Ehlinger v. Sipes
454 N.W.2d 754, 155 Wis. 2d 1, 1990 Wisc. LEXIS 233 (1990)
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Rule of Law:
In a medical malpractice action for negligent failure to diagnose, a plaintiff satisfies the burden of production on causation by introducing evidence that the omitted treatment was intended to prevent the resulting harm, that the patient would have submitted to it, and that it is more probable than not that the treatment could have lessened or avoided the plaintiff's injury.
Facts:
- Carol Ehlinger was under the care of Dr. Sipes for her second pregnancy.
- During the pregnancy, Mrs. Ehlinger felt more fatigued, suffered back pains, and was noticeably larger than during her first pregnancy.
- She communicated these symptoms to Dr. Sipes and directly asked if she might be carrying twins.
- Dr. Sipes dismissed her concerns and did not perform an ultrasound, which would have revealed the multiple pregnancy.
- Mrs. Ehlinger gave birth prematurely at thirty-two weeks to twin boys, Kurt and Cory.
- The twins' premature birth was not known to be a multiple pregnancy until delivery.
- As a result of being born prematurely, Kurt developed spastic quadriplegia and Cory suffered severe hearing loss.
- Dr. Sipes acknowledged that a multiple pregnancy is high-risk and that a different course of treatment, such as bedrest and stress reduction, is used to prevent premature delivery in such cases.
Procedural Posture:
- The Ehlingers sued Dr. Sipes in the circuit court for Oconto county, the trial court of first instance.
- At the close of the Ehlingers' case at trial, the circuit court granted Dr. Sipes' motion to dismiss for insufficiency of the evidence on causation.
- The Ehlingers (appellants) appealed to the Wisconsin Court of Appeals.
- The Court of Appeals, an intermediate appellate court, reversed the trial court's dismissal and remanded the case for a new trial.
- Dr. Sipes (petitioner) sought review from the Supreme Court of Wisconsin, the state's highest court, which granted the petition.
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Issue:
Does a plaintiff in a medical malpractice case for negligent failure to diagnose present sufficient evidence of causation to reach the jury by showing that the omitted treatment could have lessened or avoided the harm, even without proving that it more probably than not would have done so?
Opinions:
Majority - Day, J.
Yes. In a case where a causal link can only be inferred, a plaintiff satisfies the burden of production on causation by showing the omitted treatment was intended to prevent the harm that occurred and could have lessened or avoided it. The court rejected the 'all or nothing' approach, which would require the plaintiff to prove that proper treatment more probably than not would have been successful. Requiring a plaintiff to prove a negative—what would have happened had the defendant not been negligent—is an impossible burden that requires speculation. Instead, the plaintiff must only show that the omitted treatment was intended to prevent the very harm that resulted, that the plaintiff would have accepted the treatment, and that it is more probable than not the treatment could have lessened or avoided the injury. This evidence is sufficient to allow a jury to determine if the defendant's negligence was a 'substantial factor' in causing the harm.
Concurring - Steinmetz, J.
Yes. A plaintiff is not required to prove that the outcome would have been different if non-negligent care had been provided. Under the substantial factor test, showing that the doctor's negligence deprived the patient of the opportunity for proper medical care is sufficient proof that the negligence increased the risk of harm. This 'lost opportunity' evidence is enough to create a jury issue on causation.
Analysis:
This decision significantly lowers the causation burden for plaintiffs in 'lost chance' medical malpractice cases in Wisconsin, moving the state away from the harsh 'all or nothing' rule. By allowing the causation question to reach the jury on a showing that treatment could have helped, the court makes it easier for plaintiffs to survive motions to dismiss and hold healthcare providers accountable for diagnostic errors. The ruling establishes a more plaintiff-friendly precedent that recognizes the inherent uncertainty created by a defendant's negligence and refuses to let that uncertainty bar recovery completely.
