Smith v. State Dept. of Health & Hosp.
1996 WL 344861, 676 So. 2d 543 (1996)
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Rule of Law:
In a medical malpractice action for loss of a chance of survival, damages are not calculated by a rigid mathematical formula. Instead, the factfinder determines a lump sum award based on all evidence, valuing the lost chance itself as a distinct compensable injury.
Facts:
- In August 1987, Benjamin Smith was hospitalized at E.A. Conway Memorial Hospital for a foot infection.
- A routine chest x-ray taken during his stay revealed a mediastinal mass, and the radiologist recommended a CT scan, suspecting lymphoma.
- The hospital staff failed to inform Smith or his family about the x-ray results or the need for follow-up testing, and he was discharged without knowledge of the mass.
- Almost fifteen months later, in October 1988, Smith returned to the hospital with chest pain, fever, and chills.
- A new chest x-ray showed the mass had doubled in size, and Smith was diagnosed with small cell carcinoma of the lungs that had progressed to an inoperable, 'extensive' stage.
- Smith died from the cancer on March 16, 1989, nineteen months after the initial x-ray.
Procedural Posture:
- Rachel Smith and her children (plaintiffs) petitioned for a medical review panel against the Louisiana Department of Health and Hospitals (defendant).
- The Department stipulated that it breached the standard of care but reserved the right to contest causation and damages.
- The Smiths filed a medical malpractice suit in a Louisiana trial court seeking survival and wrongful death damages.
- The trial court judge ruled in favor of the Department, finding that the plaintiffs failed to prove the delay in treatment caused Smith to die or lose a chance of survival.
- The Smiths appealed to the Louisiana Court of Appeal, Second Circuit.
- The court of appeal reversed, finding that Smith did lose a chance of survival. It calculated damages by taking the total value of wrongful death claims ($764,347) and multiplying it by the lost chance (10%), awarding $76,434.
- The Smiths (as applicants) sought and were granted a writ of certiorari by the Supreme Court of Louisiana to review the method of measuring damages.
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Issue:
In a medical malpractice case involving the loss of a chance of survival, are damages calculated by a rigid mathematical formula that multiplies the total value of a wrongful death claim by the percentage chance of survival that was lost?
Opinions:
Majority - Lemmon, Justice
No. Damages for the loss of a chance of survival are not calculated using a rigid mathematical formula. The proper method is for the factfinder to focus on the chance of survival lost as a distinct compensable injury and to value it as a lump sum award based on all the evidence. The court rejected the 'percentage probability' method used by the court of appeal, which multiplies total hypothetical wrongful death damages by the percentage chance lost, deeming it mechanistic and based on imprecise estimates. The court reasoned that the loss of a chance has its own intrinsic value, distinct from a wrongful death claim, and the jury should directly assess this value by considering all relevant factors, including expert testimony on percentage chances, loss of support, and loss of love and affection, without being bound by a formula. This approach values the actual injury at issue—the lost chance—rather than hypothetically valuing a claim that was not proven (i.e., that the negligence more likely than not caused the death).
Dissenting - Marcus, Justice
Yes. The court should have adopted the method used by the court of appeal for measuring damages recoverable for the loss of a chance of survival. The percentage probability method is the proper way to calculate these damages.
Dissenting - Victory, Justice
Yes. While disagreeing with the entire 'lost chance of survival' doctrine as contrary to Louisiana statutes, if it is to be applied, the percentage probability test is the far superior method for valuation. The majority's 'lump sum' approach is a 'rabbit-out-of-the-hat' method that will be virtually impossible to review on appeal for manifest error because it lacks a clear basis. The percentage probability test, adopted by a majority of other states, is more precise, logical, and fair because it ensures damages redress the actual injury—the decreased chance of survival—not the death itself. It properly ties the compensation to the specific harm caused by the defendant's negligence.
Analysis:
This decision establishes the valuation method for 'loss of a chance' claims in Louisiana, rejecting the more common percentage-based approach in favor of a holistic, lump-sum valuation by the factfinder. This gives juries and judges significant discretion, potentially leading to less predictable and more varied damage awards compared to the formulaic method. The ruling also makes appellate review more challenging, as there is no mathematical basis to scrutinize the award; instead, appellate courts must review the lump sum for reasonableness based on the entire record. This case solidifies the 'loss of a chance' as a distinct injury in Louisiana tort law, separate from a traditional wrongful death claim.
