Court Opinion

ID: 9930583
Source: CourtListenerOpinion
Date Created: 2024-02-07 13:01:54.416587+00
Date Added: 2024-06-11T11:17:21.018857
License: Public Domain

***********************************************
    The “officially released” date that appears near the be-
ginning of each opinion is the date the opinion will be pub-
lished in the Connecticut Law Journal or the date it was
released as a slip opinion. The operative date for the be-
ginning of all time periods for filing postopinion motions
and petitions for certification is the “officially released”
date appearing in the opinion.

   All opinions are subject to modification and technical
correction prior to official publication in the Connecticut
Reports and Connecticut Appellate Reports. In the event of
discrepancies between the advance release version of an
opinion and the latest version appearing in the Connecticut
Law Journal and subsequently in the Connecticut Reports
or Connecticut Appellate Reports, the latest version is to
be considered authoritative.

   The syllabus and procedural history accompanying the
opinion as it appears in the Connecticut Law Journal and
bound volumes of official reports are copyrighted by the
Secretary of the State, State of Connecticut, and may not
be reproduced and distributed without the express written
permission of the Commission on Official Legal Publica-
tions, Judicial Branch, State of Connecticut.
***********************************************
            AARON LYNCH ET AL. v. STATE OF
                CONNECTICUT ET AL.
                     (SC 20646)
                  Robinson, C. J., and McDonald, D’Auria,
                    Mullins, Ecker and Alexander, Js.

                                   Syllabus

The plaintiffs, L and M, individually and in their representative capacities
   as parents of their minor son, J, and as the administrators of the estate
   of their daughter, S, sought to recover damages for the alleged medical
   malpractice of the named defendant, the state of Connecticut, in connec-
   tion with certain therapeutic donor insemination (TDI) services and
   prenatal care provided to them at a state hospital. Prior to the plaintiffs’
   initial visit, hospital staff sent them a patient information packet that
   included general information about TDI risks, approved sperm banks,
   and testing that TDI patients are required to undergo, including testing
   for cytomegalovirus (CMV). Because of the risks to fetal health associ-
   ated with a mother’s initial exposure to CMV in early pregnancy, it was
   necessary for the hospital to determine both M’s and the sperm donor’s
   CMV status. The patient information packet also stated, in accordance
   with accepted professional guidelines, that, if a patient tests negative
   for CMV, only CMV negative donor sperm should be used. Thereafter,
   M, who had tested negative for CMV, underwent a successful intrauterine
   insemination procedure using sperm from a CMV positive donor and
   became pregnant with J and S. The physician who performed the proce-
   dure did not check the donor’s CMV status and allegedly did not seek
   or obtain M’s informed consent for the procedure. Throughout her preg-
   nancy, M received care from the hospital’s prenatal care staff. When M
   was twenty-two weeks pregnant, she underwent an ultrasound that
   revealed that J and S displayed conditions associated with an in utero
   CMV infection. M’s prenatal care physician did not perform any follow-
   up tests to rule out a CMV infection, inform M of the ultrasound results,
   or include a copy of those results in M’s medical records. Subsequently,
   it was discovered that S had died in utero from a severe CMV infection,
   and J was born with debilitating, lifelong medical conditions as a result
   of congenital CMV. Thereafter, pursuant to statute ((Rev. to 2015) § 4-160
   (b)), the plaintiffs filed a notice of claim with the Claims Commissioner,
   seeking permission to bring an action against the state for medical
   malpractice arising out of the fertility treatment and prenatal care M
   had received at the state hospital. Although the notice of claim stated
   that a good faith certificate, as required by statute (§ 52-190a), was
   attached thereto, the plaintiffs inadvertently failed to attach it. The
   plaintiffs did, however, attach a physician’s statement that set forth the
   physician’s reasons for concluding that the standard of care relating to
   the fertility treatment claims had been breached and stated that it was
   offered in support of the plaintiffs’ good faith certificate, as required
   by § 52-190a. The Claims Commissioner found that the requirements of
   § 4-160 (b) had been met and granted the plaintiffs permission to bring
   an action against the state, limited to the portion of the claim alleging
   medical malpractice. In the counts of their complaint setting forth claims
   related to M’s fertility treatment, the plaintiffs alleged, inter alia, that
   the hospital staff had committed medical malpractice by inseminating
   M, a CMV negative patient, with sperm from a CMV positive donor,
   causing S’s death and J’s severe injuries. In the counts setting forth
   claims related to M’s prenatal care, the plaintiffs alleged, inter alia, that
   the hospital’s prenatal care staff had been negligent in failing to properly
   interpret and respond to the ultrasound images indicating that M, J, and
   S were infected with CMV. The plaintiffs attached to their complaint a
   certificate of good faith and two opinion letters from similar health care
   providers, including a copy of the physician’s statement that the plaintiffs
   had attached to their notice of claim. The state moved to strike the
   fertility treatment claims brought on behalf of S and J, and the prenatal
   care claim brought on behalf of J, on the ground that they were wrongful
   life claims, which the state claimed were not legally cognizable in Con-
    necticut. The trial court struck the prenatal care claim but denied the
    motion to strike as to the fertility treatment claims, concluding that they
    were ordinary medical malpractice claims. Prior to trial, the plaintiffs
    disclosed that their causation expert, E, would testify that, to a reason-
    able degree of medical probability, the use of sperm from a CMV positive
    donor to inseminate M caused the CMV infection that resulted in S’s
    death and J’s severe injuries. The state moved, pursuant to State v.
    Porter (241 Conn. 57), to preclude E’s testimony on the ground that it
    lacked a valid scientific basis, but the trial court ultimately ruled that
    E’s testimony satisfied the admissibility requirements of Porter and
    credited that testimony in concluding that the donor sperm more likely
    than not caused the CMV infection in M, J, and S. Following the plaintiffs’
    case-in-chief, the state moved to dismiss the plaintiffs’ fertility treatment
    claims, contending that they sounded in informed consent rather than
    in medical malpractice and, therefore, did not fall within the scope of
    the waiver of sovereign immunity insofar as § 4-160 (b) applies only to
    medical malpractice claims. The trial court denied the motion to dismiss,
    concluding that the plaintiffs’ fertility treatment claims were hybrid
    claims because, in the field of reproductive endocrinology, it is medical
    malpractice to inseminate a CMV negative patient with CMV positive
    donor sperm except when the patient is appropriately counseled as to
    the risks and gives her informed consent. The trial court ultimately
    found in favor of the plaintiffs on thirteen counts and awarded them
    economic and noneconomic damages. On the state’s appeal from the
    trial court’s judgment, held:

1. The state could not prevail on its claim that the judgment should be set
    aside on the ground that the claims on which the plaintiffs prevailed at
    trial were barred by sovereign immunity:

   a. There was no merit to the state’s contention that the plaintiffs’ fertility
   treatment claims were outside the scope of the action authorized by the
   Claims Commissioner’s waiver of sovereign immunity because they were
   informed consent claims, not medical malpractice claims based on the
   failure of a physician to comply with the standard of care established
   through expert testimony at trial:

   When permission to sue the state is granted pursuant to § 4-160 (b),
   it applies to medical malpractice claims only, and, although medical
   malpractice and lack of informed consent are distinct causes of action,
   they are not mutually exclusive, and the same set of facts can give rise
   to both types of claims.

   Upon reviewing the allegations in the complaint related to the plaintiffs’
   fertility treatment claims, this court concluded that they were clearly
   allegations of medical malpractice.

   Moreover, it was of no consequence that both parties’ experts testified
   that a CMV negative patient could elect to be inseminated with sperm
   from a CMV positive donor, as the trial court repeatedly observed that
   insemination of a CMV negative patient with CMV positive donor sperm
   is only within the standard of care if the patient consents after she is
   appropriately informed of the risk of congenital CMV, and it was testi-
   mony regarding the standard of care in the absence of informed consent
   that led the trial court to conclude that the fertility treatment claims
   were medical malpractice claims within the scope of the Claims Commis-
   sioner’s waiver of sovereign immunity.

   b. There was no merit to the state’s arguments that the waiver of sovereign
   immunity was invalid due to the plaintiffs’ failure to submit to the Claims
   Commissioner a physician’s opinion letter specifically addressing the
   prenatal care claims and a certificate of good faith in accordance with
   § 52-190a, as required by § 4-160 (b):

   It was clear from the record that the Claims Commissioner reviewed
   the plaintiffs’ notice of claim and the physician’s statement, and con-
   cluded that, together, they satisfied the good faith certificate requirement
   of § 52-190a.

   To the extent that the state disputed the applicability of § 4-160 (b)
   because of alleged defects or shortcomings in the plaintiffs’ good faith
   certificate, it was incumbent on the state to raise that issue with the
   Claims Commissioner while the matter was still under his review, as the
   state was precluded from doing so once the Claims Commissioner had
   authorized the plaintiffs’ action by virtue of § 4-160 (c), which provides
   that the state waives all defenses related to the governmental nature of
   the complained of activity once the Claim Commissioner authorizes suit
   pursuant to § 4-160 (b).

   Moreover, the state did not claim that the plaintiffs failed to submit to
   the trial court a certificate of good faith and an opinion letter from a
   similar health care provider addressing both their fertility treatment
   claims and their prenatal care claims or that the opinion letters and
   good faith certificate that they had filed with the court were in any
   way deficient.

2. The state could not prevail on its claim that J was not entitled to recover
    any damages based on the fertility treatment claims brought by the
    plaintiffs on his behalf because he did not suffer any legally cognizable
    injuries, this court having concluded that common-law negligence princi-
    ples were sufficiently adaptable to provide a remedy for injuries such
    as those sustained by J, without disturbing the fundamental rules govern-
    ing tort liability and compensation:

   a. The fertility treatment claims brought by the plaintiffs on J’s behalf
   were properly construed and adjudicated as conventional medical mal-
   practice claims and not, as the state contended, as wrongful life claims:

   The term ‘‘wrongful life’’ refers to a claim, brought by a child, based on the
   theory that that child would not have been born but for the defendant’s
   negligence, and those cases generally involve plaintiffs seeking to hold
   medical professionals responsible for failing to prevent a birth that would
   have occurred regardless of medical intervention, such as when a child
   with a congenital abnormality is born to a mother who would not have
   proceeded with the pregnancy if she had received timely notice of the
   condition, or when a medical professional fails to prevent an unwanted
   pregnancy by negligently performing a birth control or abortion pro-
   cedure.

   The present case differed in fundamental ways from those paradigmatic
   wrongful life cases because the state was directly responsible both for
   J’s birth and for his condition, insofar as the hospital staff created the
   pregnancy, and it was their negligence in doing so that was the proximate
   cause of J’s injuries.

   Moreover, in most wrongful life cases, but for the defendant’s negligence,
   there never could have been a healthy child, whereas, in the present case,
   the plaintiffs presented undisputed testimony that antiviral medications
   were available that had been used to prevent CMV or to treat the disease
   in utero after infection.

   Furthermore, because the plaintiffs consistently represented that the
   fertility treatment claims were medical malpractice claims and not wrong-
   ful life claims, and the trial court understood and evaluated them as
   medical malpractice claims, the most prudent course was to evaluate
   the claims as articulated by the plaintiffs and to let them rise or fall
   on the plaintiffs’ ability to establish a valid medical malpractice cause
   of action.

   b. There was no merit to the state’s contention that the plaintiffs had
   failed to establish a valid, conventional medical malpractice claim with
   respect to J’s injuries:

   The state’s arguments that any damages awarded to J would be unavoid-
   ably speculative and predicated on the impermissible concept that
   nonexistence can be preferable to impaired existence were unavailing,
   as this court previously had rejected versions of those arguments when
   it recognized a cause of action for wrongful birth in Och v. Borrelli (187
   Conn. 253).

   Moreover, this court rejected the state’s argument that the standard
   formula for calculating damages in tort, namely, making the plaintiff
   whole by returning him to the position he would have been in but for
   the defendant’s negligence, precluded any recovery in this case insofar
   as J arguably would not have existed but for the state’s conduct, as such
   a rigid conception of tort damages left no room for the substantial
   technological advancements that have occurred in the field of assisted
   reproductive technologies.
   This court reviewed the state’s challenge to the trial court’s damages
   award in the light of the underlying purposes and principles that inform
   tort law, namely, compensation for innocent parties, shifting the loss to
   responsible parties or distributing it among appropriate entities, and
   deterrence of wrongful conduct.

   In the present case, all of those considerations weighed in favor of
   holding the state liable for the full amount of J’s economic and noneco-
   nomic damages proximately caused by the state’s negligence, as J was
   an innocent victim whose serious injuries were caused by the state’s
   failure to adhere to the applicable standard of care, the state was the
   party best equipped to avoid such mishaps and best positioned to absorb
   and spread the costs of J’s lifelong care, and, if this court were to deny
   recover to children who, like J, were injured by the negligent provision
   of assisted reproductive technologies, there would be little to deter the
   state or other providers of artificial insemination services from such
   negligence and its consequences.

   Accordingly, because the trial court found, on the basis of abundant
   evidence, that J suffered economic and noneconomic harms, losses, and
   injuries as a result of the state’s negligence, he was no less entitled to
   be compensated financially for those damages than are other victims
   of medical malpractice, the trial court’s award of damages was fully
   commensurate with the injuries that J suffered, and it restored J as
   nearly as possible to the position that he had occupied before the state’s
   negligence, which was consistent with the underlying goals and purposes
   of tort law.

