Court Opinion

ID: 9655179
Source: CourtListenerOpinion
Date Created: 2023-08-23 19:02:09.296725+00
Date Added: 2024-06-11T18:13:16.505990
License: Public Domain

CARTER, Justice.
This is an appeal from the granting of a new trial in a medical malpractice action, which resulted in a substantial verdict for the patient’s personal representative. The plaintiff is Patricia Mead, executor of the estate of Lucille Humpal, deceased. The defendant is Dr. Burton Adrian.1
The grant of a new trial was posited on two grounds: inconsistency in allowing the jury to award both wrongful-death damages and lost-chance damages, and failure to adequately instruct the jury as to the basis for determining lost-chance damages. After reviewing the record and considering the arguments presented, we affirm the judgment of the district court.
In April 1997 Lucille Humpal was seventy-three years old. During the first few weeks of that month, she began to feel weak and eventually became bedridden. By April 20 she was too weak to get out of bed, and an ambulance was summoned to her home. She was delivered to the emergency room of a Waterloo hospital. After a series of tests, she was released.
The results of a blood analysis revealed that Mrs. Humpal’s white blood cell count was 27,000. When that result was shared with her personal physician, Dr. Burton Adrian, he ordered that she be admitted to the hospital as an inpatient. She entered the hospital at 9:30 a.m. on April 21.
At the time of her hospital admission, Mrs. Humpal had a distended abdomen and was complaining of severe lower abdominal pain. Dr. Adrian saw her in the hospital that afternoon. His tentative diagnosis of her condition was an infection of the urinary tract. Because she had indicated to hospital personnel at the time of her admission that she could not recall having any recent bowel movements, Dr. Adrian ordered laxatives and enemas. X-rays taken at this time were inconclusive.
Over the next four days, Mrs. Humpal received five enemas, but they produced no relief from her abdominal pain. Her abdomen continued to be distended and by April 24 had attained the size of a basketball. On April 25 Dr. Adrian suspected diverticulitis. He ordered additional x-rays, which revealed that Mrs. Humpal’s colon had ruptured. Emergency surgery revealed an advanced infection of the area surrounding the ruptured colon. Mrs. Humpal died while the surgery was in progress. It was subsequently determined that she had been suffering from diverticulitis. Her cause of death was determined to be toxicity resulting from a spread of bacteria secondary to a ruptured diverticu-lum. Other facts that bear on the disposition of the appeal will be considered in our discussion of the legal issues presented.
I. The Issues Submitted to the Jury.
In her petition in this action, Mrs. Hum-pal’s personal representative claimed wrongful-death damages based on the alleged negligence of Dr. Adrian. The elements of damage requested in the petition included loss of accumulation to the decedent’s estate, interest on funeral and burial expenses, and physical and mental suffering.2 During the trial, there were amend-*177merits to conform to proof that added claims for predeath loss of full mind and body and lost chance of survival.3 In addition, the personal representatives asked to amend to conform to proof and include claims for loss of services and support recoverable under Iowa Code section 613.15 (2001). That request was denied by the court as untimely.
At the conclusion of plaintiffs evidence, Dr. Adrian moved for a directed verdict. That motion was sustained with respect to the claim for loss of accumulation by the estate on the ground that there was insufficient evidence of such loss. The motion was overruled as to the other items of damage. The items of damage submitted for the jury’s consideration were:
interest on burial expenses
predeath physical and mental pain and suffering
predeath loss of full mind and body
lost chance of survival
As to all of these items of damage, the jury was instructed that to recover the personal representative must prove that the damages claimed were proximately caused by Dr. Adrian’s negligence and the amount of the damages. With respect to the claim for lost chance of survival, the jury was instructed:
Damages recoverable [for this item] are limited to the value of this loss of chance. This is measured by the difference between the chance of survival if treatment had been given at the earlier time, and the chance of survival at the time when treatment was given. Plaintiff may not recover for harm caused by the preexisting condition to which defendant’s negligence did not contribute.
The jury found that the following damages were proximately caused by Dr. Adrian’s negligence:
interest on burial expense $ 3,500
predeath physical and mental pain and suffering $100,000
predeath loss of ful mind and body $ 25,000 lost chance of survival $125,000
TOTAL $253,500
II. The Motion for New Trial.
Following the jury’s verdict, Dr. Adrian filed a motion for new trial in which he urged:
[The court submitted] both the traditional “all or nothing” damages and “lost chance of survival” damages to the jury. Both theories should not have been submitted to the jury. Submittal of both theories was not in accordance with Iowa law and resulted in improper, du-plicative and excessive damages being awarded by the jury under the court’s instructions. Plaintiff was fully compensated by the jury’s award of damages for the traditional elements for wrongful death allowed by Iowa law. Nevertheless, the court’s instructions allowed the jury to award an additional lump sum of $125,000 for the “lost chance of survival.” Since it cannot be determined whether the jury found for plaintiff on the “all or nothing” theory or the “lost chance of survival” theory, a new trial is required.
