Wendland v. Sparks
1998 WL 63519, 1998 Iowa Sup. LEXIS 35, 574 N.W.2d 327 (1998)
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Rule of Law:
In a medical malpractice action, a plaintiff can recover damages for the loss of a chance of survival even if that chance was less than fifty percent. This 'lost chance' theory is not limited to cases involving a failure to diagnose but also applies to a failure to treat.
Facts:
- Callie Rose Wendland was a patient at Davis County Hospital, suffering from several serious conditions, including multiple myeloma and fibrotic lung disease.
- Callie's husband, Lawrence Wendland, had previously communicated his desire to Dr. Stephen Sparks that Callie be placed on a ventilator if it became necessary.
- On prior occasions, Callie had suffered respiratory arrest and been successfully resuscitated, possibly as many as three times.
- At the time of her final hospitalization, neither Callie nor any family member had signed a 'no code' or do-not-resuscitate (DNR) order.
- On February 24, 1994, Callie suffered cardiorespiratory arrest while in the hospital.
- A nurse retrieved a 'crash' cart, but Dr. Sparks, upon arriving and assessing Callie, decided not to attempt cardiopulmonary resuscitation (CPR).
- Dr. Sparks instructed the nurses that 'no code would be made,' effectively ordering them not to attempt resuscitation.
- A nurse testified that had Dr. Sparks not intervened, the nursing staff would have 'called a code' and performed CPR.
Procedural Posture:
- Lawrence Wendland, on behalf of himself and Callie Wendland's estate, sued Dr. Sparks and Davis County Hospital in a state trial court for medical malpractice.
- The defendants moved for summary judgment, arguing the plaintiff could not prove that their alleged negligence was the probable cause of Callie's death.
- The trial court granted the defendants' motion for summary judgment.
- The plaintiff appealed the trial court's grant of summary judgment to the Supreme Court of Iowa.
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Issue:
Does Iowa law permit a medical malpractice plaintiff to recover for a lost chance of survival when the defendant's negligence deprived the patient of a less than fifty percent chance of survival?
Opinions:
Majority - Larson, Justice.
Yes, Iowa law permits recovery for a lost chance of survival even if that chance is less than fifty percent, because the lost opportunity itself is a compensable injury distinct from the underlying condition. The traditional 'all-or-nothing' rule for proximate cause, which requires a plaintiff to prove a defendant's negligence more likely than not (>50%) caused the ultimate harm, is inequitable and distorts causation principles in cases involving preexisting conditions. Instead, the court adopts a proportional approach where the lost chance is the actual injury, and damages are calculated based on the percentage of the chance lost due to the defendant's negligence. This doctrine is not limited to negligent diagnosis cases, as seen in this failure-to-treat scenario. The court reasons that even a small chance of survival has inherent value, and its destruction by a negligent act is a legally redressable harm.
Analysis:
This decision significantly expands the 'lost chance' doctrine in Iowa, lowering the causation threshold for plaintiffs in certain medical malpractice cases. By explicitly allowing claims for a less-than-50% chance of survival and extending the doctrine beyond misdiagnosis to active treatment decisions, the court opens the door to claims that previously would have failed summary judgment. This precedent makes it more difficult for healthcare providers to defeat claims at an early stage by arguing that a patient's poor prognosis made death inevitable. It shifts the focus from whether negligence was the probable cause of death to whether it deprived the patient of a measurable opportunity to survive, making the lost chance itself the compensable injury.
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