3. The trial court did not abuse its discretion in admitting E’s expert testimony
    regarding causation under Porter:

   The methodologies underlying E’s causation testimony, namely, differen-
   tial diagnosis and polymerase chain reaction testing, are two of the most
   common and accepted methods for diagnosing disease, and, as such,
   are among the well established principles of the scientific community
   to which Porter does not apply.

   Moreover, contrary to the state’s argument that E’s testimony should
   have been excluded because it was based on a series of factual assump-
   tions that lacked a reliable scientific and factual basis, namely, that the
   CMV positive sperm donor was shedding the infectious virus into his
   sperm when he donated it, the state’s argument went to the weight of
   E’s testimony, not to its admissibility.
      Argued February 22, 2023—officially released February 6, 2024

                             Procedural History

   Action to recover damages for the alleged medical
malpractice of the named defendant et al., and for other
relief, brought to the Superior Court in the judicial dis-
trict of Hartford, where the action was withdrawn as
against the defendant Claudio Benadiva et al.; there-
after, the court, Cobb, J., granted in part the named
defendant’s motion to strike; subsequently, the court,
M. Taylor, J., denied the named defendant’s motion to
preclude certain evidence; thereafter, the case was tried
to the court, M. Taylor, J.; subsequently, the court, M.
Taylor, J., denied the named defendant’s motion to
dismiss and rendered judgment in part for the plaintiffs,
from which the named defendant appealed. Affirmed.
  Jeffrey R. Babbin, with whom was Michael G. Rigg,
for the appellant (named defendant).
  James J. Healy, with whom were Karolina A. Dowd,
Caitlyn S. Malcynsky and, on the brief, Michael J.
Walsh, for the appellees (plaintiffs).
                          Opinion

