Introduction to American Tort Law Syllabus, Outline of Course and Course Materials University of Insubria, Como, Italy July 9-13, 2012 Ann C. McGinley, William S. Boyd Professor of Law, University of Nevada, Las Vegas, William S. Boyd School of Law 1 Outline and Syllabus: Introduction to American Tort Law University of Insubria, Como, Italy July 9 – 13, 201 Ann C. McGinley William S. Boyd Professor of Law, University of Nevada Las Vegas Students: Please find the Course Materials for our course on American Tort Law. This document includes the outlines, syllabus and background materials as well as the materials for all the classes I teach to you separately. Please read the materials BEFORE the class for which they are assigned. Also, at the end of each day’s reading is a list of “key terminology.” Look at these words BEFORE you do the reading and try to understand what they mean in context. As in American law school classrooms, I intend to ask you questions about your readings. Please be prepared. Do NOT worry about your English. Your English is much better than my Italian! Course Outline 1. The American System A. Courts – Federal, State 1. Jury system 2. Alternative Dispute Resolution B. Legislatures – Federal, State C. Executive Branch – Administrative regulations, courts 2. Tort Law A. Primarily state law (occasional federal statutes) B. Common law (at times supplemented by state statute) C. Usually enforced in state court (But may be brought in federal court if federal law or diversity jurisdiction—citizens of two states – but even where diversity jurisdiction, federal court will apply state law); some administrative law – e.g. OSHA 3. Common Law A. Ordinarily in state court B. Progression and interpretation of law via courts’ interpretations C. Binding/Persuasive precedent D. Each state: lower courts, Supreme Court (most have intermediate courts) E. Higher courts binding on lower courts F. How to defend against binding precedent? Importance of the facts of the case—distinguish the case; look at the policy underlying the precedent and argue based on policy; G. Supreme Court’s Stare decisis - argue to overrule old precedent—no longer up to date; rule no longer supports underlying policy; policies have changed H. Common argument: Not for the judiciary – for the legislature to decide 4. Procedure A. Judge vs. Jury 2 B. Mechanisms for avoiding trials (Motions to Dismiss; Summary Judgment) C. Appeals and Standards of Review 5. Coverage A. The American System B. State v. federal law C. Common law v. statutory law D. Torts 1. Intentional Torts 2. Negligence/ Contingency Fees 3. Special Topics in Negligence (Medical Malpractice, Health Care Reform)(Class 3) 4. Strict Liability/Products Liability 5. Remedies E. Exam Background for Class Materials, Outline of Class Materials and Materials for Class American Tort Law University of Insubria, Como, Italy The American torts system is a common law system that is generally a matter of state, not federal, law. Thus, the 50 states may have slightly varying law in torts, and it is up to the state Supreme Court to determine what the law is in the particular state. Historically, torts developed as common law without statutes, but there have been statutes emerging in many states that deal with some of the law of torts. We will see some of these statutes as we go along. Also, there is a body called the American Law Institute that writes the Restatements of the Law. The Restatements are similar to statutes. They have provisions and commentary and examples explaining the provisions. They are not binding on the state courts, however, unless the state Supreme Court has adopted the Restatement provision as the law of the state. Because the American Law Institute is a very prestigious organization, the Restatements are influential, however, and are followed by many courts. In Torts, there is a Restatement (Second) of Torts, which was published in 1965. There are other Restatements that deal with tort law. For example, there is a Restatement of Products Liability, which was published in 1998. Outline of Readings I. Intentional Torts A. Battery (Cohen) B. Assault (Raess) C. False Imprisonment (Fuerschbach) D. Trespass; Conversion E. Practice Problems and Questions 3 II. Negligence A. Duty (Doe) B. Breach of Duty (Doe) C. Causation 1. Actual Cause (Zuchowicz) 2. Proximate Cause (Palsgraf) D. Harm III. Medical (or other professional) Malpractice A. Standard of Care B. Expert testimony – importance -- lecture C. Policy supporting medical malpractice D. Policy Issues: Concern about the rising costs of healthcare and the legislative response – Nevada statute limiting non-economic damages IV. Vicarious Liability V. Strict Liability VI. Products Liability A. Restatement (Second) Section 402A B. Restatement (Third) of Products Liability C. Manufacturing