Leubner v. Sterner, C5-91-2239
| Decision Date | 18 December 1992 |
| Docket Number | No. C5-91-2239,C5-91-2239 |
| Parties | Georgena LEUBNER, et al., Respondents, v. Barbara J. STERNER, M.D., et al., Defendants, Ronald C. Jensen, M.D., et al., petitioners, Appellants. |
| Court | Minnesota Supreme Court |
Syllabus by the Court
This state does not recognize a medical malpractice cause of action for negligent aggravation of a preexisting condition.
Kay Nord Hunt, Phillip A. Cole, Lommen, Nelson, Cole & Stageberg, P.A., Minneapolis, for appellants.
Judy Emmings, John W. Carey, Sieben, Grose, Von Holtum, McCoy & Carey, Ltd., Fairfax, for respondents.
Mary Prentnieks, Suzanne Veenhuis, Minnesota Medical Ass'n, Minneapolis, for amicus curiae MN Medical Assoc.
Heard, considered, and decided by the court en banc.
We hold there is no such thing as a medical malpractice cause of action for "negligent aggravation of a preexisting condition," and reverse the court of appeals.
Plaintiff-respondent Georgena Leubner, a 54-year-old woman, visited her family doctor, who confirmed two small lumps in the area of her left breast. A mammogram was negative. The family doctor referred plaintiff to defendant-appellant Dr. Ronald C. Jensen, who, a week later, on June 25, 1987, examined Ms. Leubner but chose not to order a biopsy at that time. Instead Dr. Jensen scheduled another appointment for December 19, 1987, about 6 months later. When Dr. Jensen examined his patient on the appointed day, he noticed the two nodules were enlarged and advised a biopsy.
The biopsy was performed in February 1988, about 7 months after Dr. Jensen's first examination. (Plaintiff did not have the biopsy sooner after the December 19 visit because her health insurance was being transferred to another plan in which Dr. Jensen did not participate.) The biopsy revealed cancer in the patient's left breast and a partial mastectomy was done. Since then, plaintiff has had several local recurrences of cancer in her left breast, ultimately resulting in a total mastectomy of the breast and two additional instances in which chest-wall lesions were discovered and removed.
Plaintiff and her husband commenced this medical malpractice action against defendant Dr. Jensen and his clinic (and others, since dismissed from the action). At a pretrial hearing in August 1991, the question arose whether plaintiffs could prove the necessary causation for their medical malpractice claim. Pursuant to agreement, for the purpose of a defense motion, plaintiffs submitted the following written offer of proof:
Dr. Newman [plaintiff's expert] will opine that if Georgena Leubner had been diagnosed and surgically treated in July, 1987, rather than February 1988, she would possess an increased chance of survival from her disease of breast cancer, in contrast to present chance of survival with diagnosis and treatment in February 1988. Her decreased chances [sic] of survival was directly caused by the delay in diagnosis and treatment.
Presumably, for the purpose of resolving the causation issue, we are also asked to assume that the delay in diagnosis and treatment could be found to be negligent.
The trial court ruled that plaintiffs had failed to sustain their burden of proof on causation and granted summary judgment in favor of the defendants. The trial court concluded plaintiffs' offer of proof, as a matter of law, failed to establish that it was more likely than not that the specified consequences resulted from the alleged negligence. The trial court also rejected plaintiffs' claim under a "loss of chance" theory.
The court of appeals ruled that plaintiffs' "loss of chance" claim was "misplaced in the present case" and affirmed summary judgment for defendants on that theory of recovery. The court of appeals went on, however, and decided (although the parties had not raised the theory) that plaintiffs had established a prima facie "cause of action for negligent aggravation of pre-existing disease," which, said the court, is a "long recognized" cause of action in this state. The case was remanded for trial on this theory. Leubner v. Sterner, 483 N.W.2d 518 (Minn.App.1992). In arriving at this conclusion, the court of appeals went beyond plaintiffs' formal offer of proof and cited an opinion of Dr. Newman in another affidavit that defendant's negligence resulted in a decline from 70-to-80 percent to a 40-percent chance of being free of disease 5 years after the initial 1987 examination; and that Dr. Jensen's negligence caused "twice the risk of having positive nodes and for distant metastases."
We granted the defendants' petition for further review. Plaintiffs did not file a notice of review to preserve their "lost chance of survival" claim. On the other hand, defendants frame the issue before us as whether plaintiffs failed to present a prima facie case of medical malpractice on the causation element.
In order to establish a prima facie case of medical malpractice in this state, a plaintiff must prove, among other things, that it is more probable than not that his or her injury was a result of the defendant health care provider's negligence. See, e.g., Plutshack v. University of Minnesota Hospitals, 316 N.W.2d 1 (Minn.1982); Cornfeldt v. Tongen, 295 N.W.2d 638, 640 (Minn.1980). Failure to present such proof (normally in the form of expert testimony) mandates either summary judgment or a directed verdict for the defendant. Cf. Carlson v. Fredrickson & Byron, P.A., 475 N.W.2d 882, 886 (Minn.App.1991), pet. for rev. denied (Minn., October 31, 1991) (legal malpractice case). The guiding principle behind this rule is that a jury should not be permitted to speculate as to possible causes of a plaintiff's injury or whether different medical treatment could have resulted in a more favorable prognosis for the plaintiff. See Smith v. Knowles, 281 N.W.2d 653, 656 (Minn.1979); Cornfeldt v. Tongen, supra. This court has reaffirmed the "more probable than not" standard for establishing causation in medical malpractice claims in case after case. See, e.g., Harvey v. Fridley Medical Center, P.A., 315 N.W.2d 225, 227 (Minn.1982); Silver v. Redleaf, 292 Minn. 463, 465, 194 N.W.2d 271, 273 (1972). Thus the standard in this state is both well settled and well grounded in considerations of both equity and public policy.
Causation, by definition, is something producing a certain effect or result. Legal causation cannot be discussed intelligently without reference to the injury...
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...plaintiff cannot do. He has identified no injury arising from the 48-hour interval. This is fatal to his claim. See Leubner v. Sterner, 493 N.W.2d 119, 121 (Minn.1992) (affirming summary judgment for doctor in medical malpractice action where patient could not identify cognizable injury res......
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Parents v. Green, A11–0402.
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