   ALEXANDER, J. In this medical malpractice action
arising from a therapeutic donor insemination (TDI)
procedure, the named defendant, the state of Connecti-
cut (state),1 appeals from the judgment of the trial court
rendered in favor of the plaintiffs, Aaron Lynch (Aaron)
and Jean-Marie Monroe-Lynch (Jean-Marie), individu-
ally and in their representative capacities as parents of
their minor son, Joshua Isaac Monroe-Lynch (Joshua),
and as the administrators of the estate of Shay Ashlan
Monroe-Lynch (Shay). On appeal, the state contends
that (1) the claims on which the plaintiffs prevailed at
trial were barred by sovereign immunity, (2) Joshua
and Shay did not suffer legally cognizable injuries neces-
sary to support the trial court’s award of damages, and
(3) the testimony of the plaintiffs’ primary causation
expert was improperly admitted because it was not
supported by a valid scientific methodology. The plain-
tiffs ask this court to resolve a split among Superior
Court decisions and to recognize a cause of action for
wrongful life. We conclude that it is unnecessary to
reach the wrongful life issue and, finding no error,
affirm the trial court’s judgment.
   The trial court’s comprehensive memorandum of
decision sets forth the following relevant facts and pro-
cedural history. Jean-Marie and Aaron are a married
couple who wanted to have children but were unable
to conceive without medical assistance. In the summer
of 2013, the couple sought TDI services at the Center
for Advanced Reproductive Services (CARS) at the Uni-
versity of Connecticut Health Center (UConn). Prior to
their initial visit, CARS sent them a TDI patient informa-
tion packet, which included general information about
TDI risks and CARS approved sperm banks. The packet
also included information about testing that TDI patients
are required to undergo, including testing for cytomega-
lovirus (CMV), a type of herpes virus that has infected
considerably more than 50 percent of the general popu-
lation.
   A blood test can reveal whether an individual has
ever been infected with CMV. The presence of immuno-
globulin M (IgM) antibodies is associated with an initial
CMV infection. Generally, IgM antibodies remain in the
blood for approximately six to nine months after infec-
tion, decreasing over time until they are no longer
detectable. As the IgM antibodies decrease, they are
replaced by immunoglobulin G (IgG) antibodies, which
typically increase over time and stay in the body for
the remainder of the person’s life. A person who tests
positive for IgG antibodies will not be continuously
infectious but nonetheless will periodically shed ‘‘live,’’
infectious virus through bodily fluids, including urine
and seminal fluid. For most adults, symptoms of a CMV
infection are mild. An initial infection during early preg-
nancy, however, can result in profound health complica-
tions for the developing fetus.
   In light of the risks to fetal health associated with a
mother’s initial exposure to CMV in early pregnancy, it
is necessary for those providing TDI services to deter-
mine whether both the patient and the prospective
sperm donor have ever been infected with CMV.
Although semen collected at sperm banks is subjected
to a process known as ‘‘washing’’ to remove CMV and
other pathogens,2 there is no way of ensuring that all
infectious agents, including CMV, are completely
removed from the sperm and will not be introduced
during a TDI procedure. The patient information packet
that CARS sent to Jean-Marie stated that, ‘‘[i]f you have
never been exposed to CMV, your test will come back
negative, and then, you may only choose a CMV nega-
tive donor.’’ (Emphasis added.) This restriction accords
with the guidelines of the American Society for Repro-
ductive Medicine (ASRM), the leading professional
organization in reproductive medicine, which recom-
mends that CMV positive donor sperm be used only for
patients who are also CMV positive.3 Federal regula-
tions require sperm banks to notify fertility clinics of
a sperm donor’s CMV status with each sperm shipment.
See 21 C.F.R. § 1271.370 (2022).
  At the commencement of her TDI treatment, in Sep-
tember, 2013, Jean-Marie tested negative for both IgM
and IgG antibodies. On May 11, 2014, Jean-Marie under-
went a successful intrauterine insemination (IUI) proce-
dure using sperm from CMV positive donor No. 013673
and became pregnant with twins. Claudio Benadiva, the
physician who performed the IUI procedure on Jean-
Marie, did not check the CMV status of donor No. 013673
prior to using the sperm.4 As a result, Benadiva was
unaware that he was inseminating a CMV negative patient
with sperm from a CMV positive donor.5 Because he
was unaware, he did not seek or obtain Jean-Marie’s
informed consent for the procedure.
  Although some organizations proscribe any insemi-
nation of CMV negative patients with sperm from CMV
positive donors, the trial court found that the standard
of care may permit such inseminations, but only if the
patient is appropriately counseled as to the risks of
congenital CMV and gives her full, informed consent.
Such counseling must include a discussion of the ‘‘dev-
astating neurological and cognitive outcomes’’ associ-
ated with a congenital CMV infection in utero.
  Throughout her pregnancy, Jean-Marie received pre-
natal care from both a maternal fetal medicine team
and an obstetrics and gynecology team at UConn (pre-
natal care providers). In June, 2014, when she was
approximately five weeks pregnant, Jean-Marie pre-
sented at the emergency department of the Hospital of
Central Connecticut in New Britain complaining of a
rash of unknown origin and respiratory issues. The next
day, she went to UConn’s emergency department com-
plaining of a persistent rash on her abdomen and facial
swelling, symptoms that are consistent with an acute
CMV infection. CARS was informed of these symptoms,
and they were recorded in her medical chart.
   Jean-Marie was classified as having a high-risk preg-
nancy, and she was scheduled for regular ultrasounds
to closely monitor her progression. In October, 2014,
when she was twenty-two weeks pregnant, Jean-Marie
underwent an ultrasound that revealed that the twins
both had small heads and hyperechoic bowels—condi-
tions associated with an in utero CMV infection. Not-
withstanding these ultrasound findings and in violation
of the standard of care, Jean-Marie’s maternal fetal med-
icine physician, Garry Turner, did not perform any serol-
ogy tests, amniocentesis, or other follow-up steps to
rule out a CMV infection; nor did he inform Jean-Marie
about these findings. Compounding these errors, a copy
of the abnormal ultrasound result was not included in
Jean-Marie’s medical record, which led to an additional
failure to diagnose her and the twins with CMV.
   In January, 2015, Jean-Marie, who was then thirty-
seven weeks pregnant, went to UConn for a regularly
scheduled nonstress test. During the visit, she was
informed that one of the twins, Shay, had died in utero.
A cesarean section was immediately performed to
deliver both twins. At the time of delivery, Jean-Marie
had an IgM antibody level of 51.5, which is consistent
with a current or recent CMV infection. Shay’s autopsy
revealed that she had died from a severe CMV infection.
Joshua was born with severe health complications as
a result of his own congenital CMV. Specifically, Joshua
is unable to eat, communicate, or attend to any of his
personal needs in a normal or independent manner. For
the rest of his life, he will have to be fed through a
gastrostomy tube. In addition, he suffers from global
developmental delay and cognitive, hearing, and motor
deficits, including related diagnoses of epilepsy, autism,
and cerebral palsy. Joshua will require constant ser-
vices and care for the remainder of his life, including
physical and occupational therapies and a home health
aide.
   Pursuant to General Statutes (Rev. to 2015) § 4-160
(b),6 Jean-Marie and Aaron sought permission from the
Claims Commissioner to sue the state for medical mal-
practice, both individually and in their representative
capacities as Joshua’s parents and as the administrators
of Shay’s estate. Their notice of claim stated that the
injuries arose out of the fertility treatments and prenatal
care Jean-Marie had received from UConn medical pro-
viders. A physician’s statement was included with the
notice of claim, describing the physician’s reasons for
concluding that the standard of care relating to the
plaintiffs’ fertility treatment claims had been breached.
After reviewing the plaintiffs’ claims, the Claims Com-
missioner found that the requirements of § 4-160 (b)
had been met and granted the plaintiffs’ request for
permission to sue the state for medical malpractice.
   The plaintiffs subsequently commenced this action.
Counts one through ten of the plaintiffs’ revised com-
plaint alleged that CARS staff committed medical mal-
practice by inseminating Jean-Marie, a CMV negative
patient, with sperm from a CMV positive donor, causing
Shay’s death and Joshua’s debilitating injuries (fertility
treatment claims). Counts eleven through seventeen
alleged that Jean-Marie’s prenatal care providers were
negligent in failing to properly interpret and respond
to the October, 2014 ultrasound images indicating that
Jean-Marie, Joshua, and Shay were infected with CMV
(prenatal care claims). The prenatal care claims further
alleged that, as a result of the prenatal care providers’
negligence, ‘‘Aaron . . . and Jean-Marie . . . were
not advised that [the twins] had developed congenital
CMV, and were not counseled with respect to the treat-
ment options available to them and the recommended
treatment plan, which would have included a recom-
mendation that the pregnancy be terminated in view of
the significant risks associated with congenital CMV.’’
   The state moved to strike the fertility treatment
claims brought on behalf of Joshua and Shay (counts
one and two) and the prenatal care claim brought on
behalf of Joshua (count eleven) on the ground that they
were ‘‘wrongful life’’ claims, which it claimed were not
legally cognizable in Connecticut. The trial court granted
the motion to strike only as to count eleven. The court
explained that a wrongful life action differs from an
ordinary medical malpractice action in that the com-
plaint does not allege that the physician’s negligence
caused the child’s abnormality but, rather, that the phy-
sician’s failure to timely diagnose the abnormal condi-
tion prevented the mother from making the choice to
terminate her pregnancy. In granting the motion to
strike as to count eleven, the court observed that most
courts that have considered the issue have declined to
recognize wrongful life as a cause of action due to
the difficulty of calculating damages, which requires a
comparison between life in the child’s impaired state
and no life at all.
   The trial court denied the motion to strike as to
counts one and two, however, concluding that they
were ordinary medical malpractice claims in that they
alleged that the negligence of CARS staff, in using sperm
from a CMV positive donor to inseminate Jean-Marie,
‘‘caused . . . Joshua [to sustain] severe life-lasting
injuries and . . . Shay’s death.’’ In reaching its deci-
sion, the court observed that ‘‘[n]owhere in these counts
do the plaintiffs assert that the [state] negligently failed
to diagnose the CMV infections in sufficient time to
allow the [plaintiffs] the ability to terminate the preg-
nancy,’’ the touchstone of a wrongful life claim.
  The case proceeded to a bench trial before the trial
court, which found in favor of the plaintiffs on thirteen
of the remaining sixteen counts7 and awarded them
$36,621,026.53 in economic and noneconomic damages.
That sum was later reduced to $34,619,799.22 following
a collateral source reduction hearing.8 The state there-
after appealed to the Appellate Court, and we trans-
ferred the appeal to this court pursuant to General
Statutes § 51-199 (c) and Practice Book § 65-1. Addi-
tional facts and procedural history will be set forth
as necessary.
                             I
   We first address the state’s contention that the judg-
ment should be set aside because the claims on which
the plaintiffs prevailed at trial were barred by sovereign
immunity. The state argues that the waiver of sovereign
immunity obtained from the Claims Commissioner
authorized the plaintiffs to bring a medical malpractice
action only, but the trial court upheld the fertility treat-
ment claims on the basis of a theory of informed con-
sent, which is a separate and distinct cause of action.
According to the state, permission to sue for lack of
informed consent could be obtained only from the
Claims Commissioner pursuant to § 4-160 (a),9 not § 4-
160 (b), which applies to medical malpractice claims.
The state further argues that the physician’s statement
that accompanied the plaintiffs’ notice of claim did not
specifically address the prenatal care claims, and, as a
result, there was no waiver of sovereign immunity as
to those claims. Finally, the state argues that the waiver
of sovereign immunity failed as to both the fertility
treatment claims and the prenatal care claims because
the plaintiffs did not submit a certificate of good faith
pursuant to General Statutes § 52-190a (a)10 with their
notice of claim.
   The plaintiffs respond that the present case was a
medical malpractice action ‘‘from start to finish.’’ They
contend that, although medical malpractice and lack of
informed consent are distinct causes of action, they are
not mutually exclusive, and it is well established that
the same set of facts can give rise to both types of
claims. The plaintiffs further contend that the state is
precluded from challenging the court’s jurisdiction on
the basis of alleged defects in the certificate of good
faith by operation of § 4-160 (c), which provides that,
once the Claims Commissioner authorizes suit pursuant
to § 4-160 (b), the state waives all defenses related to
the governmental nature of the complained of activity.
We agree with the plaintiffs.
   In May, 2015, the plaintiffs filed a timely notice of
claim with the Claims Commissioner, requesting per-
mission to bring a medical malpractice action against
the state arising out of the events in question. Although
the notice of claim concluded by stating that ‘‘[a] [g]ood
[f]aith [c]ertificate, pursuant to . . . § 52-190a, is
attached [hereto] and is fully incorporated herein by
reference,’’ it appears that the certificate itself was inad-
vertently omitted. The notice of claim was, however,
accompanied by a physician’s statement that was
offered ‘‘to support the plaintiffs’ certificate of prior
reasonable inquiry and good faith, as required by . . .
§ 52-190a.’’
   Six months after the plaintiffs filed their notice of
claim, the state notified the Claims Commissioner that
it had ‘‘no objection to permission to sue being granted’’
and that it was withdrawing its notice of intent ‘‘to
[c]ontest [j]urisdiction or [o]therwise [d]ispute the
[a]pplicability of [§] 4-160 (b) . . . .’’ In January, 2016,
the Claims Commissioner issued a decision granting
the plaintiffs permission to sue the state for medical
malpractice. The decision stated in relevant part: ‘‘The
[c]laimant has filed a [c]ertificate of [g]ood [f]aith and
the [state] has not filed a position or other motion
challenging the jurisdiction of the Claims Commis-
sioner. The [c]laimant is hereby granted permission to
sue the state as the . . . the requirements of [§] 4-160
(b) . . . have been met. This grant of permission to
sue is limited to that portion of the ‘claim alleging mal-
practice against the state, a state hospital or . . .
against a physician, surgeon . . . or [any] other
licensed health care providers employed by the state.’ ’’
   In April, 2016, the plaintiffs commenced this action.
Attached to the complaint was a certificate of good
faith11 and two opinion letters from similar health care
providers. The first opinion letter was a copy of the
physician’s statement that the plaintiffs had attached
to their notice of claim. The second opinion letter was
written by a physician specializing in the field of obstet-
rics and gynecology, and addressed the plaintiffs’ prena-
tal care claims.12
   The case proceeded to trial in November, 2020. When
the plaintiffs finished presenting their case-in-chief, the
state filed a motion to dismiss the plaintiffs’ fertility
treatment claims, arguing that the waiver of sovereign
immunity obtained from the Claims Commissioner was
granted pursuant to § 4-160 (b), which waives the state’s
sovereign immunity for medical malpractice claims
only, whereas the plaintiffs’ fertility treatment claims
sounded in informed consent. In support of this con-
tention, the state argued that the plaintiffs had failed