and Design Defects 1. Consumer Expectations Test (Leichtamer) 2. Risk/Utility Analysis (Honda) D. Warning Defects (Liriano) E. Case Study: Hepatitis C Case VII. Remedies A. Compensatory Damages B. Punitive Damages VIII. Insurance 4 Prof. McGinley Class Materials Wednesday, July 11, 2012 12-1:30 class READING MATERIALS FOR CLASS (The following readings will be discussed in Class. Please be prepared to discuss them.) I. Intentional Torts What does “intent” mean? 1. acting with the purpose of bringing about the result; or 2. acting with the knowledge that the result is substantially certain A. Battery PATRICIA K. COHEN and JOE COHEN, Plaintiffs-Appellants, v. ROGER SMITH, Defendant-Appellee. NOS. 5-94-0203 & 5-94-0204 APPELLATE COURT OF ILLINOIS, FIFTH DISTRICT 269 Ill. App. 3d 1087; 648 N.E.2d 329; 1995 Ill. App. LEXIS 185; 207 Ill. Dec. 873 March 24, 1995, FILED1 JUDGES: JUSTICE CHAPMAN delivered the opinion of the court: MAAG, P.J., and HOPKINS, J., concur. OPINION BY: CHAPMAN OPINION JUSTICE CHAPMAN delivered the opinion of the court: 1 Citations to cases have been omitted. Throughout the materials, I have edited the cases and other materials without indicating where the editing takes place, but I have not changed the meaning of any case or other material. 5 Patricia Cohen was admitted to St. Joseph Memorial Hospital ("Hospital") to deliver her baby. After an examination, Cohen was informed that it would be necessary for her to have a cesarean section. Cohen and her husband allegedly informed her physician, who in turn advised the Hospital staff, that the couple's religious beliefs prohibited Cohen from being seen unclothed by a male. Cohen's doctor assured her husband that their religious convictions would be respected. During Cohen's cesarean section, Roger Smith, a male nurse on staff at the Hospital, allegedly observed and touched Cohen's naked body. Cohen and her husband filed suit against Nurse Smith and the Hospital. The trial court allowed defendants' motions to dismiss. We reverse. The Restatement (Second) of Torts provides that an actor commits a battery if: "(a) he acts intending to cause a harmful or offensive contact with the person of the other or a third person, or an imminent apprehension of such a contact, and (b) a harmful contact with the person of the other directly or indirectly results." (Restatement (Second) of Torts, § 13 (1965).)2 Liability for battery emphasizes the plaintiff's lack of consent to the touching. "Offensive contact" is said to occur when the contact "offends a reasonable sense of personal dignity." Restatement (Second) of Torts § 19 (1965). Cohen alleges that Roger Smith knowingly violated her privacy interests and religious standards and beliefs by touching her without her consent. The only reason there is some hesitancy over the issue of whether a battery occurred in this case is because the contact took place in a hospital between a medical professional and a patient. If Patricia Cohen had been struck in the nose by Nurse Smith on a public street, everyone would agree that a battery occurred, and under those limited facts, there would be no defense to the battery. In contrast, medical professionals are allowed to touch patients during the course of medical treatment because patients consent, either explicitly or implicitly, to the touching. The violation of a plaintiff's right to bodily and personal integrity by an unconsented-to touching is the essence of a claim for battery. II. CAUSES OF ACTION A. Battery The plaintiffs' complaint against Nurse Smith alleges that Smith touched Cohen's naked body after being informed of her moral and religious beliefs against such touching by a male. According to the complaint, despite being informed of Cohen's religious beliefs, Nurse Smith, an agent and employee of the Hospital, intentionally saw and touched Cohen's naked body. The allegation that both Nurse Smith and the Hospital were informed in advance of plaintiffs' religious beliefs is important in this case, because the religious convictions of plaintiffs might not be 2 The Restatement (Second) of Torts is not a statute. Rather, it is a compilation by the American Law Institute, a prestigious body of lawyers, judges and academics, who study the law and its trends and attempt to codify it. It is not binding on any court unless the Supreme Court of the state in which the court sits has adopted it as the law of the state. But, it is influential. 