Court Opinion

ID: 9656582
Source: CourtListenerOpinion
Date Created: 2023-08-23 19:51:43.797889+00
Date Added: 2024-06-11T18:13:33.378191
License: Public Domain

KELLER, Justice,
Concurring in Part and Dissenting in Part.
[T]he termination of pregnancy involves controversial and divisive social issues. Nonetheless, the Supreme Court of the United States has held that a woman has a constitutionally secured right to terminate a pregnancy. It follows from Roe that the plaintiff [mother] may seek, and the defendants may provide, information and advice that may affect the exercise of that right. The basic social and constitutional issue underlying this case has been resolved; we need not cover ground already traveled by a court whose interpretation of the National Constitution binds us. Today we decide only whether, given the existence of the right of choice recognized in Roe, our common law should allow the development of a duty to exercise care in providing information that bears on that choice.1
In Kentucky, a medical malpractice action is merely a “branch of [the] well traveled road [of common law negligence],”2 and a medical malpractice plaintiff must demonstrate the same prima facie case— *694consisting of duty, breach, causation, and injury — required in any negligence case. Thus, a medical malpractice plaintiff must “prove that the treatment given was below the degree of care and skill expected of a reasonably competent practitioner and that the negligence proximately caused injury[.]”3 The Court of Appeals below concluded that, of the various tort claims presented in these combined appeals, the only timely-filed tort claim for which a prima facie case was supported by the evidence— and thus the only tort claim appropriate for jury resolution — was Gretchen and Daniel Bogan’s (“the Bogan parents” ’) allegation that their physicians negligently interfered with their reproductive rights when they deprived them of information necessary to make an informed decision whether to carry the fetus to term by incorrectly interpreting an ultrasound examination and failing to perform additional prenatal testing. A majority of this Court concedes that “the claims should be analyzed under traditional negligence principles”4 and concludes that a jury could reasonably determine that the Bogans’ physicians breached a duty of care by “misdiagnosi[ng] or withholding ... medical information regarding the pregnancy!.]”5 A majority of this Court concludes, however, that none of the plaintiffs in these combined appeals can demonstrate a cognizable legal injury and therefore holds that the trial courts should have granted summary judgment for the defendants as to all of the tort claims against them. Although I agree with the majority’s conclusion that the claims brought on behalf of Carlei Grubbs and Nathan Bogan do not demonstrate an injury for which a recovery is available in tort, I would hold that a viable jury issue exists as to the Bogan parents’ claim in their complaint that the defendants’ negligence “deprived [them] of the opportunity to make informed decisions as to whether to seek treatment or terminate the pregnancy.” Accordingly, I agree with the Court of Appeals’s holding in its entirety, and I thus dissent from the majority opinion to the extent that I would reverse the trial court’s partial summary judgment against the Bogan parents and remand the Bogan parents’ negligence action for trial in the Pike Circuit Court. In my opinion, if a jury finds one or more of the defendants liable to the Bogan parents, the trial court should permit the Bogan parents to recover for any of the elements of damages listed in the complaint that are supported by the evidence at trial.
In my view, the majority and concurring opinions suffer from a common analytical flaw. Perhaps misled by the confusing “wrongful birth” label6 that is often at*695tached to such claims, the justices who today deny the Bogan parents’ claim do so under a skewed analysis that improperly conflates the claimants’ injury allegation with their ultimate claims for damages. The majority and concurring opinions mis-characterize the Bogan parents’ legal injury as Nathan Bogan’s very existence7 when, in fact, the plaintiffs allege that they suffered legal injury from the physicians’ “negligent invasion of the parental right to decide whether to avoid the birth of a child with congenital defects.”8 Stated otherwise, while both the majority and concurring opinions attempt to frame the relevant issue before us as whether Nathan Bogan’s life can constitute a legal injury in the context