Alexander v. Scheid
726 N.E.2d 272, 2000 WL 343808, 2000 Ind. LEXIS 248 (2000)
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Rule of Law:
A plaintiff in a medical malpractice action may bring a claim for an increased risk of future harm, such as a decreased life expectancy, as a present and compensable injury. This "loss of chance" is recognized as the injury itself, and the plaintiff does not need to wait for the ultimate harm to materialize to recover damages.
Facts:
- In June 1993, Dr. D. Kevin Scheid ordered a pre-surgery chest x-ray for his patient, sixty-year-old JoAnn Alexander.
- The x-ray revealed a 'density' in her right lung, and the radiologist's report recommended further comparison with old films.
- The report was delivered to Dr. Scheid's office and placed in Alexander's chart, but neither Dr. Scheid nor his staff informed Alexander of the findings or took any follow-up action.
- In the spring of 1994, Alexander began spitting up blood and consulted another physician.
- In May 1994, she was diagnosed with non-small cell lung cancer which had progressed from what experts believed was Stage I to Stage IIIa and had metastasized.
- This 10-month delay in diagnosis reduced Alexander's probability of long-term survival from an estimated 60-80% to an estimated 10-30%.
- After undergoing extensive chemotherapy and radiation, Alexander's cancer went into remission in approximately October 1994.
Procedural Posture:
- JoAnn and Jack Alexander filed a proposed medical malpractice complaint with the Indiana Department of Insurance on December 22, 1994.
- The Medical Review Panel issued a unanimous opinion that Dr. Scheid and Orthopaedics Indianapolis failed to comply with the appropriate standard of care, and this failure was a factor in the resultant damages.
- On October 8, 1996, the Alexanders filed a complaint in Marion Superior Court (trial court) against Dr. Scheid and Orthopaedics Indianapolis.
- The defendants moved for summary judgment, arguing that because JoAnn's cancer was in remission, she had suffered no present compensable injury.
- The trial court granted the defendants' motion for summary judgment.
- The Alexanders (appellants) appealed to the Indiana Court of Appeals, which affirmed the trial court's ruling.
- The Alexanders (appellants) then petitioned for transfer to the Supreme Court of Indiana.
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Issue:
Does Indiana law recognize a claim for medical malpractice based on an increased risk of future harm and decreased life expectancy (i.e., "loss of chance") as a present, compensable injury, even if the ultimate harm has not yet occurred?
Opinions:
Majority - Boehm, J.
Yes. A patient may maintain a cause of action in negligence for an increased risk of harm, which can be described as a decreased life expectancy or the diminished probability of long-term survival. The court reasoned that 'loss of chance' is better understood as a description of the injury itself rather than a new cause of action or a modification of the causation element. The court held that a significant reduction in the probability of survival is a very real and serious injury that should not go uncompensated simply because the ultimate harm—death—has not yet occurred. Forcing a plaintiff to wait until a relapse may bar the claim entirely under Indiana's occurrence-based statute of limitations. The court also held that Alexander satisfied the modified impact rule for negligent infliction of emotional distress, reasoning that the unchecked growth of the tumor and destruction of healthy lung tissue constituted the required 'direct impact' caused by the defendants' negligence.
Analysis:
This decision formally recognizes the 'loss of chance' doctrine in Indiana not as a theory of causation but as a compensable injury in itself. It allows plaintiffs to recover for a statistically significant reduction in their likelihood of a better medical outcome, even if the ultimate harm is not yet certain. This prevents a perverse result where a defendant's negligence causes substantial, life-altering harm (a decreased chance of survival) that would otherwise go uncompensated until it is too late. The ruling also broadens the application of the 'modified impact rule' for emotional distress claims, finding that the internal progression of a disease, worsened by a failure to diagnose, constitutes a sufficient physical impact.