6 those of most people who enter the hospital to give birth. As a matter of fact, plaintiffs' counsel candidly conceded that there would be no cause of action for battery if Patricia Cohen had been placed in Nurse Smith's and the Hospital's care in an emergency situation in which Patricia had been unable to inform the Hospital or its agents of her beliefs. Plaintiffs' attorney acknowledged that his clients' moral and religious views are not widely held in the community and, because of this, plaintiffs could state a claim against defendants only if the plaintiffs plead that the defendants had knowledge of those beliefs. Specifically, plaintiffs contend that defendants' knowledge is clearly illustrated by an allegation in the plaintiffs' amended complaint that Nurse Smith requested the presence of the Murphysboro City Police at the Hospital to prevent Mr. Cohen from objecting to Nurse Smith's presence in the operating room while Mrs. Cohen was naked, and to physically restrain Mr. Cohen if necessary. Although most people in modern society have come to accept the necessity of being seen unclothed and being touched by members of the opposite sex during medical treatment, the plaintiffs had not accepted these procedures and, according to their complaint, had informed defendants of their convictions. A person's right to refuse or accept medical care is not one to be interfered with lightly. As Justice Cardozo stated, "Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient's consent commits an assault, for which he is liable in damages." Knowing interference with the right of determination is battery. Our examination of the record reveals that facts charging that interference are pleaded in plaintiffs' complaint against Nurse Smith and against the Hospital. For purposes of a motion on the pleadings, a court must accept these facts as true. Based on the information found in the Cohen’s complaint against Nurse Smith and the Cohen’s complaint against the Hospital, we find that the trial court erred in dismissing both complaints. Reversed and remanded. B. Assault DANIEL H. RAESS, M.D., Appellant (Defendant), v. JOSEPH E. DOESCHER, Appellee (Plaintiff). No. 49S02-0710-CV-424 SUPREME COURT OF INDIANA 883 N.E.2d 790; 2008 Ind. LEXIS 313; 155 Lab. Cas. (CCH) P60,601 April 8, 2008, Decided April 8, 2008, Filed 7 OPINION BY: Dickson OPINION Dickson, Justice. This is an appeal by defendant Daniel Raess, M.D., a cardiovascular surgeon, challenging a $325,000 jury verdict and judgment on a claim for assault brought by plaintiff Joseph Doescher, a hospital operating room perfusionist (the person who operates the heart/lung machine during open heart surgeries). The Court of Appeals reversed and remanded for a new trial. We granted transfer and now affirm the judgment of the trial court. In his action against the defendant surgeon, the plaintiff perfusionist sought compensatory and punitive damages for assault following a verbal altercation adjacent to the open-heart surgery area at St. Francis Hospital in Beech Grove, Indiana. The jury found for the plaintiff on his assault claim and awarded compensatory but not punitive damages. 1. Denial of Judgment on the Evidence The defendant argues (a) that there was no evidence to support liability for assault and seeks entry of judgment in his favor. The defendant first argues that there was no evidence to establish the following: (a) that an assault occurred, (b) that he acted with the requisite intent, or (c) that the plaintiff's reaction was reasonable. The elements of assault were explained to the jury in Instruction 10C, to which neither party objected. To establish assault, Mr. Doescher [the plaintiff] must prove, by a preponderance of the evidence, that Dr. Raess acted in such a manner that Mr. Doescher was in reasonable fear of imminent harm at the time when Dr. Raess had the ability to inflict harm. No physical contact had to occur so long as Mr. Doescher was reasonably afraid that such contact would occur. If you find from the evidence that Dr. Raess committed an assault upon Mr. Doescher, then Dr. Raess is liable for damages caused by the assault. Assault is effectuated when one acts intending to cause an imminent apprehension of a harmful or offensive contact with another person as we have explained, "Any act of such a nature as to excite an apprehension of a battery may constitute an assault. It is an assault to shake a fist under another's nose, . . . ." We find testimony from the plaintiff that the defendant, angry at the plaintiff about reports to the hospital administration about the defendant's treatment of other perfusionists, aggressively and rapidly advanced on the plaintiff with clenched fists, piercing eyes, beet-red face, popping veins, and screaming and swearing at him. The plaintiff backed up against a wall and put his hands up, believing that the defendant was going to hit him, "[t]hat he was going to smack the s**t out of me or do something." Then the defendant suddenly stopped, turned, and stormed past the plaintiff and left the room, momentarily stopping to declare to the plaintiff "you're finished, you're history." In light of this evidence, there has not been a complete failure of proof. To the contrary, there is substantial evidence or reasonable inferences to support the jury's conclusions that an assault occurred, that the defendant acted with the requisite intent, and that the plaintiff's reaction was reasonable. 