of a prima facie case for medical malpractice, “we need not find that ‘life, even life with severe defects,’ constitutes a legal injury in order to recognize the ... claim for relief’9 because “[t]he resulting injury to the plaintiff parents lies in their being deprived of the opportunity to make an informed decision to terminate the pregnancy[.]”10 The Supreme Court of New Jersey recently discussed the theoretical basis for a medical malpractice claim in this context and explained that, although one facet of a plaintiffs compen-sable damages in such cases may consist of extraordinary costs associated with the care and education of a child with birth-defect-related disabilities, those damages are available only because they are the result of a physician’s violation of the patient’s right to make an informed procreative decision:
A wrongful birth cause of action is predicated on a woman’s right to determine for herself whether or not to continue or terminate her pregnancy. Persons “have a right of then- own either to accept or reject a parental relationship, and the deprivation of that right by the negligent misconduct of another creates a cause of action in the parents.” The right protects a distinctly personal interest.
The violation of the interest in self-determination that undergirds a wrongful birth cause of action consists of the parents’ lost opportunity to make the personal decision of whether or not to give birth to a child who might have birth defects. The claim in a wrongful birth action can arise when a physician fails to provide adequate genetic counseling, fails to detect a discoverable fetal defect or to inform the parents thereof, fails to interpret test results properly, or fails to warn of a child being born with a defect.
Because the patient’s protectable interest is the personal right of self-determination, the doctor’s duty of disclosure *696must be sufficient to enable her to make an informed and meaningful decision concerning whether or not to continue the pregnancy.
Compensable damages in a wrongful birth case include the emotional injury of the parents caused by the deprivation of “the option to accept or reject a parental relationship with the child .... ” These damages also include the special medical expenses attributable to raising a child with a congenital impairment. Damages, however, do not encompass the birth defect or congenital impairment itself.11
Once the plaintiffs’ injury is properly conceptualized as an invasion of their reproductive autonomy, the majority’s con-elusion that “a life cannot be an injury” is not relevant to an evaluation of the merits of their cause of action.12 There is “no reason to hold that as a matter of law those who act negligently in providing [prenatal] care cannot cause harm”13 because “[s]uch a holding would ‘leave[] a void in the area of recovery for medical malpractice and dilute[] the standard of professional conduct’ in a growing and increasingly important professional field.”14 In addition, a correct understanding of the plaintiff’s legal injury: (1) exposes as non sequitur any concern about the inability to demonstrate a causal link between a physician’s negligence and the child’s abnormalities; 15 (2) helps to illustrate the types of damages that are available in such cases;16 *697and (3) demonstrates that the trial court correctly dismissed the Grubbs parents’ claim under KRS 413.140(l)(e) because it was filed more than one year after the plaintiffs discovered, prior to Carlei’s birth, that their physicians had failed to inform them of Carlei’s disabilities in time for them to make an election whether to terminate the pregnancy.17
“The law of Kentucky permits ‘[o]ne injured by the negligence of another ... to recover of him full compensation for all damages proximately caused from the negligence.’ ”18 In their complaint, the Bogan parents sought compensation for: (1) pain and suffering and permanent scarring that Gretchen Bogan suffered as a result of the emergency caesarian section required to effect Nathan’s delivery;19 (2) “[pjresent and future damages relating to the cost of reasonable and necessary medical expenses, special care, and treatment for Nathan; (3) emotional suffering caused by the afflictions of Nathan”; and (4) “[l]ost wages and expenses due to the need for one or both of Gretchen Bogan or Daniel Bogan to help care for Nathan[.]” Today, by misconstruing the nature of the Bogan parents’ claim and holding, in effect, that no parent in the Bogans’ position can demonstrate an injury necessary to prove a prima facie case for medical negligence, this Court’s holding will prevent future parents in this position from recovering any tort damages for their physicians’ negligence.
