Scafidi v. Seiler
574 A.2d 398, 119 N.J. 93, 1990 N.J. LEXIS 55 (1990)
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Rule of Law:
In a medical malpractice action involving a patient's pre-existing condition, a plaintiff establishes proximate cause by demonstrating that the defendant's negligence increased the risk of the ultimate harm and that the increased risk was a substantial factor in producing that harm. If causation is proven, damages are limited to the value of the lost chance of recovery attributable to the defendant's negligence.
Facts:
- In July 1982, Jamie Scafidi was in her seventh month of a difficult pregnancy.
- On July 7th, her obstetrician, Dr. Franzoni, noted severe bleeding, warned she was 'threatening abortion,' and prescribed bed rest.
- That afternoon, Scafidi experienced abdominal cramps and spoke on the phone with Dr. Seiler, an associate covering for her regular doctor.
- Scafidi described her symptoms and relayed Dr. Franzoni's earlier warning to Dr. Seiler.
- Without examining her, Dr. Seiler prescribed an oral medication (vasodilian) to 'calm' the uterus and instructed her to call back if cramping intensified.
- Scafidi's cramping continued overnight despite taking the medication.
- The next morning, Dr. Franzoni found her cervix dilated, hospitalized her, and began intravenous tocolytic therapy to stop premature labor, but the treatment was unsuccessful.
- Later that day, Scafidi gave birth to a premature infant who died two days later from respiratory failure.
Procedural Posture:
- The Scafidis (plaintiffs) sued Dr. Seiler (defendant) in a state trial court for medical malpractice resulting in the wrongful death of their infant.
- At trial, plaintiffs requested a jury instruction on causation based on the 'increased risk' standard from Evers v. Dollinger, but the trial court denied the request.
- The trial court instead instructed the jury using the traditional, stricter standard of proximate cause.
- The jury found Dr. Seiler was negligent, but concluded his negligence was not a proximate cause of the infant's death, returning a verdict for the defendant.
- Plaintiffs appealed to the Appellate Division.
- The Appellate Division reversed the trial court's judgment, holding it was a reversible error not to give the 'increased risk' instruction.
- The New Jersey Supreme Court granted certification to review the matter.
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Issue:
In a medical malpractice case involving a pre-existing condition, does a plaintiff establish proximate cause by proving that the defendant's negligence increased the risk of harm and that such increased risk was a substantial factor in producing the ultimate injury?
Opinions:
Majority - Stein, J.
Yes. In cases where a defendant's negligence combines with a plaintiff's pre-existing condition to cause harm, proximate cause is established if the defendant's negligence increased the risk of that harm and the increased risk was a substantial factor in producing the ultimate result. The court reasoned that the traditional 'but-for' causation standard is often inappropriate and confusing in such cases. Adopting the standard from Evers v. Dollinger and the Restatement (Second) of Torts § 323(a), the court held that this 'increased risk' test prevents a healthcare provider from being insulated from liability simply because a patient's chance of a positive outcome was already less than fifty percent. As an essential complement to this relaxed causation standard, the court also adopted the 'lost chance' doctrine for damages. This requires the jury to apportion damages, limiting the defendant's liability to the value of the chance of recovery that was lost due to the negligence, rather than the full value of the ultimate harm.
Concurring - Handler, J.
Yes. Justice Handler agreed with the majority's adoption of the 'increased risk' standard for causation and the apportionment of damages based on the 'lost chance' doctrine. He argued that valuing the 'increased risk' of harm for the purpose of apportioning damages is functionally the same as treating the increased risk itself as a discrete, compensable injury. Building on this logic, he questioned why the ultimate harm must actually occur before a plaintiff can recover. He contended that if the increased risk of future harm can be demonstrated and valued, a plaintiff should be able to recover for that increased risk alone, without having to wait for the feared harm to materialize.
Analysis:
This decision fundamentally altered medical malpractice law by establishing the 'increased risk' or 'lost chance' doctrine in New Jersey. It lowers the burden of proof for causation in cases involving pre-existing conditions, allowing plaintiffs to proceed even if they cannot prove the defendant's negligence was the 'probable' cause of the injury. Simultaneously, it limits damages by requiring apportionment, ensuring defendants are liable only for the value of the chance of recovery they destroyed, not the entire harm. This framework balances the interests of patients in complex medical scenarios against the concern of holding physicians liable for outcomes that may have been inevitable due to the underlying condition.