The district court granted a new trial for the reasons urged in Dr. Adrian’s motion and also for the reason that “the jury was not properly instructed on how to compute those [lost chance of survival] damages.” The grant of a new trial was conditional on Mrs. Humpal’s personal representative not agreeing to a remittitur of $125,000, the amount awarded for lost chance of surviv*178al. The personal representative did not agree to the remittitur.
The personal representative urges that both traditional death damages and lost-chance damages may be submitted to the jury. In addition, she contends that in the present case the recovery for lost-chance damages was not inconsistent with or du-plicative of the other damages awarded. To resolve this contention, we must consider the basis for recovering damages under a theory of lost chance of survival.
This court has considered allowing damages for lost chance of survival on three prior occasions. The case of DeBurkarte v. Louvar, 393 N.W.2d 131 (Iowa 1986), was an action by a plaintiff who was still living and seeking to recover damages for medical malpractice that would shorten her life expectancy. Traditional wrongful-death damages were not an issue because death had not occurred. Although the doctrine of lost chance of survival was discussed and approved in our opinion, there was no issue with regard to damages to be allowed under that theory. The district court’s instructions in that case had limited recovery to past, unreimbursed medical expenses caused by the physician’s negligence and past and future pain and suffering, including mental anguish. Consequently, the damage issue on appeal only concerned a sufficiency of the evidence to support the verdict under those instructions.
In Sanders v. Ghrist, 421 N.W.2d 520 (Iowa 1988), a claim was made that a doctor negligently failed to diagnose and treat a malignant tumor. A traditional wrongful-death recovery was sought against the doctor, and in addition a claim was made for “lost chance to survive the disease.” Sanders, 421 N.W.2d at 521. The trial court submitted the traditional wrongful-death damages to the jury but declined the plaintiffs request to submit a claim for lost chance of survival. In a general verdict, the jury rejected the traditional wrongful-death claim. We held that the jury should have been given the opportunity to consider the alternative claim of lost chance of survival and that the trial court erred in not so instructing the jury. A new trial was ordered on all issues.
In Wendland v. Sparks, 574 N.W.2d 327 (Iowa 1998), a medical malpractice action was based on the failure of a doctor to attempt to resuscitate a patient. Based on deposition testimony by expert witnesses that the patient’s chance of survival was less than probable, the district court granted summary judgment for the defendants. Although lost chance of survival had not been pleaded, it was raised in the personal representative’s resistance to the motion for summary judgment. Among the summary judgment papers was deposition testimony indicating that the decedent had a ten percent chance of survival if resuscitation had been undertaken. We concluded that this was sufficient to permit a trier of fact to find that the decedent had sustained a loss for which damages could be awarded.
As developed in our case law, the last-chance-of-survival doctrine is not an alteration of the traditional rules for determining proximate cause, but, rather, the creation of a newly recognized compensable event to which those traditional rules apply. It is manifest from the Sanders and Wendland decisions that a personal representative may recover damages for a lost chance of survival as an alternative to a traditional wrongful-death recovery. Recovery in such instances is for the lost chance of survival “evaluated independently.” Wendland, 574 N.W.2d at 331. We have recognized in a medical malpractice case in which death could be attributed to a preexisting condition that the amount of *179the damages for lost chance of survival is “the percent of lost chance attributed to the intervening act of negligence.” Id. This is consistent with our general rule limiting the defendant’s liability to compensation for injuries “caused by his own acts of negligence and not for injury, suffering or impaired health due to other causes.” Becker v. D & E Distrib. Co., 247 N.W.2d 727, 730 (Iowa 1976). This appears to be the general rule for valuing lost chance of survival. See Todd S. Aagaard, Identifying and Valuing the Injury in Lost Chance Cases, 96 Mich. L.Rev. 1335, 1349 (1998) (collecting cases). It means that a decedent with a ten percent chance of survival is entitled to recover ten percent of the amount of damages that could have been awarded if the defendant’s negligence had proximately caused the death.
In the application of these principles, it is important to identify the damages that are to be proportionately reduced to arrive at an award for lost chance of survival. Logically, this should be the amount of damages attributable to the death as such and should not include pre-death elements of recovery such as pain and suffering, loss of full mind and body, and increased medical expenses.4 We have recognized damages attributable to the death as such include:
1. The present worth or value of the estate, which the decedent would reasonably be expected to have accumulated between the time of death and the end of the decedent’s natural life expectancy.
2. An award of interest on the reasonable funeral expenses of decedent for the length of time that they were prematurely incurred not to exceed the reasonable costs of a funeral for a person of decedent’s social and financial standing.