I question the relevance of the majority’s observation that a divergence of opinion exists as to the proper measure of damages in such cases. I can find no warrant for the implicit suggestion that this Court must await nationwide “consensus” before we evaluate the compensation due to an injured Kentucky plaintiff. In any event, however, I would observe that in cases such as the one at bar “almost all courts have allowed the parents to recover against a negligent physician the extraordinary medical, educational, and other expenses that are associated with and are consequences of the disorder.”20 Allowing *698the recovery of extraordinary expenses associated with the defect avoids the philosophical objections to weighing quality of life and is consistent with public policy:
The economic burden related solely to the physical defects of the child is a different matter which is free from the above objection [that courts cannot “measure life with defects against no life at all].” These expenses he within the methods of proof by which courts are accustomed to determine awards in personal injury cases. No public policy obstacle should be interposed to that recovery. It is impossible for us to justify a policy which at once deprives the parents of information by which they could elect to terminate the pregnancy likely to produce a child with a defective body, a policy which in effect requires that the deficient embryo be carried to full gestation until the deficient child is born, and which policy then denies recovery from the tort-feasor of costs of treating and caring for the defects of the child.21
Although different jurisdictions have adopted different approaches to the recovery of emotional damages in such cases, a reasonable argument can be made that at least Gretehen Bogan could satisfy Kentucky’s physical contact requirement for emotional damages recovery.22 Finally, the Bogan parents’ lost wages and other damages should be recoverable even under existing precedent.23 Thus, I would allow the Bogan parents’ claim to proceed to trial, and would permit them to recover any of the items of damages named in their complaint.
I will conclude this dissent where I began — by observing that the issue before us does not “requir[e] our decision of the public policy either for or against abortion.”24 Regardless of one’s personal beliefs concerning the propriety or morality of eugenic abortion procedures, “[u]nder Roe, prospective parents may have constitutionally cognizable reasons for avoiding the emotional and pecuniary burdens that attend the birth of a child suffering from birth defects,”25 and “[t]hose who do not wish to undertake the many burdens associated with the birth and continued care of such a child have the legal right ... to terminate their pregnancies.”26 The ma*699jority and concurring opinions do not, of course, dispute the fact that under existing precedent the right of privacy found in the United States Constitution protects parents’ reproductive choices. Nonetheless, by characterizing a parent’s decision to terminate a pregnancy as elimination of the “unfit” or “defective” and alluding to Nazi-style eugenics programs, the majority and concurring opinions step outside the judiciary’s proper role and inappropriately volunteer personal opinions regarding the morality of the choices that the Grubbs and Bogan parents say they would have made if their physicians had fully informed them. Moreover, the “tyranny of the slippery slope” argument implicitly referenced in today’s concurring opinion27 is by no means the exclusive province of those who trumpet the sanctity of life. As a countervailing perspective, I would offer Margaret Atwood’s The Handmaid’s Tale28 as a powerful vision of the dystopia that could exist in a world where citizens’ individual rights of procreative freedom are completely disregarded. In any event, “[t]he fact that this particular claim involves some moralistic and social overtones having to do with contraception and childbirth should not be permitted to become the handmaiden for the destruction of our established notions of tort law.”29 Issues like the one at bar are unquestionably difficult, but they demand careful analysis within the framework of the law. Personal ideology, which only adds to the difficulty by breeding additional and unnecessary divisiveness at the expense of the legal questions before us, simply has no place in this analysis.
STUMBO, J., joins.

