McKellips v. Saint Francis Hospital, Inc.
81 A.L.R. 4th 467, 1987 OK 69, 741 P.2d 467 (1987)
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Rule of Law:
In a medical malpractice action, a plaintiff can establish causation by presenting evidence that the defendant's negligence substantially reduced the patient's chance of survival, even if the original chance was less than 50%. Damages in such cases are limited to the value of the lost chance, calculated by multiplying the total wrongful death damages by the percentage of chance lost.
Facts:
- On July 12, 1981, Reverend Allan David McKellips, a sixty-one-year-old man with a family history of heart disease, went to the Saint Francis Hospital emergency room.
- McKellips complained of pain over his breastbone that radiated to both sides of his chest.
- Dr. George B. Caldwell, the attending physician, examined McKellips and diagnosed his condition as gastritis.
- Based on this diagnosis, Dr. Caldwell released McKellips from the hospital at approximately 4:15 p.m. the same day.
- Shortly after being released, McKellips suffered a cardiac arrest.
- McKellips was returned to the hospital where he was pronounced dead at 9:30 p.m.
Procedural Posture:
- The family of Reverend Allan David McKellips sued Saint Francis Hospital, Inc., Emergency Care, Inc., and Dr. George B. Caldwell in the United States District Court for the Northern District of Oklahoma for wrongful death.
- At trial, the plaintiffs' expert witness testified that the defendants' negligence 'unquestionably' and 'significantly' reduced McKellips' chance of survival but could not quantify it.
- After the plaintiffs presented their case, the defendants moved for a directed verdict, arguing the plaintiffs had failed to establish causation.
- The federal district court granted the defendants' motion for a directed verdict.
- The plaintiffs, as appellants, appealed the district court's decision to the United States Court of Appeals for the Tenth Circuit.
- The Tenth Circuit certified two questions of state law concerning the 'loss of chance' doctrine to the Supreme Court of Oklahoma.
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Issue:
In a medical malpractice action where a patient had a less than 50% chance of survival, may a plaintiff establish causation by showing that a healthcare provider's negligence substantially lessened that chance, even if the expert cannot quantify the specific percentage of the reduction?
Opinions:
Majority - Hodges, Justice
Yes. Oklahoma adopts the 'loss of chance' doctrine, which allows a plaintiff in a medical malpractice case to establish a jury question on causation by showing that the defendant's negligence substantially reduced the patient's chance of survival. This approach, derived from the Restatement (Second) of Torts § 323, applies even when the patient's initial chance of survival was less than 50%. The traditional 'more likely than not' standard of causation is too rigid in cases where a healthcare provider's duty is to prevent the very harm that occurs, and their negligence makes it impossible to know if a better outcome was possible. Adhering to the old rule would immunize providers from liability for even gross negligence in cases involving critically ill patients. Expert testimony stating that a patient's chances were 'significantly improved' by proper care is sufficient to submit the issue to a jury, without needing a specific percentage. The jury must then determine if the increased risk was a substantial factor in causing the harm. However, damages must be apportioned to reflect only the value of the chance that was lost due to the provider's negligence.
Analysis:
This decision formally adopts the 'loss of chance' doctrine in Oklahoma, aligning the state with a growing majority of jurisdictions and significantly altering medical malpractice litigation. By lowering the burden of production for causation, the ruling makes it easier for plaintiffs in cases involving pre-existing conditions to survive summary judgment and reach a jury. The court's adoption of a proportional damage formula balances the interests of plaintiffs and defendants by ensuring that recovery is tied directly to the harm—the lost opportunity—rather than the full value of the patient's life, which could constitute a windfall. This framework provides a new avenue for recovery in complex medical cases while deterring negligence in the treatment of critically ill patients.
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