3.The value of services and support recoverable by a designated beneficiary under Iowa Code section 613.15.
Schmitt v. Jenkins Truck Lines, Inc., 170 N.W.2d 632, 661 (Iowa 1969). One seeking to recover these damages may also recover predeath damages under our survival statute, see Fitzgerald v. Hale, 247 Iowa 1194, 1198, 78 N.W.2d 509, 511 (1956), but those damages are not attributable to a decedent’s death because they may be recovered in instances where death has not occurred.
Predeath injuries, if proximately caused by the defendant’s negligence, are recoverable in full. They may be recovered in addition to the amount awarded for lost chance of survival. See David A. Fischer, Tort Recovery for Loss of a Chance, 36 Wake Forest L.Rev. 605, 620-21 (2001) (“The most accurate method of valuing damages [for lost chance of survival] is to award proportional compensation for damages, such as lost earnings, that should be reduced and to award full recovery for damages, such as extra medical expenses, that should not be reduced.”). Although such damages may be challenged based on insufficient proof, they are recoverable to the full extent that the evidence supports the jury’s award. In the present case, Mrs. Humpal’s preexisting condition may have made it difficult to separate the amount of the predeath damages that were caused by Dr. Adrian’s negligence from those that flowed from the preexisting condition. Nevertheless, there was evidence *180from which the jury could make that separation. It acted under instructions limiting recovery to only those damages that were proximately caused by the defendant’s negligence. We must assume that it did this. Consequently, there is no basis for reducing this portion of the recovery under the proportional-reduction analysis that applies to damages awarded for lost chance.
The Sanders case is similar to the present case in that it involved alternative claims for traditional wrongful-death damages. Implicit in the reversal and remand that was ordered was a recognition that such claims may be asserted in the alternative. We are convinced that this should be allowed because a trier of fact might fail to find on the evidence that a negligent act was a proximate cause of a patient’s death yet believe that the negligence deprived the patient of a chance to survive. However, if both a traditional wrongful-death claim and a lost-chanee-of-survival claim are submitted, the proportionally reduced recovery for lost chance would be included within and duplicated by an award of traditional wrongful-death damages.
In the present case, the district court found that the proof of medical causation was sufficient to submit an ordinary wrongful-death claim to the jury. At the request of the personal representative, it also submitted a claim for lost chance of survival.5 The ordinary wrongful-death claim was severely limited because the court ruled that there was no evidentiary support for a loss of accumulation to the estate. It also ruled that the claims for loss of services and support had not been timely asserted.
The only element of an ordinary wrongful-death recovery submitted to the jury was interest on burial expenses. Although the recovery allowed for that item was small when compared to the rest of the verdict, we believe it was nevertheless improper to allow an award for lost chance of survival when the jury found from the evidence that ordinary wrongful-death damages were proximately caused by the defendant’s negligence. The nature of a claim for lost chance of survival is such that it must be proportionally less than a recovery for traditional wrongful-death damages for the same decedent in the same case. Consequently, the trial court was correct in sustaining Dr. Adrian’s motion for a new trial.
III. The Remittitur Issue.
Dr. Adrian has attempted to appeal from that portion of the district court’s order conditioning the grant of a new trial on the refusal of the personal representative to accept a reduced award. There is no legal basis for pursuing such an appeal. Once the personal representative appealed the district court’s order for a new trial, the conditional feature of that order became of no force and effect. Iowa R. Civ. P. 1.1010(3). Notwithstanding rule 1.1010(3), this court is free to impose its own conditions for sustaining the district court’s grant of a new trial. Larsen v. United Fed. Sav. & Loan Ass’n, 300 *181N.W.2d 281, 289 (Iowa 1981); Miller v. Young, 168 N.W.2d 45, 58 (Iowa 1969). In considering whether to do that, we give deference to Dr. Adrian’s arguments in his purported cross-appeal, but believe that this is clearly a case calling for a conditional new trial.
The damages were itemized by the jury. The only element of damage challenged as improper in the motion for new trial was the award for lost chance of survival. The personal representative should be allowed to avoid a new trial by agreeing to delete that award in the sum of $125,000 from the total damages awarded. In the event that reduction is agreed to, interest on the remaining award shall be computed as provided in the original judgment. The election to accept the remittitur must be made within thirty days of the filing of the pro-cedendo in the district court.
We have considered all issues presented and conclude that the judgment of the district court should be affirmed. A conditional new trial is awarded and the case remanded to the district court for further proceedings consistent with this opinion.
AFFIRMED AND REMANDED.
All justices concur except CADY, J., who concurs specially, and LAVORATO, C.J., and TERNUS, J., who take no part.