. Smith v. Cote, 128 N.H. 231, 513 A.2d 341 (1986) (citation omitted).

. Farmers Bank & Trust Co. v. Rice, Ky., 674 S.W.2d 510, 511 (1984).

. Reams v. Stutler, Ky., 642 S.W.2d 586, 588 (1982). See also Mitchell v. Hadl, Ky., 816 S.W.2d 183, 185 (1991).

. Grubbs v. Barbourville Family Health Center, P.S.C., Ky., 120 S.W.3d 682 at 687 (2001).

. Id. at 688. Later, however, the majority opinion expresses reservations about the scope of potential liability. Id. at 690 (“If we held otherwise, there would be questions regarding which incurable birth defects, left negligently undiagnosed from prenatal diagnostic procedures, should warrant recovery.”). In response, I would observe that such concerns should be allayed by defining the physician's duty in terms of the reasonably prudent patient’s expectations. See Canesi v. Wilson, 158 N.J. 490, 730 A.2d 805, 816 (1999).

.See Viccaro v. Milunsky, 406 Mass. 777, 551 N.E.2d 8, 9 (1990):
These labels [wrongful life/birth/conception/pregnancy] are not instructive. Any "wrongfulness” lies not in the life, the birth, the conception, or the pregnancy, but in the negligence of the physician. The harm, if any, is not the birth itself, but the effect of the defendant's negligence on the parents’ physical, emotional, and financial well-being resulting from the denial of the *695parents of their right ... to decide whether to bear a child or whether to bear a child with a genetic or other defect.
See also Greco v. Untied States, 111 Nev. 405, 893 P.2d 345, 348 n. 5 (1995) (explaining that "wrongful life" was originally a play on the statutory wrongful death action and recognizing the observation that "the net effect of these terms has been to 'spawn confusion’ and distort or impair judicial vision."); Lininger v. Eisenbaum, 764 P.2d 1202, 1204 (Colo.1988) ("The use of the term[] ... 'wrongful birth' more often serves to obscure the issues than to elucidate them.").

. Grubbs v. Barbourville Family Health Center, P.S.C., supra at 689 ("[W]e are unwilling to equate the loss of an abortion opportunity resulting in a genetically or congenitally tin-paired human life, even severely impaired with a cognizable legal injury." (emphasis added)); Id. (Wintersheimer, J., concurring) at 693 ("It is also clear that any claim for wrongful birth should not be recognized because it requires that life itself constitute some kind of legal injury.”).

. Smith v. Cote, supra note 1 at 348.

. Lininger v. Eisenbaum, supra note 6 at 1206.

. Garrison v. Medical Center of Delaware, Inc., 581 A.2d 288, 289 (Del.1989).

. Canesi v. Wilson, supra note 5 at 810-811 (citations omitted). See also Smith v. Cote, supra note 1 at 348 ("Although it involves an allegation of medical malpractice, it is not a claim arising from physical injury. It is instead based on a negligent invasion of the parental right to decide whether to avoid the birth of a child with congenital defects.”).

. See Bader v. Johnson, 732 N.E.2d 1212 (Ind.2000):
[In Cowe v. Forum Group, Inc., 575 N.E.2d 630, 633 (Ind.1991)] we were unwilling to allow a child plaintiff to proceed with this cause of action, in part because it involved "a calculation of damages depen-dant upon the relevant benefits of an impaired life as opposed to no life at all ... a comparison the law is not equipped to make.” Here, however, the injury is the lost opportunity and ability to terminate the pregnancy. Failure to allow the [plaintiffs] to proceed with their claim would "immunize those in the medical field from liability for their performance in one particular area of medical practice.” (citations omitted).

. Smith v. Cote, supra note 1 at 347.

. Id. (citation omitted).

. See Greco v. United States, supra note 6 at 349:
We also reject the ... argument that [plaintiff mother's] physicians did not cause any of the injuries that [she] might have suffered. We note that the mother is not claiming that her child’s defects were caused by her physician's negligence; rather, she claims that her physician’s negligence kept her ignorant of those defects and that it was this negligence which caused her to lose her right to choose whether to carry the child to term.
See also Canesi v. Wilson, supra note 5 at 818 ("The appropriate proximate cause question, therefore, is not whether the doctor's negligence caused the fetal defect; the congenital harm suffered by the child is expressly not compensable. Rather, the determination to be made is whether the doctors' inadequate disclosure deprived the parents of their deeply personal right to decide for themselves whether to give birth to a child who could possibly be afflicted with a physical abnormality.”); Keel v. Banach, 624 So.2d 1022, 1029 (Ala.1993) ("The nature of the tort of wrongful birth has nothing to do with whether a defendant caused the injury or harm to the child, but, rather, with whether the defendant’s negligence was the proximate cause of the parents' being deprived of the option of ... making an informed and meaningful decision either to terminate the pregnancy or to give birth to a potentially defective child.”).

