Mayhue v. Sparkman
653 N.E.2d 1384, 1995 WL 440310, 1995 Ind. LEXIS 107 (1995)
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Rule of Law:
In a medical malpractice action where a physician's negligence combines with a pre-existing condition to cause harm, the plaintiff may proceed to a jury by showing that the negligence increased the risk of that harm, allowing the jury to determine if the increased risk was a substantial factor in causing the injury.
Facts:
- In 1981, Norma Sparkman was diagnosed with cervical cancer and received radiation therapy from her gynecologist, Dr. H. Wayne Mayhue.
- Between 1985 and 1988, Mrs. Sparkman received several pap smears from her family physicians which indicated no malignant cells were present.
- On May 18 and 23, 1989, another doctor, Dr. Jordan, performed pap smears that indicated the presence of cancer and referred her back to Dr. Mayhue.
- On May 26, 1989, Mrs. Sparkman informed Dr. Mayhue that her recent tests were abnormal. Dr. Mayhue's own pap smear was 'atypical,' and a pathologist recommended a biopsy, but he attributed the results to inflammation from prior radiation therapy and did not perform one.
- Over the next several months, Mrs. Sparkman's condition did not improve under Dr. Mayhue's care.
- On November 10, 1989, a pap smear performed by Dr. Mayhue finally revealed malignant cells.
- In January 1990, an exploratory surgery revealed that the cancer had spread extensively throughout Mrs. Sparkman's abdominal cavity, making radical surgery impossible. She died in November 1990.
- Expert testimony established that even if Dr. Mayhue had diagnosed the cancer's recurrence in May 1989, Mrs. Sparkman's chance of survival would have been less than fifty percent.
Procedural Posture:
- Charles Sparkman (plaintiff-appellee) filed a medical malpractice suit against Dr. H. Wayne Mayhue (defendant-appellant) in an Indiana trial court.
- A Medical Review Panel issued an opinion that Dr. Mayhue breached the standard of care but that this breach was not a cause of the damages.
- Dr. Mayhue filed a motion for summary judgment in the trial court, arguing that his alleged negligence could not be the proximate cause of death since Mrs. Sparkman's survival chance was under 50%.
- The trial court denied Dr. Mayhue's motion for summary judgment.
- Dr. Mayhue, as appellant, brought an interlocutory appeal to the Indiana Court of Appeals.
- The Court of Appeals affirmed the trial court's denial, adopting a 'pure' loss of chance doctrine.
- Dr. Mayhue, as petitioner, sought, and was granted, transfer to the Supreme Court of Indiana.
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Issue:
Does Indiana law recognize a separate 'loss of chance' doctrine for medical malpractice claims where the patient's chance of survival was already less than fifty percent?
Opinions:
Majority - DeBRULER, Justice.
No. Indiana law does not adopt a separate 'loss of chance' doctrine, but instead applies the framework of the Restatement (Second) of Torts § 323 to analyze causation in such medical malpractice cases. Under the traditional 'more likely than not' standard of proximate cause, a plaintiff cannot recover if the patient's chance of survival was already below 50%, as the pre-existing condition, not the negligence, would be considered the cause-in-fact of the death. However, adopting the Restatement's § 323 approach provides a more just result. This approach allows a plaintiff to get to the jury on the issue of causation by showing that the physician's negligence increased the risk of harm to the patient. Once this is established, it becomes a question for the jury to decide whether the physician's negligence was a 'substantial factor' in producing the ultimate harm. This framework avoids the harshness of the traditional rule without creating an entirely new cause of action for 'loss of chance' and aligns with Indiana's faith in the jury system to resolve complex factual questions.
Analysis:
This decision is significant because it establishes the legal standard in Indiana for medical malpractice cases involving patients with a poor prognosis (less than 50% chance of survival). By rejecting a 'pure' loss of chance doctrine in favor of the Restatement's § 323 'substantial factor' test, the court created a viable path for plaintiffs to overcome summary judgment on the issue of causation. This prevents healthcare providers from being automatically shielded from liability simply because a patient was already very ill. The ruling ensures that cases where a doctor's negligence demonstrably worsens a patient's outcome can be heard by a jury, focusing the inquiry on whether the negligence was a substantial contributing cause, rather than the sole or primary cause, of the harm.
