Dughaish Ex Rel. Dughaish v. Cobb
2000 WL 576489, 2000 Ind. App. LEXIS 713, 729 N.E.2d 159 (2000)
Premium Feature
Subscribe to Lexplug to listen to the Case Podcast.
Rule of Law:
In a medical malpractice action, the 'increased risk of harm' standard for causation applies only in cases where a patient's pre-existing condition already resulted in a less than 50% chance of recovery. In all other cases, the traditional standard of proximate cause must be used.
Facts:
- In 1971, Laura Dughaish gave birth to her first child, who weighed eight pounds fourteen ounces, qualifying as a macrosomic (large) infant.
- In 1986, Laura became pregnant with her second child, Sabría, and was under the care of obstetrician Dr. Donald Cobb.
- During the pregnancy, Dr. Cobb did not perform a glucose test to screen Laura for gestational diabetes, a condition that can lead to having a large baby.
- On May 9, 1987, Laura was admitted to the hospital to deliver Sabría, and Dr. Cobb induced labor.
- During the delivery, Sabría's head was delivered with forceps, but then her shoulder became stuck behind Laura's pubic bone, a complication known as shoulder dystocia.
- Sabría was born weighing eleven pounds and thirteen ounces, making her a macrosomic infant.
- As a result of the shoulder dystocia, Sabría suffered several injuries, including a brachial plexus palsy injury (Erb's Palsy), a fractured collarbone, and bruises.
Procedural Posture:
- The Dughaish family (plaintiffs) filed a proposed complaint with the Indiana Department of Insurance.
- A Medical Review Panel issued an opinion that Dr. Cobb failed to comply with the standard of care but that it was not possible to determine if this failure was a factor in the resultant damages.
- The plaintiffs filed a medical malpractice complaint against Dr. Cobb in the Vanderburgh Superior Court (trial court).
- Following a trial, the jury returned a verdict in favor of the defendant, Dr. Cobb.
- The plaintiffs filed a Motion to Correct Errors with the trial court, requesting relief under Indiana Trial Rules 50 and 59.
- The trial court denied the plaintiffs' Motion to Correct Errors.
- The plaintiffs, as appellants, appealed the denial of their motion to the Court of Appeals of Indiana, with Dr. Cobb as the appellee.
Premium Content
Subscribe to Lexplug to view the complete brief
You're viewing a preview with Rule of Law, Facts, and Procedural Posture
Issue:
Does the lesser 'increased risk of harm' standard of causation, rather than the traditional proximate cause standard, apply in a medical malpractice case alleging that a doctor's failure to test for gestational diabetes led to injuries during a difficult birth?
Opinions:
Majority - Robb, J.
No, the traditional proximate cause standard applies. The 'increased risk of harm' standard is a narrow exception reserved for a specific class of plaintiffs: those who, due to a pre-existing illness or injury, already had a less than 50% chance of recovery. In such cases, traditional proximate cause would be impossible to prove, as the pre-existing condition was already the more likely cause of the negative outcome. The Dughaish case does not fit this scenario. The plaintiffs' claim is a classic negligence argument positing a direct causal chain: the failure to test for gestational diabetes led to a failure to anticipate a macrosomic infant, which led to a vaginal delivery instead of a caesarean section, which proximately caused Sabría's injuries. Because the plaintiffs' theory of liability fits within the traditional 'natural and probable consequence' framework of proximate cause, the trial court correctly instructed the jury on that standard.
Analysis:
This decision clarifies and narrows the application of the 'increased risk of harm' doctrine (from Restatement (Second) of Torts § 323, adopted in Mayhue v. Sparkman) in Indiana medical malpractice law. It establishes that this doctrine is not a general alternative to proximate cause but is an exception specifically for 'loss of chance' cases where a patient's prognosis was already poor. By restricting the doctrine's use, the court reinforces the high bar of traditional proximate cause for most malpractice claims, preventing plaintiffs from using a lower burden of proof for causation outside of the specific context for which the exception was created. This holding ensures that the traditional tort principle—requiring a direct causal link between negligence and injury—remains the default rule.
