Smith v. Providence Health & Services - Oregon
361 Or. 456, 393 P.3d 1106 (2017)
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Rule of Law:
In Oregon, a common-law medical malpractice claim is cognizable when a defendant's negligence causes a patient to lose a substantial chance of a better medical outcome, even if the original chance of recovery was less than 51 percent. The 'loss of chance' itself is recognized as the legal injury.
Facts:
- Joseph Smith, age 49, went to the Providence Hood River Memorial Hospital emergency room with symptoms of a stroke, including visual difficulties, confusion, slurred speech, and headache.
- Dr. Dessiter attended to Smith but did not perform a complete physical or thorough neurological examination. A CT scan showed no bleeding, making Smith a candidate for stroke treatment.
- Dessiter concluded Smith's symptoms were from a sleep aid, advised an eye exam, and discharged him without aspirin.
- The next day, Smith returned to the emergency room with increased head pain and continued visual problems. Dessiter again saw him, did not perform a thorough examination, diagnosed a mild headache, prescribed Vicodin, and sent him home.
- Two days later, Smith's family physician, Dr. Harris, ordered a non-expedited MRI and did not advise Smith to take aspirin.
- By the end of the week, an MRI revealed Smith had suffered substantial, permanent brain damage from a stroke.
- With proper and timely treatment, there was a 33 percent chance that Smith would have had a much better outcome with reduced or no stroke symptoms.
Procedural Posture:
- Joseph Smith sued Dr. Dessiter, Dr. Harris, their medical groups, and Providence Health & Services in an Oregon trial court for medical negligence under a 'loss of chance' theory.
- All defendants filed motions to dismiss Smith's complaint, arguing that Oregon law did not recognize a claim for loss of chance.
- The trial court granted the defendants' motions and entered a judgment dismissing the action with prejudice.
- Smith, as appellant, appealed to the Oregon Court of Appeals.
- The Court of Appeals affirmed the trial court's dismissal, holding that Smith's allegation of losing a 33% chance was insufficient to plead the causation element of a negligence claim.
- Smith successfully petitioned the Oregon Supreme Court for review.
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Issue:
Does Oregon common law recognize the 'loss of a chance' for a better medical outcome as a cognizable injury in a medical negligence claim, when the lost chance was less than 51 percent?
Opinions:
Majority - Nakamoto, J.
Yes. A medical negligence claim based on a loss-of-chance theory of injury is cognizable under Oregon common law. This case presents an issue of first impression, as prior Oregon cases, such as Joshi v. Providence Health System, were decided on statutory grounds (wrongful death) and did not address the common-law theory of loss of chance as a distinct injury. The court adopts the 'injury-based' approach, which treats the lost opportunity for a better outcome as the actual, compensable harm, rather than relaxing the traditional causation standard for the ultimate physical injury. This approach is consistent with tort law principles of fairness and deterrence, as it prevents medical providers from being insulated from liability simply because a patient's prognosis was less than 51 percent. Under this theory, the plaintiff must still prove by a preponderance of the evidence that the defendant's negligence caused the loss of a substantial chance for a better outcome. The court explicitly limits this doctrine to the medical malpractice context, citing the special nature of the physician-patient relationship and the availability of reliable statistical evidence to quantify the lost chance.
Analysis:
This decision formally establishes the 'loss of chance' doctrine in Oregon for common-law medical malpractice claims, creating a new avenue for recovery. It shifts the legal inquiry from whether a defendant's negligence was the 'more likely than not' cause of the ultimate physical harm to whether it caused the loss of a significant opportunity for a better outcome. This change primarily benefits patients who present with conditions that have a less than 51% chance of successful treatment, as they previously had no remedy for negligent care that eliminated their chance of recovery. For future litigation, this precedent requires plaintiffs to plead the loss of a 'substantial chance' with specificity, while defendants will need to counter with evidence challenging the statistical probability of the claimed lost chance.
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