.See Smith v. Cote, supra note 1 at 348 ("When parents are denied the opportunity to make this decision, important personal interests may be impaired, including an interest in avoiding the special expenses necessitated by *697the condition of a child born with defects

. Although the Grubbs parents did not know the full extent of their damages at this time, they were aware of their legal injury at the hands of their physicians, and the statute of limitations began running upon that discovery. KRS 413.140(2) ("[T]he cause of action shall be deemed to accrue at the time the injury is first discovered or in the exercise of reasonable care should have been discovered[.]”); Wiseman v. Alliant Hospitals, Inc., Ky. 37 S.W.3d 709, 712 (2001) (“ ‘Injury,’ ... is defined as ‘the invasion of any legally protected interest of another.' Thus, injury in the medical malpractice context refers to the actual wrongdoing, or the malpractice itself. ... Under the discovery rule, it is the date if the actual or constructive knowledge of the injury which triggers the running of the statute of limitations.”).

. Smith v. McMillan, Ky., 841 S.W.2d 172, 175 (1992) (quoting Field Packing Co. v. Denham, 342 S.W.2d 524, 526 (1961)).

. Although the majority’s ultimate holding is that the Bogan parents cannot prove a prima facie negligence case because they cannot demonstrate a cognizable legal injury, the majority acknowledges the law of the case implications present in the case at bar, which arose from the Bogan plaintiffs' appeal from the trial court’s final order that had granted partial summary judgment to the defendants, but denied summary judgment as to this particular claim for damages. Accordingly, the majority remands the Bogan appeal to the trial court for "adjudication of their claim for pain and suffering and permanent scars suffered in connection with the caesarean section delivery,” Grubbs v. Barbourville Family Health Center, P.S.C., supra at 691.

. Viccaro v. Milunsky, supra note 6 at 10 (collecting cases). See also James G. v. Caseria, 175 W.Va. 406, 332 S.E.2d 872, 882 (1985) (collecting cases and observing that "[i]t is generally recognized that in a wrongful birth action, parents may recover the extraordinary costs necessary to treat the birth defect and *698any additional medical or educational costs attributable to the birth defect[J” (emphasis added)).

. Jacobs v. Theimer, 519 S.W.2d 846, 849 (Tex.1975). See also Smith v. Cote, supra note 1 at 349 (explaining that the "extraordinary expenses only” remedy is premised on expectation damages authorized under contract law and avoids a windfall without requiring application of the benefit rule); Lininger v. Eisenb-aum, supra note 6 at 1207.

. Deutsch v. Shein, Ky., 597 S.W.2d 141 (1980). See also Bader v. Johnson, supra note 12 at 1222.

. See Schorlc v. Huber, Ky., 648 S.W.2d 861 (1983) (denying recovery for "damages based on the costs of raising a healthy but unexpected child ... following an unsuccessful sterilization procedure,” in an appeal from a partial summary judgment that permitted the plaintiffs to proceed with other damage claims, e.g., "the mother's medical expenses, pain and suffering, and loss of earnings in connection with the child's birth.”); Maggard v. McKelvey, Ky.App., 627 S.W.2d 44, 48 (1982) (holding, in a medical malpractice case involving an unwanted birth following a negligent vasectomy procedure, that "the damages are limited to the general and special damages incidental to the pregnancy and birth, such as, pain and suffering, loss of consortium, medical and hospital expenses, and loss of wages.”).

. Jacobs v. Theimer, supra note 21 at 848.

. Smith v. Cote, supra note 1 at 347.

. Greco v. United States, supra note 6 at 349.

.Grubbs v. Barbourville Family Health Center, P.S.C., supra at 692 (Wintersheimer, J., concurring) (“If logically extended, it could produce a culture that condones the extermination of the weak by the strong or the more powerful.” (emphasis added)).

. M. ATWOOD, THE HANDMAID’S TALE (1986).

. Beardsley v. Wierdsma, 650 P.2d 288, 293 (Wyo.1982) (Rose, C.J., concurring specially).