8 C. False Imprisonment MARCIE FUERSCHBACH, Plaintiff-Appellant, v. SOUTHWEST AIRLINES CO.; CITY OF ALBUQUERQUE; DUANE HOPPE; ELDON MARTINEZ; MICHAEL SANTIAGO; and TINA MARIE TAPIA, Defendants-Appellees. No. 04-2117 UNITED STATES COURT OF APPEALS FOR THE TENTH CIRCUIT 439 F.3d 1197; 2006 U.S. App. LEXIS 5108; 44 A.L.R.6th 723 February 28, 2006, Filed JUDGES: Before LUCERO, Circuit Judge, BRORBY, Senior Circuit Judge, and McCONNELL, Circuit Judge. OPINION BY: LUCERO OPINION LUCERO, Circuit Judge. Several supervisors at Southwest Airlines convinced two Albuquerque police officers to stage an arrest of Marcie Fuerschbach, a Southwest Airlines employee, as part of an elaborate prank that included actual handcuffing and apparent arrest. This was a "joke gone bad," and turned out to be anything but funny, as Fuerschbach allegedly suffered serious psychological injuries as a result of the prank. I Marcie Fuerschbach worked as a customer service representative for Southwest Airlines ("Southwest"), serving travelers at Southwest's main ticket counter in Albuquerque's Sunport airport. Southwest prides itself on being a "fun-loving, spirited company." As part of this fun-loving atmosphere, newly hired employees who have successfully completed an initial probationary period often find themselves subject to a prank commemorating the occasion. Fuerschbach's supervisor, Tina Marie Tapia, and other customer service supervisors had discussed various pranks to commemorate Fuerschbach's successful completion of probation. Tapia suggested a mock arrest. The others agreed. On the day of the incident, one of the supervisors called the Albuquerque police department and requested that officers come to the Southwest counter. When Officers Duane Hoppe and Eldon Martinez arrived at the ticket counter, the supervisors told them of the plan to arrest Fuerschbach as a celebratory prank. The officers, who were employed by the City of Albuquerque's City Aviation Department and detailed to the Sunport, asked if Fuersch9 bach "would be okay with it," and Tapia assured them that she would. With the assistance of the supervisors, the officers developed and executed the plan for staging the arrest. Fuerschbach was working at a ticket counter when the two uniformed and armed police officers approached her. One of the officers ordered Fuerschbach to go with him to answer some questions, and proceeded to escort her to the end of the ticket counter. Once there, the other officer informed Fuerschbach that the City Aviation Department discovered an outstanding warrant for her arrest. The officers asked Fuerschbach if she had ever been arrested before, and she replied that she had not. The officers demanded that she take off her badges and turn them in. The officers then placed Fuerschbach's hands behind her back and handcuffed her tightly. A crowd of employees and customers formed to watch the unfolding arrest. One of the officers said to Fuerschbach, "we don't want to embarrass you anymore so we'll take you to the elevator so we don't have to walk in front of all those people." Fuerschbach continued to cry. The officers led Fuerschbach in handcuffs fifteen feet to the elevator, at which point someone jumped out and yelled, "congratulations for being off probation." The officers removed the handcuffs and people began to clap. Fuerschbach, however, continued to cry. Later that day, she was found in the break room weeping and was sent home. As a result of her distress, Fuerschbach began seeing a psychologist for treatment. The psychologist diagnosed Fuerschbach as suffering from post-traumatic stress disorder ("PTSD"). In discussing intentional torts, the Restatement provides: The fact that the defendant who intentionally inflicts bodily harm upon another does so as a practical joke, does not render him immune from liability so long as the other has not consented. This is true although the actor erroneously believes that the other will regard it as a joke, or that the other has, in fact, consented to it. One who plays dangerous practical jokes on others takes the risk that his victims may not appreciate the humor of his conduct and may not take it in good part. Thus, the common law of torts instructs that an intentional tortfeasor is held to the applicable standard of care, notwithstanding the characterization of the tort as a prank, or even a good faith but incorrect belief that the tort victim will enjoy the joke. III Fuerschbach asserts several state tort claims against Officers Hoppe and Martinez. Specifically, Fuerschbach alleges that the officers committed false imprisonment. A "Under New Mexico