to present ‘‘evidence of medical malpractice’’ with
respect to the fertility treatment claims and that, in fact,
the plaintiffs’ own expert ‘‘opined that it was acceptable
for the plaintiffs to be matched with an IgG positive
donor if informed consent was obtained.’’
   Thereafter, the trial court denied the state’s motion
to dismiss, stating that it would address the merits of the
motion in its memorandum of decision on the plaintiffs’
claims. Subsequently, the court issued a corrected mem-
orandum of decision in which it rejected the state’s
contention that the plaintiffs’ fertility treatment claims
were not medical malpractice claims. In so doing, the
court stated that the plaintiffs had presented ‘‘the ques-
tion of informed consent as a hybrid claim, contending
that, in the field of reproductive endocrinology, it is
malpractice to introduce sperm from an IgG positive
donor into an IgG negative woman, except [when] there
is informed consent.’’ The court further explained that
this hybrid approach is consistent with Connecticut
case law, in particular Downs v. Trias, 306 Conn. 81,
49 A.3d 180 (2012), in which this court recognized that
a failure to obtain a patient’s informed consent can
support a medical malpractice cause of action when
the standard of care required the physician to obtain
such consent prior to performing a medical procedure.
Id., 88–91; see also DiLieto v. County Obstetrics &
Gynecology Group, P.C., 297 Conn. 105, 129 n.30, 998
A.2d 730 (2010).
                             A
   We begin with the state’s argument that the judgment
should be set aside with respect to the plaintiffs’ fertility
treatment claims on the basis that those claims were
barred by sovereign immunity because the theory on
which they were upheld by the trial court sounded
exclusively in informed consent, not medical malprac-
tice. We disagree.
   ‘‘We have long held that because [a] determination
regarding a trial court’s subject matter jurisdiction is a
question of law, our review is plenary.’’ (Internal quota-
tion marks omitted.) Levin v. State, 329 Conn. 701,
706, 189 A.3d 572 (2018). The principle of sovereign
immunity implicates the subject matter jurisdiction of
the court. See, e.g., Giannoni v. Commissioner of
Transportation, 322 Conn. 344, 349, 141 A.3d 784
(2016). ‘‘[W]hen the doctrine of sovereign immunity is
applicable, the state must consent to be sued in order
for a claimant to pursue any monetary claim against
the state.’’ (Internal quotation marks omitted.) Escobar-
Santana v. State, 347 Conn. 601, 612, 298 A.3d 1222
(2023).
   In Levin v. State, supra, 329 Conn. 709, this court
held that, when permission to sue the state is granted
pursuant to § 4-160 (b), it applies to medical malpractice
claims only. The issue before the court in Levin was
‘‘whether an action authorized by the [C]laims [C]om-
missioner, limited to medical malpractice, may survive
a motion to strike [when] the plaintiff was not a patient
of the [state], as required by Jarmie v. Troncale, 306
Conn. 578, 587, 50 A.3d 802 (2012).’’13 Levin v. State,
supra, 703. As in the present case, the Claims Commis-
sioner’s order granting permission to sue stipulated that
the permission was ‘‘limited to that portion of the claim
alleging malpractice against the [state] . . . .’’ (Internal
quotation marks omitted.) Id., 704. In granting the
state’s motion to strike, the trial court reasoned that
its subject matter jurisdiction was ‘‘predicated on the
claim’s character as a medical malpractice action,
which . . . fails in light of . . . Jarmie.’’ (Internal
quotation marks omitted.) Id., 705. This court agreed
and affirmed the trial court’s judgment. Id., 710–11.
   Relying on Levin, the state argues that the trial court
lacked subject matter jurisdiction over the plaintiffs’
fertility treatment claims because those claims were
presented to and decided by the court on the basis of
a theory of informed consent, not medical malpractice.
We disagree. ‘‘The informed consent doctrine derives
from the principle that [e]very human being of adult
years and sound mind has a right to determine what
shall be done with his own body; and a surgeon who
performs an operation without his patient’s consent,
commits an assault, for which he is liable in damages.’’
(Internal quotation marks omitted.) Duffy v. Flagg, 279
Conn. 682, 691, 905 A.2d 15 (2006). ‘‘Thus, [u]nlike the
traditional action of negligence, a claim for lack of
informed consent focuses not on the level of skill exer-
cised in the performance of the procedure itself but on
the adequacy of the explanation given by the physician
in obtaining the patient’s consent.’’ (Internal quotation
marks omitted.) Sherwood v. Danbury Hospital, 278
Conn. 163, 180, 896 A.2d 777 (2006).
   ‘‘[A]lthough medical negligence and lack of informed
consent are clearly distinct causes of action with differ-
ent elements that must be proven . . . [it is well estab-
lished that] the same set of facts may give rise to both
causes of action. In DiLieto v. County Obstetrics &
Gynecology Group, P.C., [supra, 297 Conn. 105], for
example, we . . . rejected a contention that medical
negligence and informed consent were necessarily mutu-
ally exclusive causes of action.’’ (Citation omitted.) Downs
v. Trias, supra, 306 Conn. 89–90. ‘‘Similarly, in Viera
v. Cohen, 283 Conn. 412, 927 A.2d 843 (2007), in which
the plaintiff pursued a medical negligence claim but
not a claim of lack of informed consent, we held that
testimony regarding a physician’s failure to inform a
patient about the risks of giving birth vaginally after
previously undergoing a cesarean section ‘undoubtedly
would bear on informed consent if that were an issue
in the case,’ but that such testimony was also relevant
to the claim of medical negligence the plaintiff actually
pursued. Id., 453. Specifically, we held that ‘[i]f, as the
plaintiff’s experts had testified, the standard of care
would have obligated the defendant to discuss the risks
of vaginal delivery with [the patient], his failure to do
so would provide evidence that he had not in fact recog-
nized that those risks were present [and, therefore, that
he had breached the standard of care].’ ’’ Downs v.
Trias, supra, 90. ‘‘Consistent with a physician’s distinct
but complementary responsibilities to act in accor-
dance with the professional standard of care and to
provide material information to patients, we have held
that lack of informed consent provides the sole theory
of liability only in a single circumstance, namely, [when]
the plaintiff has failed to allege any deficiency of medi-
cal skill or care.’’ (Emphasis omitted.) Id., 91.
   The state contends that, unlike the claims in DiLieto
and Viera, ‘‘[t]he claims relating to the fertility treat-
ment, upheld by the trial court following trial, were
informed consent claims, and not medical malpractice
claims based on the failure of a physician to comply
with the medical standard of care established through
expert testimony at trial.’’ The state contends that the
fertility treatment claims ‘‘did not rest on a theory that
the standard of care prevents sperm donation from an
IgG positive donor to an IgG negative recipient—and
no expert testified that a donation of that sort deviates
from the medical standard of care.’’ According to the
state, ‘‘the trial court only found for the plaintiffs and
awarded damages because of the absence of . . .
informed consent to a procedure that no doctor said
was medically improper if consented to after being fully
advised of the risks involved.’’ We find no merit in
these contentions.
   Counts one through ten of the plaintiffs’ revised com-
plaint, which set forth the claims related to Jean-Marie’s
fertility treatment, each alleged, inter alia, that ‘‘[t]he
injuries and losses sustained and suffered by [Joshua]
. . . were caused by the carelessness, negligence, and
medical malpractice of the [state], acting through its
agents, servants and/or employees,’’ in that the state
‘‘failed to take the necessary steps to protect against a
congenital CMV infection, when it knew, or should have
known, that [Jean-Marie] tested negative for CMV and
was at risk for developing a primary CMV infection
during pregnancy, which significantly increased the risk
of a congenital CMV infection in a fetus’’; ‘‘failed to
detect that [Jean-Marie] had selected sperm from a CMV
positive donor,’’ which was ‘‘contrary to its own written
policy’’; ‘‘permitted the use of sperm from a CMV posi-
tive donor in [Jean-Marie], a CMV negative recipient’’;
‘‘failed to determine [Jean-Marie’s] suitability for using
sperm from a CMV positive donor prior to performing
the May 11, 2014 [TDI]’’; and ‘‘inseminated a CMV nega-
tive patient with sperm from a CMV positive donor,
when it knew, or should have known, of the substantial
risks associated therewith . . . .’’ These allegations are
nothing if not allegations of medical malpractice, and
they illustrate why the trial court observed repeatedly
throughout its memorandum of decision that the plain-
tiffs’ claims were pleaded and prosecuted as medical
malpractice claims.14
   Our conclusion is unaffected by the fact that both
sides’ experts testified that a CMV negative patient
could elect to be inseminated with sperm from a CMV
positive donor. The trial court found it ‘‘undisputed by
all parties and experts in this case, that insemination
of a CMV negative patient with CMV positive donor
sperm is . . . within the standard of care [only] if the
patient consents, after she is appropriately informed
of the risk of congenital CMV.’’ (Emphasis added.)
When discussing the fertility treatment claims specifi-
cally, the trial court reiterated ‘‘that insemination of a
CMV negative patient with CMV positive donor sperm
is . . . within the standard of care [only] if the patient
is appropriately counseled as to the risks of congenital
CMV and gives her full, informed consent.’’ These state-
ments would have been entirely gratuitous if, as the
state contends, the trial court viewed the fertility treat-
ment claims as sounding in informed consent rather
than in medical malpractice. See, e.g., Shortell v. Cava-
nagh, 300 Conn. 383, 388, 15 A.3d 1042 (2011) (‘‘[u]nlike
a medical malpractice claim, a claim for lack of
informed consent is determined by a lay standard of
materiality, rather than an expert medical standard of
care [that] guides the trier of fact in its determination’’).
It was precisely because there was testimony that insemi-
nation of a CMV negative patient with sperm from a
CMV positive donor deviated from the standard of care
in the absence of informed consent that the trial court
concluded that the fertility treatment claims were medi-
cal malpractice claims and, therefore, within the scope
of the Claims Commissioner’s waiver of sovereign
immunity.15
                             B
  We next address the state’s arguments that the judg-
ment should be set aside due to the plaintiffs’ failure
to submit to the Claims Commissioner (1) a physician’s
opinion letter specifically addressing the plaintiffs’ pre-
natal care claims, and (2) an attorney’s certificate of
good faith. We disagree.
   General Statutes (Rev. to 2015) § 4-160 (b) provides
in relevant part that an ‘‘attorney or party filing [a mal-
practice] claim may submit a certificate of good faith16
to the Claims Commissioner in accordance with section
52-190a. If such a certificate is submitted, the Claims
Commissioner shall authorize suit against the state on
such claim.’’17 (Footnote added.) General Statutes (Rev.
to 2015) § 4-160 (c) further provides in relevant part
that, ‘‘[i]n each action authorized by the Claims Com-
missioner pursuant to subsection (a) or (b) of this sec-
tion or by the General Assembly pursuant to section 4-
159 or 4-159a . . . [t]he state waives its immunity from
liability and from suit . . . and waives all defenses
which might arise from the . . . governmental nature
of the activity complained of. The rights and liability
of the state in each such action shall be coextensive
with and shall equal the rights and liability of private
persons in like circumstances.’’ (Emphasis added.)
   It is clear from the statutory scheme, therefore, that,
once the Claims Commissioner authorized the plaintiffs’
medical malpractice action, the state was precluded
from raising a sovereign immunity defense to ‘‘the activ-
ity complained of’’ in the notice of claim. General Stat-
utes (Rev. to 2015) § 4-160 (c). The activities complained
of, and for which permission to sue was granted, were
(1) the insemination of a CMV negative patient with
sperm from a CMV positive donor, and (2) the failure
to appropriately interpret the October, 2014 fetal ultra-
sound and to advise Aaron and Jean-Marie regarding
the results.
   The state’s jurisdictional claim in this regard is unlike
the claim that we addressed in part I A of this opinion,
which required us to determine whether the plaintiffs’
fertility treatment claims were within the scope of the
action authorized by the Claims Commissioner. This
court is often called on to decide whether a claim falls
within the narrow confines of the waiver of sovereign
immunity obtained from the Claims Commissioner or
otherwise authorized by statute. See, e.g., Escobar-San-
tana v. State, supra, 347 Conn. 605 (deciding whether,
for purposes of § 4-160 (f), ‘‘the statutory phrase ‘medi-
cal malpractice claims’ is broad enough to encompass a
mother’s allegation that she suffered emotional distress
damages from physical injuries to her child that were
proximately caused by the negligence of health care
professionals during the birthing process’’). In each
such case, ‘‘[a]ny statutory waiver of immunity must
be narrowly construed . . . and its scope must be con-
fined strictly to the extent the statute provides.’’ (Inter-
nal quotation marks omitted.) Levin v. State, supra, 329
Conn. 709.
   In the present case, the Claims Commissioner author-
ized the plaintiffs to bring a medical malpractice action,
the plaintiffs’ claims fall squarely within the scope of
that authorization, and the authorization is consistent
with the legislature’s decision to waive the state’s sover-
eign immunity with respect to medical malpractice
claims. What the state is arguing is that the judgment
should be set aside because the Claims Commissioner
incorrectly determined that the plaintiffs had submitted
a certificate of good faith in accordance with § 52-190a.
We disagree.
   It is clear from the record that the Claims Commis-
sioner reviewed the plaintiffs’ notice of claim and the
physician’s statement, and concluded that together they
satisfied the good faith certificate requirement of § 52-
190a (a). To the extent the state disputed the applicabil-
ity of § 4-160 (b) because of alleged defects or shortcom-
ings in the plaintiffs’ good faith certificate, it was incum
bent on it to raise the issue with the Claims Commission-
er while the matter was still under his review.
   In this way, § 4-160 (c) operates in a manner similar to
General Statutes § 4-164 (b), which provides in relevant
part that ‘‘[t]he action of the . . . Claims Commis-
sioner in approving or rejecting payment of any claim
or part thereof shall be final and conclusive on all ques-
tions of law and fact and shall not be subject to review
except by the General Assembly.’’ This court has held
that the Claims Commissioner ‘‘performs a legislative
function directly reviewable only by the General Assem-
bly.’’ Circle Lanes of Fairfield, Inc. v. Fay, 195 Conn.
534, 541, 489 A.2d 363 (1985); see also Cooper v. Delta
Chi Housing Corp. of Connecticut, 41 Conn. App. 61,
64, 674 A.2d 858 (1996) (‘‘The legislature has established
a system for the determination of claims against the
state. . . . A significant part of that system is the
appointment of a [C]laims [C]ommissioner . . . who
is vested with sole authority to authorize suit against the
state.’’ (Citations omitted.)) The legislature’s decision
to insulate the Claims Commissioner’s decision under
§ 4-160 (b) from collateral attack by the state is consis-
tent with the broader statutory scheme.18
  We note, finally, that, when the plaintiffs filed this
action in 2015, they were required by § 52-190a to submit
to the trial court a certificate of good faith and an
opinion letter from a similar health care provider
addressing both their fertility treatment claims and their
prenatal care claims.19 The state does not claim that
they failed to do this or that the opinion letters and
good faith certificate that they filed with the court were
in any way deficient.
                            II
   We next consider the state’s contention that Joshua
was not entitled to recover any damages based on the
fertility treatment claims brought by the plaintiffs on his
behalf because he did not suffer any legally cognizable
injuries.20 Specifically, the state contends that those