. Dr. Adrian’s employer, Iowa Physician’s Clinic Medical Foundation d/b/a Integra Health, is also a defendant on a respondeat superior theory, but our opinion will proceed as if Dr. Adrian was the sole defendant.

. Claims were also included for medical expenses, but the personal representative made no attempt to have the court submit those claims to the jury.

. In Wendland v. Sparks, 574 N.W.2d 327, 329 (Iowa 1998), we held that it is not necessary to plead a theory of lost chance of survival in order to avail a party of that claim.

. Some confusion on this issue has resulted from the statement in DeBurkarte that "the better approach is to allow recovery, but only for the lost chance of survival.” DeBurkarte, 393 N.W.2d at 137. Dr. Adrian urges that the quoted language means that, when lost-chance-of-survival damages are awarded, no other damages, including predeath damages, are recoverable. We do not find this to be the intent of the quoted language.

. Dr. Adrian argued to the district court that in order to sustain a recovery for lost chance of survival there must be expert testimony concerning the probability of survival expressed as a percentage. We believe that when the claim is submitted as an alternative to ordinary wrongful-death damages it is unrealistic to require a claimant who is arguing that it is more probable than not that death resulted from the defendant’s negligence to also present evidence that the probability of survival was in fact some lesser percentage. The jury must determine the amount of proportionate reduction based on all of the evidence in the case.