lost-chance damages.” Ante at 407, 574 A.2d at 112 (citations omitted).
The Court, in its discussion of damages, uses the term “lost-chance damages” — those measured by the “lost chance” to avoid or prevent future harm. This terminology obscures somewhat the fact that the Court’s discussion of damages is equally understandable if it were couched in terms of the increased risk of harm. The opinion, in practical effect, focuses on increased risk as a discrete element of compensatory damages. The reference to “lost chance” to avoid further harm can be understood to embrace the “reduced chance” to avoid such harm. For purposes of apportioning damages, there is no conceptual difference between malpractice that reduces a patient’s chances of averting future harm and malpractice that negates or eliminates such a chance. See ante at 103, 574 A.2d at 403. If we characterize such damages as involving the *117“reduced chance” to avert future harm, then we can more readily see that it is the functional equivalent of the increased risk of future harm.
Thus, to say, as the Court effectively does, that the increased risk of future harm can be valued for purposes of apportioning compensatory damages is to say that such an increased risk can be valued as a discrete or separate element of compensatory damages. This is so whether the determination of damages entails the establishment or the apportionment of damages. It should, analytically, make no difference in terms of the ability to ascribe a value to the increased risk of harm whether that value is used as a subtraction from a greater amount of damages or as an addition to other damages. With respect to either of these determinations or results, the process of valuation is the same.
I have previously questioned the fairness and wisdom of a requirement that future or eventual harm actually be sustained in order to permit a recovery for malpractice that increases the risk of future harm. Ayers v. Jackson Township, 106 N.J. 557, 614-21, 525 A.2d 287 (1987) (Handler, J., concurring in part and dissenting in part); Evers v. Dollinger, supra, 95 N.J. at 421-30, 471 A.2d 405 (Handler, J., concurring). The implications of the Court’s application of Fosgate to this case lead me once again to question the requirement of harm as a precondition to recovery in increased-risk-of-harm cases. Given the Court’s basic conclusion — that damages can be calculated for the increased risk of harm — I find no principled basis for insisting that a plaintiff incurring an increased risk of future harm as a result of medical malpractice, or, indeed, of other kinds of tortious misconduct, see, e.g., Ayers v. Jackson Township, supra, 106 N.J. 557, 525 A.2d 287, can recover only if and when that harm eventually occurs. The occurrence of ultimate harm simply does not bear on whether the chance of avoiding or the risk of incurring that harm can otherwise be demonstrated and valued for purposes of awarding damages.
*118I remain persuaded that the occurrence of ultimate harm should not be a condition precedent to the recovery of compensatory damages. If that chance or risk is demonstrated by evidence grounded in reasonable medical possibility, it should, based on ordinary experience and notions of fairness and sound policy, constitute a sufficient basis for redress. The Court’s logic itself dictates that if it is possible to ascribe a value to the increased risk of future harm, the actual occurrence of that harm ought not be the condition precedent to recovery. To emphasize the point, I repeat what I stated in Ayers v. Jackson Township:
The majority reasons that plaintiffs’ claim is not cognizable in part because the risk of future disease does not rise to the level of “reasonable probability.” See ante [106 N.J.] at 591-599 [525 A.2d 287]. Yet the Court concedes, for the purpose of argument, that the plaintiffs have proven that they have a “significantly ... enhanced risk” of contracting serious diseases. Ante [106 N.J.] at 591 [525 A.2d 287]. It nowhere explains why a risk that generates the “reasonable probability” of future injury can be compensated while one that “significantly enhances” the likelihood of future injury cannot.
I do not criticize the Court for illogic or inconsistency. I stress only that if it is just and fair, and it is, to compensate a victim in one case for an unquantified enhanced risk of future disease, it cannot be right to deny recovery in a second case also involving a claim of unquantified enhanced risk. [106 N.J. at 617, 525 A.2d 287 (Handler, J., concurring in part and dissenting in part).]
I would now add, in light of the Court’s holding that damages attributable to a measurable enhanced risk should be apportioned, that if it is just and fair — and it is — to compensate a victim in one case, where the harm has occurred, for a measurable risk of future harm, then it cannot be right to deny recovery in a second case, where the harm has not yet occurred, that also involves a claim of a measurable risk of future harm.
Moreover, I remain of the view that for purposes of awarding compensatory damages based on the increased risk of future harm caused by the tortious conduct of others, we need not insist on a quantification of the risk of future harm with mathematical exactitude. What should suffice is the reality confirmed by common sense and ordinary experience that a plaintiff has actually incurred the increased risk of future harm. I stressed this, also, in Ayers v. Jackson Township:
*119Allowing recovery for enhanced risk in Evers where the plaintiff suffered subsequent harm cannot be reconciled with the denial of recovery for enhanced risk in the present case. The majority professes to deny compensation because it cannot “measure” or “quantify” the enhanced risk of future injury [to plaintiff’s suffering exposure to toxic chemicals]. The fact that the plaintiffs in the present case have not — yet—suffered extreme symptoms is no justification for denying recovery. As in Evers v. Dollinger, “[t]he Court is ... troubled by a seeming inability to quantify the risk of future cancer. But, adding the incurrence of future harm as a requirement for the recovery for such increased risk does not resolve the dilemma since the risk still remains unquantified.” Id. 95 N.J. at 421, 471 A.2d 405 (Handler, J., concurring). When the Court allowed recovery for enhanced risk in Evers, it did not in the slightest way insist that the risk be quantified. [106 N.J. at 616-17, 525 A.2d 287 (Handler, J., concurring in part and dissenting in part).]
I add these reasons in concurring in the opinion of the Court.
Justice HANDLER concurs in the result.
For Modification, Affirmance and Remandment — Chief Justice WILENTZ and Justices CLIFFORD, HANDLER, POLLOCK, O’HERN, GARIBALDI and STEIN — 7.
Opposed — None.