claims must be understood as ‘‘wrongful life’’ claims
and that this court should follow the majority of states
and decline to recognize such claims.21 The state further
contends that the plaintiffs failed to make out a valid
conventional medical malpractice claim with respect
to Joshua’s injuries. The plaintiffs counter that Joshua’s
claims are medical malpractice claims and that the trial
court correctly determined that they had established
cognizable injuries and nonspeculative damages, such
that the judgment can be affirmed without having to
recognize a new cause of action for wrongful life. In
the alternative, the plaintiffs invite us to follow the
Supreme Courts of California, New Jersey, and Wash-
ington in recognizing a claim for wrongful life. See Tur-
pin v. Sortini, 31 Cal. 3d 220, 643 P.2d 954, 182 Cal.
Rptr. 337 (1982); Procanik v. Cillo, 97 N.J. 339, 478 A.2d
755 (1984); Harbeson v. Parke-Davis, Inc., 98 Wn. 2d
460, 478–83, 656 P.2d 483 (1983). We conclude that
Joshua’s claims, which arise in the context of innovative
assisted reproductive technologies, are properly under-
stood and adjudicated within the context of conven-
tional medical malpractice claims. Established principles
underlying the common law of negligence are suffi-
ciently adaptable to provide a remedy for injuries such
as those sustained by Joshua, without disturbing the
fundamental rules governing tort liability and compen-
sation.
   The following well established legal principles inform
our analysis. ‘‘[T]o prevail in a medical malpractice
action, the plaintiff must prove (1) the requisite stan-
dard of care for treatment, (2) a deviation from that
standard of care, and (3) a causal connection between
the deviation and the claimed injury.’’ (Internal quota-
tion marks omitted.) Jarmie v. Troncale, supra, 306
Conn. 588. ‘‘[A]s in any other negligence action, the
medical malpractice plaintiff must establish proximate
cause and damages, as well as breach of the profes-
sional duty of care.’’ Escobar-Santana v. State, supra,
347 Conn. 614. ‘‘Proof of damages should be established
with reasonable certainty and not speculatively and
problematically. . . . Damages may not be calculated
based on a contingency or conjecture.’’ (Internal quota-
tion marks omitted.) Carrano v. Yale-New Haven Hos-
pital, 279 Conn. 622, 650, 904 A.2d 149 (2006).
   At the most basic level, courts use the terms ‘‘wrong-
ful birth’’ and ‘‘wrongful life’’ to refer to claims that are
based on the theory that a child would not have been
born but for the defendant’s negligence. See, e.g., Tur-
pin v. Sortini, supra, 31 Cal. 3d 225–26, 231–32. ‘‘Wrong-
ful birth’’ generally refers to claims of this sort brought
by the parent or parents whereas ‘‘wrongful life’’ refers
to claims brought by the child. See, e.g., Harbeson v.
Parke-Davis, Inc., supra, 98 Wn. 2d 478. This court
has recognized claims for wrongful birth; see Ochs v.
Borrelli, 187 Conn. 253, 256–60, 445 A.2d 883 (1982);
but has not yet had occasion to consider the wrongful
life issue.22
  The issues addressed in this part of the opinion—
whether claims such as Joshua’s must be construed as
wrongful life claims and, if not, whether they constitute
cognizable medical malpractice claims—are issues of
law and, indeed, issues of first impression for this court.
Our review therefore is plenary. See, e.g., Finan v.
Finan, 287 Conn. 491, 499–500, 949 A.2d 468 (2008).
                             A
   We first address the state’s contention that the fertil-
ity treatment claims brought by the plaintiffs on behalf
of Joshua must be understood as wrongful life claims.
We disagree and conclude that those claims should be
construed and adjudicated as conventional medical mal-
practice claims.
   The present case differs in fundamental ways from
the paradigmatic wrongful life cases. Most cases that
bear the ‘‘wrongful life’’ label involve a child who has
a congenital abnormality born to a mother who would
not have proceeded with the pregnancy had she received
timely notice of that condition. See, e.g., Turpin v.
Sortini, supra, 31 Cal. 3d 223. The alleged negligence
is the failure to detect and educate the parents regarding
the congenital abnormality. Indeed, it has been said
that the hallmark of a wrongful life case is that the
defendant bears no direct responsibility for the child’s
condition, and courts have relied in part on that fact
in declining to recognize such claims. See, e.g., Johnson
v. Superior Court, 101 Cal. App. 4th 869, 888, 124 Cal.
Rptr. 2d 650 (2002) (‘‘[i]n a wrongful life case, the child
does not assert that the negligence of the defendant
caused the inherited or congenital abnormalities’’ (empha-
sis omitted; internal quotation marks omitted)); Wilson
v. Kuenzi, 751 S.W.2d 741, 744–45 (Mo.) (‘‘The heart of
the problem in [wrongful life] cases is that the physician
cannot be said to have caused the [abnormality]. The
disorder is genetic and not the result of any injury
negligently inflicted by the doctor. In addition it is incur-
able and was incurable from the moment of conception.
. . . The child’s handicap is an inexorable result of
conception and birth.’’ (Internal quotation marks omit-
ted.)), cert. denied, 488 U.S. 893, 109 S. Ct. 229, 102 L.
Ed. 2d 219 (1988). Other cases styled as wrongful life
cases generally involve allegations that the defendant
negligently performed some sort of birth control or
abortion procedure, and thus failed to prevent an
unwanted pregnancy. See, e.g., McKernan v. Aasheim,
102 Wn. 2d 411, 687 P.2d 850 (1984). In both types of
cases, plaintiffs have sought to hold medical profession-
als responsible for failing to prevent a birth that would
have occurred regardless of medical intervention.
   In the present case, by contrast, the state is directly
responsible both for Joshua’s birth and for his condi-
tion; CARS staff created the pregnancy, and it was pre-
cisely their negligence in doing so that was the
proximate cause of Joshua’s injuries. Purportedly fol-
lowing their own, internally developed policies, they
used a state-of-the-art procedure to implant previously
frozen sperm into Jean-Marie. It was their decision to
implant sperm from a CMV positive donor into a CMV
negative woman, without adequately educating her as
to the risks and alternatives. Indeed, under the facts
found by the trial court, Joshua may well have devel-
oped as a healthy, uninfected embryo.23 In a recent
federal case involving comparable circumstances, in
which the defendants’ negligent choice of assisted
reproductive technologies was allegedly the direct
cause of the fetal disability, the United States District
Court for the District of Maryland rejected the defen-
dants’ contention that the claim was a nonactionable
wrongful life claim and allowed the action to proceed
as a conventional medical malpractice claim. See Dow-
ling v. A.R.T. Institute of Washington, Inc., 372 F. Supp.
3d 274, 288–92 (D. Md. 2019).
   A Connecticut case, Vasquez v. Roy, Superior Court,
judicial district of New Britain, Docket No. HHB-CV-
XX-XXXXXXX-S (June 18, 2018) (66 Conn. L. Rptr. 602), is
also instructive. In Vasquez, the defendant physician
administered methotrexate, a toxic, off-label chemo-
therapy agent, in a failed attempt to perform an abor-
tion. Id., 602–603. The plaintiff mother ultimately gave
birth to a child, Xavier, who was severely disabled as
a result of the methotrexate. Id., 603. When the mother,
individually and on behalf of Xavier, brought a medical
malpractice action, the defendants argued that Xavier’s
claims were noncognizable wrongful life claims because,
if the abortion had been properly performed, Xavier
would not have existed. See id. The trial court disagreed
and allowed the case to proceed as a conventional medi-
cal malpractice action, reasoning that Xavier was ‘‘seek-
ing to hold the defendants accountable for causing his
physical injuries . . . . Xavier does not allege any fail-
ure on the part of the defendants to predict or diagnose
a disease or defect, and he does not allege that the
injury suffered is his birth or existence. . . . To the
contrary, Xavier alleges that the defendants caused his
developmental damages . . . . These are not the type
of allegations that would necessarily cause the trier of
fact to delve into the . . . choice of existence versus
[nonexistence].’’ (Citation omitted.) Id., 604. The same
reasoning applies in the present case.
   A related and important difference is that, in most
wrongful life cases, but for the defendants’ negligence,
there never could have been a healthy child. See, e.g.,
Procanik v. Cillo, supra, 97 N.J. 353 (‘‘[o]ur analysis
begins with the [unfortunate] fact that the infant plain-
tiff never had a chance of being born as a normal,
healthy child’’). In the present case, one of the allega-
tions contained in the fertility treatment claims of the
plaintiffs’ complaint is that the CARS staff, having
inseminated Jean-Marie with sperm from a CMV posi-
tive donor, failed to appropriately monitor her for signs
and symptoms of the disease.24 The plaintiffs presented
undisputed testimony from three different medical pro-
fessionals that antiviral medications were available that
had been used, at least on an experimental basis, to
prevent CMV or to treat the disease in utero after infec-
tion. Although the trial court made no specific findings
regarding whether this particular treatment could have
been a viable treatment for Joshua and Shay had the
CARS staff properly assessed the risk, it illustrates that
key considerations that have led other courts to fore-
close wrongful life actions are not present in this case.
See, e.g., id., 347–55 (holding that claims arising from
very existence of child are barred but allowing claims
arising from specific impairments caused or exacer-
bated by defendants’ alleged wrongs to proceed); Vas-
quez v. Roy, supra, 66 Conn. L. Rptr. 604 (‘‘[t]he tragic
fact in a wrongful life case is that there was never a
possibility the child would have been born healthy’’).
   Moreover, the plaintiffs consistently have repre-
sented that Joshua’s claims are medical malpractice
claims and not wrongful life claims, and the trial court
understood and evaluated them as medical malpractice
claims. We agree with those courts that, under similar
circumstances, have determined that the most prudent
course is to evaluate the claims as articulated by the
plaintiffs and to let them rise or fall on the plaintiffs’
ability to make out a valid medical malpractice cause
of action. See, e.g., Zelt v. Xytex Corp., 766 Fed. Appx.
735, 740 (11th Cir. 2019) (‘‘[The plaintiffs] did not ask the
court to compare their two children’s possibly impaired
existence to their nonexistence, which is the essence
of a wrongful birth action. Rather, the relevant count-
erfactual is the children’s existence had their parents
used sperm donated by someone [else].’’); Hester v.
Dwivedi, 89 Ohio St. 3d 575, 578, 733 N.E.2d 1161 (2000)
(‘‘such cases are properly decided by applying the same
legal analysis employed in any medical negligence
claim’’). For these reasons, we will proceed to evaluate
the state’s challenge to the trial court’s damages award
according to conventional tort principles and leave for
another day the issue of whether Connecticut law recog-
nizes wrongful life claims.
                             B
   The state next contends that the plaintiffs cannot
prevail on a conventional medical malpractice claim
with respect to any harm to Joshua because they did
not establish injury in fact and nonspeculative damages.
The state argues that (1) there is no nonspeculative
way to measure Joshua’s damages, (2) damages can be
awarded only if the trial court were to conclude that
it would have been better for Joshua not to exist than
to exist in an impaired state, and (3) the standard for-
mula for calculating damages in tort—making the plain-
tiff whole by returning him to the situation he would
have been in but for the defendant’s negligence—pre-
cludes any recovery in this case, insofar as Joshua argu-
ably would not have existed but for the state’s conduct.
  The first two arguments—that any damages awarded
to Joshua would be unavoidably speculative and that
an award would be predicated on the impermissible
concept that nonexistence can be preferable to impaired
existence—are the standard arguments marshalled against
recognizing a cause of action for wrongful life. As we
explained, however, this is not a wrongful life action.
Joshua does not contend that he would be better off
dead or that his life is not worth living. His claim is
that, like any other tort victim, he is entitled to compen-
sation for injuries he sustained as a proximate result
of the state’s negligence.
  In fact, this court already has rejected versions of
the state’s first two arguments when we recognized a
cause of action for wrongful birth. In Ochs v. Borrelli,
supra, 187 Conn. 253, a child was conceived after the
defendant physician negligently performed an unsuc-
cessful sterilization procedure. Id., 254–55. The child
was afflicted with a genetic orthopedic disability, and
her parents sought compensation from the physician
for the costs of raising her. Id., 255. The jury, finding
the physician negligent, awarded not only medical
expenses but also the general costs of raising the child
to the age of majority. Id. In affirming the award of
damages on appeal, this court rejected the argument
that for the legal system to award the parents the cost
of raising the child would, in effect, be to impermissibly
say that parenthood constitutes an injury and that it
would be better if the child had not existed. Id., 259.
This court held that weighing the benefits and costs of
a child’s life is an analysis that a jury reasonably may
conduct on a case-by-case basis, albeit subject to the
provisions of § 920 of the Restatement (Second) of
Torts.25 Id., 260.
   This court in Ochs also rejected the notion that calcu-
lating such damages would be ‘‘impermissibly specula-
tive,’’ observing that juries are regularly called on to
fix monetary damages for seemingly incalculable, non-
economic, existential losses such as wrongful death
and loss of consortium. Id.; see also Burns v. Hanson,
249 Conn. 809, 819, 734 A.2d 964 (1999) (reaffirming
Ochs and emphasizing that ‘‘[this court has] declined
to carve out any exception . . . to the normal duty of
a tortfeasor to assume liability for all the damages that
he or she has caused’’).
   The nonspeculative nature of the damages award in
the present case is illustrated by considering two analo-
gous scenarios. If the state had negligently exposed
Jean-Marie and her fetuses to disease through contami-
nated medical supplies, rather than through insemina-
tion with infected sperm, there would be no question
that Joshua would be entitled to his full measure of
damages, as calculated by the trial court. The damages
do not become speculative because there is no baseline
derived from Joshua’s own life experiences against
which to measure his loss.
   These issues come into sharper contrast if we con-
sider a scenario in which the state had used split cycle
in vitro fertilization, a method that fertilizes the patient’s
eggs with sperm from different donors. If Joshua’s
embryo had been developed by sperm from a CMV nega-
tive donor while another embryo, fertilized by sperm
from donor No. 013673, had been the one to carry CMV
into the womb, Joshua’s entitlement to the damages
award would be undisputed.
   The problem created by this unique factual scenario
is not how to calculate damages but, rather, that Joshua
was, at least potentially, the vehicle of his own injuries.
The state’s negligence was using the very sperm that
created Joshua. The state contends there are no legally
compensable damages because Joshua would not exist
but for that act of negligence. This means, the state
contends, that the only way to roll back the state’s
negligence and to return Joshua to the position he occu-
pied prior to the injury would be to compensate him
as if he had never existed. We disagree.
   Our review of the state’s challenge to the trial court’s
damages award is framed by the underlying purposes
and principles that inform tort law. ‘‘[T]he fundamental
policy purposes of the tort compensation system [are]
compensation of innocent parties, shifting the loss to
responsible parties or distributing it among appropriate
entities, and deterrence of wrongful conduct . . . .
The courts are concerned not only with compensation
of the victim, but [also] with admonition of the wrong-
doer.’’ (Internal quotation marks omitted.) Doe v. Coch-
ran, 332 Conn. 325, 363, 210 A.3d 469 (2019).26 In the
present case, all of these considerations weigh in favor
of holding the state liable for the full amount of Joshua’s
economic and noneconomic damages proximately caused
by the state’s negligence.
  First, Joshua is an innocent victim, without blame
for his many afflictions and disabilities, who will suffer
every day for the rest of his life from serious physical
and ‘‘ruinous neurological maladies,’’ and require con-
stant medical care and treatment. When his parents can
no longer facilitate such care in their home, he will live
out his remaining days in residential group facilities.
Joshua’s injuries are the direct result of the state’s negli-
gence in failing to adhere to the standard of care that
the trial court found applicable to the procedures it
performed. The standards that were breached existed
to prevent precisely this sort of predictable tragedy.
   Second, it is clear that the state is both the party best
equipped to avoid mishaps of this sort and the party best
positioned to absorb and spread the costs of Joshua’s
lifelong care. See Doe v. Cochran, supra, 332 Conn. 369.
With respect to avoiding the harm, the state offers a
highly specialized medical service that poses particular
risks best known to the state and most efficiently pre-
vented by it. The state regularly shepherds inexperi-
enced and medically unsophisticated patients through
the complex process of assisted reproduction. It would
have required little effort and even less financial cost
for Benadiva or a member of his staff to confirm the
CMV status of the donor and to counsel Jean-Marie to
select a different donor or, at least, to obtain her
informed consent to be certain that she fully understood
the serious risks of going forward under the circum-
stances. As in Cochran, the trial court ‘‘reasonably could
conclude that the [state] was the party who was in the
best position to avoid the harm at the lowest cost and,
therefore, should bear the costs of the loss.’’ Id. Like-
wise, the trial court reasonably could conclude that the
state ‘‘can most readily bear and spread [the costs of
Joshua’s injuries and care] through malpractice insur-
ance . . . .’’ Id.
  Third, the state asks us to deny recovery to children
who, like Joshua, are injured by the negligent provision
of assisted reproductive technologies. If we were to
accept this argument, there would be little to deter
the state and other providers of artificial insemination
services from this sort of negligence and its potentially
devastating consequences.27 This is not disputed by the
state. Nor does the state dispute that the just and eco-
nomically efficient outcome would be to require it,
rather than Joshua, to bear the full costs of its own neg-
ligence.
   Rather, it is the state’s position that Joshua and all
similarly situated victims must be denied a full recovery
because of how tort damages traditionally have been
framed. The crux of the state’s argument is that tort
damages are typically characterized as compensatory
in nature, and the compensation provided is intended
‘‘to restore the injured party to his original position,
i.e., to make him whole.’’ (Internal quotation marks
omitted.) Langs v. Harder, 165 Conn. 490, 494, 338 A.2d
458 (1973), cert. denied, 416 U.S. 994, 94 S. Ct. 2409,
40 L. Ed. 2d 774 (1974). The proposition that damages
in tort should be awarded so as to restore a plaintiff
to his or her position prior to the defendant’s negli-
gence, thus making the plaintiff whole, was embraced
by courts as early as the turn of the nineteenth century.
See, e.g., Weld v. Bartlett, 10 Mass. 470, 473 (1813).
According to the state, Joshua has suffered no cogniza-
ble injury and is entitled to no damages because it would
be impossible to return him to the position he would
have been in but for the state’s negligence: nonexistence.
  This rigid conception of tort damages does not leave
room for the substantial technological advancements
that have occurred in the field of assisted reproductive
technology. Humans couldn’t create babies in medical
laboratories in the twelfth century, when the English
common law of tort began to coalesce, or in the early
1800s, when American courts first articulated the pur-
pose of tort damages generally (to make a person
whole). The idea that an injured party might have been
genetically different, even potentially a different person,
but for the injury would not have been comprehensible
to the architects of tort law. Our law must be willing
to recognize and accommodate the modernization of
assisted reproductive technologies.
    This court has explained that we use ‘‘ ‘figurative’ ’’
language when we say that tort law makes the victim
‘‘ ‘whole’ ’’ by returning him to his original position;
Langs v. Harder, supra, 165 Conn. 497; and we have
opined that this formulation was adopted primarily
because it offered juries and courts a helpful framework
for calculating damages. See id., 496. The law of torts
has always been highly adaptable to changing social
and technological circumstances.28 It makes no sense
to confine ourselves to one particular ‘‘ ‘metaphor[ic]’ ’’
formulation of tort damages; id., 497; when to do so
would frustrate rather than further the underlying pur-
poses of tort law in the face of a novel technological
scenario that it was never intended to address.
   Likewise, with respect to this formulation of dam-
ages, although this court generally has used the short-
hand version, the full rule is expressed as follows:
‘‘[T]he law of torts attempts primarily to put an injured
person in a position as nearly as possible equivalent
to his position prior to the tort.’’ (Emphasis added.) 4
Restatement (Second), Torts § 901, comment (a), p. 452
(1979); see also 74 Am. Jur. 2d 743, Torts § 65 (2023) (‘‘a
person injured by the commission of a tort is generally
entitled to compensation for the injury that they sus-
tained to place them as nearly as possible in the posi-
tion that they occupied before the defendant’s tort’’
(emphasis added)). The trial court in the present case
restored Joshua to that position as nearly as possible,
consistent with the underlying goals and purposes of
tort law.
   We also observe that there are other ways of express-
ing the purposes of compensatory damages that do not
require courts to engage with unsolvable metaphysical
questions when applied to measuring damages in the
context of assisted reproductive technologies. See, e.g.,
V. Schwartz et al., Prosser, Wade and Schwartz’s Torts:
Cases and Materials (11th Ed. 2005) p. 520 (tort damages
are awarded so as to approximate ‘‘the . . . financial
equivalent of the loss or harm suffered by the plaintiff’’).
We recently reiterated one such alternative formula:
the law allows ‘‘a plaintiff [to] recover all of the damages
suffered as a result of a tortfeasor’s negligence . . . .’’
(Emphasis omitted.) Maldonado v. Flannery, 343 Conn.
150, 189, 272 A.3d 1089 (2022). In the present case, the
trial court found, on the basis of abundant evidence,
that Joshua had suffered economic and noneconomic
harms, losses, and injuries as a result of the state’s
negligence. He is no less entitled to be compensated
financially for those damages than are other victims of
medical malpractice.
   The award of damages is fully commensurate with
the injuries that Joshua suffered. The state, having
undertaken the serious responsibility of medically cre-
ating human life and then having failed to follow the
standard of care governing that undertaking, should not
now be shielded from responsibility for its negligence
on the ground that traditional tort doctrine did not
encounter a scenario of this nature.29 As the Washington
Supreme Court concluded in Harbeson v. Parke-Davis,
Inc., supra, 98 Wn. 2d 460, ‘‘we prefer to place the
burden of those costs on the party whose negligence
was in fact a proximate cause of the child’s continuing
need for such special medical care and training.’’ Id.,
479.
                            III
  Lastly, we address the state’s contention that the trial
court abused its discretion in admitting the testimony
of the plaintiffs’ causation expert, Alexander McMeek-
ing, a board-certified infectious disease specialist, who
opined that the use of sperm from a CMV positive donor
caused Shay’s and Joshua’s CMV infections. The state
argues that the testimony was inadmissible under State
v. Porter, 241 Conn. 57, 698 A.2d 739 (1997), cert. denied,
523 U.S. 1058, 118 S. Ct. 1384, 140 L. Ed. 2d 645 (1998),
because it was unsupported by a valid, scientific meth-
odology and was based on unproven, speculative fac-
tual assumptions. We disagree.
   Prior to trial, the plaintiffs informed the state that
McMeeking would testify that, to a reasonable degree
of medical probability, the use of sperm from a CMV
positive donor during the May, 2014 IUI procedure
caused the CMV infection that killed Shay and severely
injured Joshua. The state thereafter filed a motion in
limine pursuant to Porter to preclude McMeeking’s tes-
timony on the ground that it lacked a valid scientific
basis.
   The trial court’s ruling on the motion in limine stated
in relevant part: ‘‘The science appears to be clear that
CMV is transmissible through the exchange of bodily
fluids, including sperm and seminal fluid. The question
of whether the donated sperm in this case may have
remained infectious . . . after freezing and washing
. . . appears to be possible, at least from an initial
review of the literature and testimony provided. . . .
Although transmission may have been unlikely, the con-
clusion that it was possible does not appear to involve,
so-called, ‘junk science.’
   ‘‘The science and methodology employed by . . .
McMeeking, however, requires further review before it
is accepted on the question of infectious transmission
under the facts and circumstances of this case. The
court simply requires more [information] from [both
parties’] experts offering opinions on the focused ques-
tion of the transmissibility of CMV in this case from
previously washed and frozen sperm before deciding
the threshold question of exclusion. As this is a court
trial, the threshold evaluation of the evidence to be
offered can be achieved during the trial, in much the
same way as a proffer and separate hearing would occur
before offering it to the jury. The court notes that an
actual Porter hearing was not specifically requested.’’
(Citation omitted.)
   At trial, McMeeking testified that, to a reasonable
degree of medical certainty, the sperm used to insemi-
nate Jean-Marie caused the CMV infection that resulted
in the death of Shay and the severe injuries to Joshua.
In formulating his opinion, McMeeking relied on a dif-
ferential diagnosis30 that took into account several fac-
tors. First, McMeeking concluded that the infection
must have occurred early in the first trimester because
injuries as severe as those suffered by Shay and Joshua
only happen if the primary infection occurs during the
first trimester, and, five weeks into her pregnancy, Jean-
Marie presented at a hospital complaining of a persis-
tent rash, which ‘‘is quite well documented [to be] one
of the . . . presenting symptoms of acute CMV infec-
tion.’’ McMeeking rejected the state’s theory that Jean-
Marie was already infected in January, 2014, when she
was treated for flu-like symptoms, four months before
the May 11, 2014 IUI procedure. He stated that this
scenario was not possible because Jean-Marie’s IgM
antibody level was 51.5 at the time of delivery in Janu-
ary, 2015. According to McMeeking, ‘‘[t]o have that high
level of IgM a year later just wouldn’t be possible.’’
   Second, McMeeking excluded other possible causes
of Jean-Marie’s infection. For example, there was no
evidence that Aaron, who was Jean-Marie’s only sexual
partner at the time, was CMV positive before her preg-
nancy, and McMeeking testified that, even if he were,
it was not reasonably possible that he was the source of
Jean-Marie’s infection because, when Jean-Marie tested
negative for CMV in 2013, the couple had already been
together since 2008. In McMeeking’s view, ‘‘it didn’t
make sense [that] all of a sudden she gets infected from
her husband . . . during her pregnancy when she
hasn’t gotten infected from him [in] all [that] time . . . .
It just medically didn’t make sense . . . .’’
   Likewise, McMeeking did not think that it was reason-
ably possible that Jean-Marie contracted the virus from
her eight year old son. Again, there was no evidence
that the son was CMV positive, but, even if he were,
McMeeking explained that ‘‘a child his age, the way he
would shed virus would be in his urine not in [his]
saliva; so she would have had to come in contact with
[an eight] year old’s urine. Again, not very likely. Can
I say 100 percent, of course not. But [I can say to] a
reasonable degree of medical certainty [that] he was not
the source.’’ Finally, McMeeking ruled out community
spread as a likely mode of transmission: ‘‘You don’t get
CMV from the air. You don’t get CMV just from touching
an inanimate object. [In] over 90 percent [of adult trans-
missions, it involves] . . . person to person contact
with . . . genital secretions.’’
   Third, McMeeking testified that insemination with
sperm from a CMV positive donor was capable of caus-
ing Jean-Marie’s infection because the washing and
freezing process to which donor sperm is subjected
does not eliminate CMV. Specifically, he testified that
viruses are ‘‘never killed by freezing. [As soon as they
are] thawed out they will reactivate.’’ He further testi-
fied that, although washing will reduce the viral load
considerably, ‘‘this particular virus, the literature
shows, can live inside the sperm cell so no amount of
washing will ever eliminate the virus totally.’’ McMeek-
ing explained that polymerase chain reaction (PCR) and
immunofluorescence testing has confirmed in separate
studies that infectious CMV virus lives ‘‘inside sperm
cells, not just in semen; not just in the white cells sur-
rounding semen; not just attached to sperm cells, but
actually inside the sperm cells.’’31 This is why, ‘‘no mat-
ter . . . how much you wash the sperm cells, you’re
never going to remove the CMV virus from the sperm
cell itself.’’ McMeeking concluded, therefore, that there
was ‘‘no other reasonable explanation for [Jean-Marie’s]
CMV infection and the infection of her fetuses other
than the [IUI procedure] on [May 11, 2014].’’
   During cross-examination, McMeeking acknowl-
edged that his causation testimony was predicated on
two assumptions. First, he assumed that the CMV posi-
tive donor was shedding infectious virus into his sperm
when he donated it, which was consistent with testi-
mony by the state’s expert that as many as 8 percent
of such donors will shed live virus. Second, he assumed
that the virus remained infectious following the washing
and freezing process. When asked whether he was
aware of any reported case of sperm from a CMV posi-
tive donor infecting a CMV negative patient or her
fetuses through an IUI procedure, he answered, ‘‘no.’’
He opined that no one would ever take the risk to
conduct a study to confirm this mode of transmission
because of ‘‘the catastrophic potential outcome of a
CMV infection in a pregnant woman . . . .’’ He further
opined that the chance of the virus being transmitted
in this way and it being recorded in scientific literature
was extremely remote to begin with because fertility
clinics presumably follow the standard of care and do
not inseminate CMV negative women with sperm from
a CMV positive donor,32 and, even if they occasionally
do so, the chances of it being reported are miniscule
because, in the vast majority of in utero CMV infections,
the fetuses develop normally.33
   The state’s expert witness on causation, Mark
Schleiss, a pediatric infectious disease specialist, dis-
agreed with McMeeking’s differential diagnosis. He tes-
tified that, to a reasonable degree of medical
probability, Jean-Marie contracted CMV through com-
munity spread, most likely in January, 2014, when she
was treated for flu-like symptoms, and that she passed
the virus to her twins through the placental wall early
in the second trimester.34 Although Schleiss acknowl-
edged that a rash can be indicative of a primary CMV
infection, he stated that ‘‘flu-like symptoms and respira-
tory systems [are] the more typical presentation.’’ He
also disagreed with McMeeking that Jean-Marie’s IgM
antibody level was too high in January, 2015, for her
to have contracted the virus in January, 2014, explaining
that studies show that IgM antibodies can remain in
the blood at low levels ‘‘for more than [twelve]
months postinfection.’’
  Finally, Schleiss vigorously disagreed with McMeek-
ing that CMV can survive the washing process or exist
inside of sperm. Schleiss testified that the washing pro-
cess ‘‘render[s] a final product . . . [entirely] free of
virus.’’ He further testified that there is ‘‘no evidence’’
that washed sperm ‘‘can harbor the virus, carry the
virus, or be infected with the virus.’’ He opined that
the studies on which McMeeking relied in reaching the
opposite conclusion do not establish that an infectious
virus survives the washing process or exists inside of
sperm. In Schleiss’ opinion, they do not establish infec-
tiousness because each of the studies utilized either
PCR testing or immunofluorescence testing. He explained
that PCR testing tests only for DNA and that, ‘‘[j]ust
because viral DNA is there, [that] doesn’t mean that it’s
an infectious virus. In fact, usually low levels of DNA
are . . . not associated with infections.’’ For much the
same reason, he did not believe that immunofluores-
cence testing conclusively establishes the presence of
infectious CMV. Immunofluorescence testing, he
explained, is ‘‘a very common technique’’ that uses anti-
bodies equipped with ‘‘fluorescent probe[s]’’ to identify
viral antigens in a laboratory specimen, which can then
be observed under a fluorescent microscope. He further
explained that, as with PCR testing, immunofluores-
cence testing cannot tell you definitively that the viral
material is infectious because ‘‘there’s a lot of junk,
there’s a lot of debris, there’s little bits and chunks of
[viral] DNA [in every sample] . . . that aren’t infec-
tious’’ and to which the fluorescent antibodies can
attach.
   In its memorandum of decision, the trial court
observed that ‘‘[t]he foundational dispute between the
parties revolves around causation’’ and that, for the
plaintiffs to prevail on this issue, they must ‘‘prove that
washed donor sperm from an IgG positive donor is
capable of containing infectious CMV and, further,
[that] it was transmitted in this case by inseminating
[Jean-Marie] with sperm from [the CMV positive] donor
. . . on May 11, 2014.’’ After a review of the evidence
and a careful consideration of the parties’ respective
arguments, the court found, consistent with the testi-
mony of McMeeking, that Jean-Marie contracted the
virus early in the first trimester of her pregnancy, at or
about the time of the IUI procedure on May 11, 2014.
   The trial court next addressed the state’s claim under
Porter that ‘‘the plaintiffs’ scientific evidence of causa-
tion is unproven as a matter of scientific fact and that
the methodology used is otherwise unreliable.’’ The
court explained that the primary methodological dis-
pute between the parties concerned ‘‘whether PCR test-
ing demonstrates that live CMV can exist in both
seminal fluid and spermatozoa after the washing proce-
dure has been conducted in preparation of a TDI sam-
ple. . . . McMeeking testified that PCR testing is the
most common scientific method for testing for the pres-
ence of infectious agents in the infectious disease field,
and it is used as a substitute for culture testing because
of its speed and efficiency.’’ The court noted that all
experts in the case, except for Schleiss, agreed that
PCR testing has demonstrated that CMV can survive the
washing process. The court further noted that Schleiss
‘‘conceded’’ that the scientific community has relied on
PCR testing to diagnose viral infections for decades
and routinely infers from a positive result that the virus
is infectious. On the basis of the foregoing, the court
concluded that ‘‘PCR methodology is accepted and used
widely in the scientific community to test for the pres-
ence of pathogens, including CMV, and that [one can
infer from] a positive finding [that] there was infectious
virus in the sample tested.’’ The court further concluded
that ‘‘studies [relying on] PCR were properly included
in . . . McMeeking’s analysis of causation, based [on]
a long established process known as differential diagno-
sis in which causes of medical conditions are estab-
lished.’’
   Having found PCR testing to be a scientifically valid
methodology for diagnosing infectious disease, the trial
court next addressed the remaining criteria for admit-
ting expert testimony under Porter and concluded that
all but one of them were met. Specifically, the court
found that both McMeeking and Schleiss were emi-
nently qualified in their fields, both were able to present
and explain the data and methodology underlying their
testimony in a manner that assisted the court, and none
of the techniques or methodologies utilized by them
was developed in connection with this litigation. The
court further found that, ‘‘[a]lthough the evidence pre-
sented was uniformly subjected to peer review, direct
evidence by testing the rate of infection in [CMV nega-
tive] women receiving sperm from CMV positive donors,
washed or otherwise, was uniformly viewed as inappro-
priate and unimaginably unethical due to the risk of
infection and the devastating effects of congenital
CMV.’’ In light of the foregoing, the court concluded
that McMeeking’s causation testimony satisfied the
admissibility requirements of Porter.
   Turning finally to the question of whether Jean-Marie
contracted CMV from the sperm used in the May 11,
2014 IUI procedure, the trial court observed that ‘‘part
of the quandary in evaluating the facts in this case
is that there is no evidence showing that donor [No.]
013673’s sample was infected at the time of insemina-
tion because, consistent with the industry standard, the
samples are not tested, despite an admitted, theoretical
risk’’ of using sperm from a CMV positive donor. The
court noted, however, that an accepted way of establish-
ing causation in negligence actions is by an expert’s
differential diagnosis. The court further noted that, ‘‘[i]n
Connecticut, [p]roof of a material fact by inference from
circumstantial evidence need not be so conclusive as
to exclude every other hypothesis. It is sufficient if the
evidence produces in the mind of the trier a reasonable
belief in the probability of the existence of the material
fact.’’ (Internal quotation marks omitted.)
   Applying this standard and taking into account the
entirety of the record, the trial court found by a prepon-
derance of the evidence that a washed sperm sample
from a CMV positive donor can cause a CMV infection
in a CMV negative patient via an IUI procedure. ‘‘By
that same evidentiary standard, the court further
[found] that the sperm sample from donor [No.] 013673,
more likely than not, caused the CMV infection in [Jean-
Marie and the twins], by either infecting [Jean-Marie]
first, who transmitted the disease later to Shay and
Joshua, or by infecting their oocytes directly, resulting
in their subsequent illnesses.’’ In reaching its determina-
tion, the court stressed that ‘‘any suggestion of ‘commu-
nity spread’ under the facts of the case is purely
speculative and is not based [on] any direct or circum-
stantial evidence proffered.’’
   The trial court further reasoned that the May 11, 2014
IUI procedure, rather than community spread, was the
more probable cause of Jean-Marie’s infection because
(1) more than 90 percent of adult CMV transmissions
involve the exchange of genital fluids, (2) an IUI proce-
dure involves such an exchange, (3) the May 11, 2014
IUI procedure took place within the narrow temporal
window required for the virus to have produced such
catastrophic injuries in Shay and Joshua, and (4) even
assuming there was evidence that Aaron was CMV posi-
tive prior to her pregnancy, ‘‘he produces no semen or
seminal fluid as a [transgender] male, thereby eliminat-
ing one significant medium of intimate, sexual transmis-
sion.’’ With these additional facts in mind, we turn to
the state’s claim.
   We review the trial court’s evidentiary ruling under
Porter for abuse of discretion. See State v. Raynor, 337
Conn. 527, 540–41, 254 A.3d 874 (2020). ‘‘In Porter, this
court followed the United States Supreme Court’s deci-
sion in Daubert v. Merrell Dow Pharmaceuticals, Inc.,
509 U.S. 579, 113 S. Ct. 2786, 125 L. Ed. 2d 469 (1993),
and held that scientific evidence should be subjected
to a flexible test, with differing factors that are applied
on a case-by-case basis, to determine the reliability of
the scientific evidence.’’ State v. Reid, 254 Conn. 540,
545, 757 A.2d 482 (2000). ‘‘A Porter analysis involves a
two part inquiry that assesses the reliability and rele-
vance of the witness’ methods. . . . First, the party
offering the expert testimony must show that the
expert’s methods for reaching his conclusion are reli-
able. A nonexhaustive list of factors for the court to
consider include: general acceptance in the relevant
scientific community; whether the methodology under-
lying the scientific evidence has been tested and sub-
jected to peer review; the known or potential rate of
error; the prestige and background of the expert witness
supporting the evidence; the extent to which the tech-
nique at issue relies [on] subjective judgments made by
the expert rather than on objectively verifiable criteria;
whether the expert can present and explain the data
and methodology underlying the testimony in a manner
that assists the jury in drawing conclusions therefrom;
and whether the technique or methodology was devel-
oped solely for purposes of litigation. . . . Second, the
proposed scientific testimony must be demonstrably
relevant to the facts of the particular case in which it
is offered, and not simply be valid in the abstract. . . .
Put another way, the proponent of scientific evidence
must establish that the specific scientific testimony at
issue is, in fact, derived from and based [on] . . . [sci-
entifically valid] methodology.’’ (Citations omitted;
internal quotation marks omitted.) Fleming v. Dionisio,
317 Conn. 498, 506–507, 119 A.3d 531 (2015).
   ‘‘[C]onsistent with the Daubert test . . . the focus
of a validity assessment must be solely on principles
and methodology, not on the conclusions that they gen-
erate. . . . So long as the methodology underlying a
scientific opinion has the requisite validity, the testi-
mony derived from that methodology meets the Daub-
ert threshold for admissibility, even if the judge
disagrees with the ultimate opinion arising from that
methodology, and even if there are other methodologies
that might lead to contrary conclusions. . . . Accord-
ingly, although the trial court properly serves a gate-
keeper function to ensure that the evidence is
sufficiently reliable . . . it should . . . deem scien-
tific evidence inadmissible only when the methodology
underlying such evidence is . . . incapable of helping
the fact finder determine a fact in dispute.’’ (Citations
omitted; internal quotation marks omitted.) State v.
Kirsch, 263 Conn. 390, 398–99, 820 A.2d 236 (2003).
   Applying these principles, we conclude, first, that
the methodologies underlying McMeeking’s causation
testimony—differential diagnosis and PCR testing—are
not ‘‘the type of ‘junk science’ that Porter is intended
to guard against.’’ Hayes v. Decker, 263 Conn. 677, 689,
822 A.2d 228 (2003). To the contrary, they are two of
the most common and accepted methods for diagnosing
disease, and, as such, they are among the ‘‘well estab-
lished principles of the scientific community to which
Porter simply does not apply.’’ Id. The state does not
contend otherwise.
   Instead, the state contends that McMeeking’s causa-
tion testimony should have been excluded because it
was based on ‘‘a series of factual assumptions that
lacked a reliable scientific and factual basis.’’ The state
argues that ‘‘there was no evidence presented to support
. . . McMeeking’s assumptions that donor [No. 013673]
was . . . shedding [infectious] CMV on the day of his
donation, that [he] shed [it] into [his] semen,’’ and that
the shed virus ‘‘survived the washing process . . . .’’
  The plaintiffs counter that what the state calls imper-
missible ‘‘factual assumptions’’ are in fact reasonable
inferences drawn from the evidence. In their view, what
the state is really arguing is that the plaintiffs were
required to provide direct evidence that the sperm used
to inseminate Jean-Marie contained infectious CMV,
even though the law is clear that causation may be
established through circumstantial evidence. The plain-
tiffs contend that the state’s true challenge is not to the
admissibility of McMeeking’s differential diagnosis, but
to the weight accorded it by the trial court, which is not
a concern of Porter.
   We agree with the plaintiffs that the state’s argument
goes to the weight of McMeeking’s testimony, not its
admissibility.35 See, e.g., Fleming v. Dionisio, supra,
317 Conn. 512 (‘‘the purpose of the Porter hearing is
to ascertain the validity, not the weight, of the methodol-
ogy underlying the proffered scientific evidence’’
(emphasis omitted)); cf. State v. Kirsch, supra, 263
Conn. 398 (‘‘the focus of a validity assessment [under
Porter] must be solely on principles and methodology,
not on the conclusions that they generate’’ (internal
quotation marks omitted)).
  In arguing to the contrary, the state cites six cases
that it contends support the view that McMeeking’s
causation testimony was inadmissible under Porter
because it was ‘‘based on unproven, speculative factual
assumptions.’’ None of the cited cases bears any factual
resemblance to the present case. One case is not even
a Porter/Daubert case. See Bagley v. Adel Wiggins
Group, 327 Conn. 89, 91–92, 171 A.3d 432 (2017). In
four of the remaining cases, the courts merely con-
cluded that the trial court had not abused its broad
discretion in excluding scientific evidence as unreliable.
See Sorensen v. Shaklee Corp., 31 F.3d 638, 650 (8th
Cir. 1994); Klein v. Norwalk Hospital, 299 Conn. 241,
263–65, 9 A.3d 364 (2010); Kairon v. Burnham, 120
Conn. App. 291, 296–97, 991 A.2d 675, cert. denied,
297 Conn. 906, 995 A.2d 634 (2010); E.I. du Pont de
Nemours & Co. v. Robinson, 923 S.W.2d 549, 558–60
(Tex. 1995). In our view, the outcomes in these factually
dissimilar cases are better explained by the deferential
standard of review applied by the courts than by any
similarity between them and the present case. In the
one case in which the court found an abuse of discretion
in the admission of expert testimony; see Tamraz v.
Lincoln Electric Co., 620 F.3d 665, 667 (6th Cir. 2010),
cert. denied, 563 U.S. 988, 131 S. Ct. 2454, 179 L. Ed.
2d 1210 (2011); the expert could ‘‘barely’’ explain his
theory of causation, which he readily ‘‘conceded’’ had
no real basis in science or fact. Id., 670. Suffice it to
say Tamraz does not persuade us that the trial court
in the present case abused its discretion in admitting
McMeeking’s expert opinion.
      The judgment is affirmed.
      In this opinion the other justices concurred.
  1
    Claudio Benadiva, Center for Advanced Reproductive Services, P.C., and
In Vitro Sciences, Inc., were also named as defendants, but the action was
withdrawn as to them prior to trial. In addition, California Cryobank, LLC,
California Cryobank Stem Cell Services, LLC, Cryobank Holdings, LLC, and
California Cryo Reproductive Tissue Services were apportionment defen-
dants in this action but are not parties to this appeal.
    2
      Washing is a process by which live sperm are separated from the donor’s
semen by centrifuge and additives, eliminating much of the white blood
cells, dead cells, and other organic materials that are more likely to harbor
pathogens, including CMV.
    3
      The trial court found that ASRM has issued specific guidelines relative
to the use of CMV positive donor sperm in CMV negative patients ‘‘because
of the significant risk it poses to mother and child. . . . Complying with
ASRM guidelines is required for clinic membership in [the Society for
Assisted Reproductive Technology (SART)]—to which CARS belongs, along
with 86 [percent] of all reproductive medicine clinics in the country. . . .
In order to obtain and keep SART accreditation, clinics are required to
comply with all guidelines and recommendations of the ASRM. . . . Begin-
ning in 2008 and continuing to its latest publication on the topic prior to
the events at issue (2013), the ASRM has recommended that CMV positive
donor sperm be used only for patients who are also CMV positive.’’ (Cita-
tions omitted.)
    4
      CARS required CMV negative patients to sign a form consenting to the
use of CMV positive donor sperm. The consent form asked the patient to
affirm that she understood ‘‘that this [s]perm [d]onor has tested positive
for CMV IgG and that this indicates a previous exposure to [CMV].’’ The
patient was further required to affirm that she had read the accompanying
information pertaining to CMV and understood ‘‘the possible risks to [herself]
and to [her] child of . . . using a ‘CMV [p]ositive’ [s]perm [d]onor.’’ The
consent form provided: ‘‘As the use of sperm from a CMV positive donor,
if you are CMV negative, remains very controversial, we at CARS require
you to discuss this with your physician and sign a waiver if you choose to
use [an] IgG positive donor.’’
    5
      Although sperm banks are required to test their donors’ blood for CMV,
‘‘[t]here is no existing medical, governmental, or industry requirement . . .
that a sperm donor sample used in a TDI procedure be tested for the presence
of CMV. Therefore, there is no direct evidence in the present case that the
sample resulting in . . . Jean-Marie’s pregnancy was either free from or
actually carrying live, infectious CMV.’’ (Footnote omitted.)
    6
      General Statutes (Rev. to 2015) § 4-160 (b) provides in relevant part that
an ‘‘attorney or party filing [a malpractice] claim may submit a certificate
of good faith to the Claims Commissioner in accordance with section 52-
190a. If such a certificate is submitted, the Claims Commissioner shall
authorize suit against the state on such claim.’’
    Hereinafter, all references to § 4-160 are to the 2015 revision of the statute.
    7
      The trial court found in favor of the state on counts six and eight,
which were brought by Aaron and Jean-Marie in their individual capacities,
respectively, and alleged loss of filial consortium as to Shay. The court also
found in favor of the state on count sixteen, which was brought by Aaron
and alleged negligent infliction of emotional distress. The plaintiffs have
not challenged the trial court’s judgment as to these counts.
    8
      Under the award, Joshua was awarded $21,954,176 in economic damages,
$146,495.98 in past medical expenses, and $7,000,000 in noneconomic dam-
ages; Jean-Marie was awarded $18,106.24 in past medical expenses, $500,000
in noneconomic damages, and $2,000,000 for loss of filial consortium as to
Joshua; Aaron was awarded $2,000,000 for loss of filial consortium as to
Joshua; and the estate of Shay was awarded $1,000,000 for loss of life and
$1021 in funeral expenses. On appeal, the state raises no additional claim,
separate from those already identified in this opinion, that damages awarded
to the estate of Shay are otherwise impermissible because Shay died in utero.
    9
      General Statutes (Rev. to 2015) § 4-160 (a) provides: ‘‘When the Claims
Commissioner deems it just and equitable, the Claims Commissioner may
authorize suit against the state on any claim which, in the opinion of the
Claims Commissioner, presents an issue of law or fact under which the
state, were it a private person, could be liable.’’
    10
       General Statutes § 52-190a provides in relevant part: ‘‘(a) No civil action
. . . shall be filed to recover damages resulting from personal injury or
wrongful death occurring on or after October 1, 1987, whether in tort or in
contract, in which it is alleged that such injury or death resulted from the
negligence of a health care provider, unless the attorney or party filing the
action . . . has made a reasonable inquiry as permitted by the circum-
stances to determine that there are grounds for a good faith belief that there
has been negligence in the care or treatment of the claimant. The complaint
. . . shall contain a certificate of the attorney or party filing the action . . .
that such reasonable inquiry gave rise to a good faith belief that grounds exist
for an action against each named defendant . . . . To show the existence
of such good faith, the claimant or the claimant’s attorney . . . shall obtain
a written and signed opinion of a similar health care provider, as defined
in section 52-184c, which similar health care provider shall be selected
pursuant to the provisions of said section, that there appears to be evidence
of medical negligence and includes a detailed basis for the formation of
such opinion. . . .’’
    Although § 52-190a has been amended by the legislature since the events
underlying this case; see Public Acts 2019, No. 19-64, § 16; that amendment
has no bearing on the merits of this appeal. In the interest of simplicity, we
refer to the current revision of the statute.
    11
       The certificate of good faith provided in relevant part: ‘‘I hereby certify
that I have made reasonable inquiry, as permitted by the circumstances, to
determine whether there are grounds for a good faith belief that there has
been negligence in the care and/or treatment of the plaintiffs. This inquiry
has given rise of a good faith belief on my part that grounds exist for an
action against each named defendant. I hereby further certify that the
attached written opinions are from similar health care providers in compli-
ance with . . . § 52-190a.’’
    12
       The state does not claim on appeal that there were any defects in the
certificate of good faith and the physician opinion letters filed in the trial
court in accordance with § 52-190a at the commencement of this action.
    13
       In Jarmie, this court held that ‘‘a cause of action alleging medical
malpractice must be brought by a patient against a health care provider
because the language of [§ 52-190a] specifically provides that the alleged
negligence must have occurred in the care or treatment of the claimant.’’
(Emphasis in original; internal quotation marks omitted.) Jarmie v. Troncale,
supra, 306 Conn. 587.
    14
       For example, the trial court stated that ‘‘the cause of action in the
present matter has been brought sounding in medical malpractice’’ and that
‘‘[t]his matter is pleaded as a medical malpractice claim . . . .’’
    15
       In arguing to the contrary, the state asserts that, because ‘‘[t]he trial
court was clear in its decision that, if the medical providers had obtained
an informed consent, the introduction of the sperm from the donor would
not have violated any medical standard,’’ it necessarily decided the fertility
treatment claims on the basis of a theory of informed consent. We disagree.
Under the plaintiffs’ theory of the case, the state committed medical malprac-
tice by failing to obtain Jean-Marie’s informed consent prior to inseminating
her with sperm from a CMV positive donor. To the extent that the trial court
focused on the issue of informed consent—in particular, what information
Jean-Marie should have received and when she should have received it—
it was only because it was integral to a decision on the merits of the medical
malpractice claims.
    16
       A certificate of good faith is a written statement by the attorney or
person filing a medical malpractice action that he or she has ‘‘made a
reasonable inquiry as permitted by the circumstances to determine that
there are grounds for a good faith belief that there has been negligence in
the care or treatment of the claimant’’ and that ‘‘such reasonable inquiry
gave rise to a good faith belief that grounds exist for an action against each
named defendant . . . .’’ General Statutes § 52-190a (a).
    17
       In 2019, the legislature amended § 4-160 to allow plaintiffs to bypass
the Claims Commissioner altogether and to bring a medical malpractice
action directly to the Superior Court in accordance with § 52-190a. See
Public Acts 2019, No. 19-182, § 4.
    18
       It is also consistent with the legislative purpose behind the good faith
certificate itself, which is merely ‘‘to expedite the disposition of obviously
frivolous medical malpractice actions.’’ Carpenter v. Daar, 346 Conn. 80,
125, 287 A.3d 1027 (2023); see also Wilkins v. Connecticut Childbirth &
Women’s Center, 314 Conn. 709, 736 n.9, 104 A.3d 671 (2014) (purpose of
certificate of good faith is to ‘‘prevent frivolous [medical] malpractice actions
. . . not . . . to serve as a sword to defeat otherwise facially meritorious
claims’’ (citation omitted)). This court recently stated that ‘‘elevating the
opinion letter to a jurisdictional prerequisite of any kind . . . [would allow]
a potential prelitigation defect to defeat a medical malpractice action that
a [fact finder] has deemed meritorious after several years of litigation’’;
Carpenter v. Daar, supra, 123–24; an outcome that is not only unjust but
wholly at odds with the letter’s modest goal of screening out patently frivo-
lous lawsuits. By the same token, § 4-160 (c) evidences the legislature’s
intent not to allow the state to attack the adequacy of a good faith certificate
submitted in accordance with § 4-160 (b), years after the Claims Commis-
sioner deemed it adequate and authorized suit pursuant to the authority
vested in him under that statute.
   19
      As we previously indicated; see footnote 17 of this opinion; after the
commencement of this action, the legislature amended § 4-160 to allow
plaintiffs to bypass the Claims Commissioner and to bring a medical malprac-
tice action directly to the Superior Court in accordance with § 52-190a. See
Public Acts 2019, No. 19-182, § 4.
   20
      We address the state’s claims regarding damages awarded for Shay’s
death in footnote 29 of this opinion.
   21
      The discussion of the state’s claims in this part of the opinion is
addressed to the fertility treatment claims contained in counts one through
ten of the revised complaint. Counts eleven through seventeen, which relate
to the prenatal care claims, raise the more conventional wrongful birth/
wrongful life allegations that the negligent review of the October, 2014
ultrasound test results by the prenatal care providers deprived Jean-Marie
of the opportunity to terminate the pregnancy. Because the trial court struck
count eleven and none of the remaining prenatal care claims is brought on
behalf of Joshua or Shay’s estste, those claims are not at issue.
   22
      Our trial courts are divided on the issue of whether an action for wrongful
life will lie in Connecticut. Compare Quinn v. Blau, Superior Court, judicial
district of Danbury, Docket No. CV-96-325691-S (December 12, 1997) (21
Conn. L. Rptr. 126) (recognizing claim), and Woodruff v. Hoffman, Superior
Court, judicial district of Fairfield, Docket No. 196095 (December 9, 1983)
(same), with Bujak v. State, Superior Court, judicial district of Hartford,
Docket No. CV-XX-XXXXXXX-S (January 15, 2010) (49 Conn. L. Rptr. 221)
(concluding that claim is not cognizable), Rich v. Foye, 51 Conn. Supp. 11,
44, 976 A.2d 819 (2007) (same), and Donnelly v. Candlewood Obstetric-
Gynecological Associates, P.C., Superior Court, judicial district of Danbury,
Docket No. 302096 (June 8, 1992) (6 Conn. L. Rptr. 532) (same).
   23
      The trial court found that it was possible either that implanted sperm
infected Jean-Marie, who then passed the CMV infection to Joshua and Shay,
or that one or both fetuses were infected directly by sperm bearing the
virus and that they then infected Jean-Marie.
   24
      In count one of their revised complaint, which claimed negligent fertility
treatment on behalf of Joshua, the plaintiffs alleged that the state was
negligent in that, ‘‘after inseminating a CMV negative patient with sperm
from a CMV positive donor, it failed to appropriately monitor the patient
during her pregnancy for any signs or symptoms of CMV . . . .’’ The plain-
tiffs made similar allegations in count two, which claimed negligent fertility
treatment as to Shay.
   25
      Section 920 of the Restatement (Second) of Torts provides: ‘‘When the
defendant’s tortious conduct has caused harm to the plaintiff or to his
property and in so doing has conferred a special benefit to the interest of
the plaintiff that was harmed, the value of the benefit conferred is considered
in mitigation of damages, to the extent that this is equitable.’’ 4 Restatement
(Second), Torts § 920, p. 509 (1979).
   26
      In Cochran, this court held that a physician who mistakenly informed
a patient that the patient had tested negative for herpes owed a duty of
care to the patient’s girlfriend, who subsequently and predictably contracted
herpes notwithstanding the physician’s representation. Doe v. Cochran,
supra, 332 Conn. 327–28.
   27
      The state acknowledges that it may be held liable to Jean-Marie for the
costs of her prenatal care, and, at oral argument before this court, it appeared
to acknowledge that, had the claims been cast as wrongful birth rather than
wrongful life claims, Jean-Marie and Aaron might have properly recovered
the costs of Joshua’s care until the age of maturity.
   28
      We note that some tort law scholars have suggested that, because ‘‘mak-
ing whole is not the be-all and end-all of tort law, then there is nothing
necessarily odd (or [untort like]) in courts sometimes recognizing claims
to ‘exemplary’ redress for certain forms of wrongdoing.’’ J. Goldberg, ‘‘Two
Conceptions of Tort Damages: Fair v. Full Compensation,’’ 55 DePaul L.
Rev. 435, 466 (2006); see also id, 435–38 (rejecting modern trend to make
tort victims whole as only conceivable tort compensation method).
   29
      The trial court awarded Shay’s estate $1 million in noneconomic dam-
ages ‘‘for her loss of the gift of life’’ pursuant to the wrongful death statute,
General Statutes § 52-555. The state also challenges this award. Although
it does not analyze Shay’s estate’s award apart from Joshua’s award, the
argument appears to be that a claim for wrongful prenatal death cannot lie
when the fetus would not have been conceived but for the allegedly wrongful
conduct. Because the parties do not contend that different considerations
govern the award of damages to Shay’s estate under the wrongful death
statute, our analysis of the claims regarding Joshua also disposes of the
issues on appeal relating to Shay. We note that the state has not challenged
the conclusion of the trial court, consistent with a line of Superior Court
decisions running from Gorke v. Le Clerc, 23 Conn. Supp. 256, 262, 181
A.2d 448 (1962), through Vecchio v. Rye Brook Obstetrics-Gynecology, P.C.,
Superior Court, judicial district of Stamford-Norwalk, Docket No. CV-01-
0185312 (June 19, 2002) (32 Conn. L. Rptr. 310, 311), that the estate of a
viable fetus that dies in utero may bring a wrongful death claim. We express
no opinion on that issue.
   30
      Differential diagnosis is ‘‘a method of diagnosis that involves a determi-
nation of which of a variety of possible conditions is the probable cause of
an individual’s symptoms, often by a process of elimination.’’ DiLieto v.
County Obstetrics & Gynecology Group, P.C., supra, 297 Conn. 114 n.13.
   31
      The studies McMeeking relied on are described in two peer reviewed
articles entered into evidence at trial. See V. Naumenko et al., ‘‘Detection
and Qualification of Human Herpes Viruses Types 4–6 in Sperm Samples
of Patients with Fertility Disorders and Chronic Inflammatory Urogenital Tract
Diseases,’’ Andrology (September 2014), available at https://onlinelibrary.wiley.
com/doi/epdf/10.1111/j.2047-2927.2014.00232.x (last visited January 30, 2024);
V. Naumenko et al., ‘‘Detection of Human Cytomegalovirus in Motile Sperma-
tozoa and Spermatogenic Cells in Testis Organotypic Culture,’’ Herpesviridae
(June 28, 2011), available at https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3143078/pdf/2042-4280-2-7.pdf (last visited January 30, 2024).
   32
      McMeeking explained, ‘‘professional organizations in this field of fertility
recommend not to give CMV positive semen to CMV negative women. That’s
the first thing; so my assumption is most people follow those recommenda-
tions and don’t do it.’’
   33
      According to the state’s causation expert, Mark Schleiss, ‘‘80 percent
of babies with congenital CMV are asymptomatic; that is to say, they look
normal at birth, they have a normal physical exam, they grow normally,
they develop normally in every way that a pediatrician or a family practitioner
might assess them in the clinic, they seem normal and have a good
prognosis.’’
   34
      Schleiss explained that, ‘‘for a fetus to become infected with CMV, you
need a placenta, you need an exchange of circulation, blood, between the
fetal compartment and the maternal compartment. Those entities are not
well formed in the first few weeks of pregnancy. So, most CMV infections—
all CMV infections to the fetus occur across that bloodstream gradient via
the placenta. So, the likelihood would be that the infection of the fetuses
came later. . . . I think it’s probable that they were infected sometime
between [twelve] and [twenty] weeks.’’
   35
      The state does not claim that there was insufficient evidence to support
the trial court’s finding that the sperm sample from donor No. 013673, more
likely than not, caused the CMV infection that killed Shay and severely
injured Joshua. It is axiomatic that, once the court concluded that McMeek-
ing’s causation testimony satisfied the admissibility requirements of Porter,
it was free to credit all, some, or none of that testimony in reaching a
decision on the plaintiffs’ claims. See, e.g., Companions & Homemakers,
Inc. v. A&B Homecare Solutions, LLC, 348 Conn. 132, 148, 302 A.3d 283
(2023) (‘‘[i]n a case tried before a court, the trial judge is the sole arbiter of
the credibility of the witnesses and the weight to be given specific testimony’’
(internal quotation marks omitted)).