law, 'false imprisonment consists of intentionally confining or restraining another person without his consent and with knowledge that he has no lawful authority to do so.'" The district court found that the officers had a good faith and reasonable belief that their actions were lawful because they only "briefly restrained Plaintiff as part of a prank at the request of SWA." Neither the brevity of the seizure nor its characterization as a prank enable the officers to prevail on summary judgment. False imprisonment may arise out of a brief encounter. Moreover, a good faith belief in the lawfulness of the action ordinarily requires probable cause to arrest. The defendant of10 ficers lacked probable cause, and indeed did not even suspect Fuerschbach of wrongdoing. Although they seized Fuerschbach at the invitation of her employer, and did so in the context of a prank, they nonetheless had no lawful authority to inform her that she was under arrest, restrain her in handcuffs, and direct her movement. *** D. Trespass, Conversion These are intentional torts dealing with real property (land) and personal property. Trespass is the intentional entry upon the property of another without permission. Conversion is the taking of the personal property of another and treating it as if it belongs to the converter. These are intentional torts, but even if the trespasser mistakenly believes that the property belong to him or her, s/he can be liable for trespass or conversion. E. Practice Problems 1. Cohen v. Smith – What if the plaintiff had not told the doctors that she did not want to be viewed naked or touched by a male doctor? Would there still be a battery? Why? Why not? Consent can be a defense to battery. How would a defendant attempt to make out this defense in a case similar to this case? 2. Cohen v. Smith – If you were a member of the jury, would you vote for the plaintiff in the battery case? 3. Raess v. Doescher – Should the doctor be liable for this behavior? Isn’t this ordinary behavior in workplaces, especially stressful workplaces? Did the defendant in this case have a purpose to bring about Raess’ distress? If not, how can Raess prove intent? 4. Fuerschbach v. Southwest Airlines – The defendants in this case were playing a prank on the plaintiff. How, then, can the plaintiff prove intent in this case? Does the intent have to be to harm the plaintiff or in a false imprisonment case, to confine the plaintiff against her will? Key Terminology: You should study and understand these key terms: Liability Battery Consent Privacy Personal integrity Damages Complaint Attorney State a claim Allegation Reversed and remanded Jury verdict Assault 11 Affirm the judgment Trial court Court of appeals/appellate court Compensatory damages Punitive damages Plaintiff Defendant Evidence Intent Burden of proof Preponderance of the evidence Substantial evidence Motion for summary judgment False imprisonment Good faith and reasonable belief Trespass Conversion II. Negligence A. Duty B. Breach of Duty JANE DOE and INFANT DOE by her Next Friend John Smith, Plaintiffs, v. EARVIN JOHNSON, JR., Defendant. UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF MICHIGAN 817 F. Supp. 1382; 1993 U.S. Dist. LEXIS 4367 February 18, 1993, Decided February 18, 1993, Filed HON. RICHARD A. ENSLEN OPINION This case is before the Court on defendant's motion to dismiss under Federal Rule of Civil Procedure 12(b)(6). Facts This case raises unique legal and policy issues, but has fairly straight forward facts. Plaintiff, Jane Doe, alleges that defendant, Earvin Johnson, Jr., wrongfully transmitted the human immunodefi12 ciency virus ("HIV virus") to her through consensual sexual contact. Ms. Doe alleges that the wrongful transmission of the HIV virus occurred on or about the evening of June 22, 1990, or the morning of June 23, 1990, or both, at her home in Ingham County, Michigan. Ms. Doe and Mr. Johnson had "sexual contact" which allegedly led to the transmission of the HIV virus. Ms. Doe alleges that immediately prior to the encounter, she asked Mr. Johnson to use a condom. Mr. Johnson allegedly refused to do so. Nonetheless, Ms. Doe engaged in consensual sexual contact with Mr. Johnson. Prior to the evening of June 22, 1990 or morning of June 23, 1990, Ms. Doe claims that Mr. Johnson "was sexually active, having sexual contact and engaging in sexual intercourse with multiple partners." Thus, Ms. Doe claims that Mr. Johnson "knew or should have known" that he had a high risk of becoming infected with the HIV virus because of his "sexually active, promiscuous lifestyle." Accordingly, Ms. Doe argues that Mr. Johnson should have (1) warned her about his past lifestyle; (2) informed her that he "may have HIV"; (3) informed her that he did in fact "have HIV"; (4) not engaged in sexual contact with her; or (5) used a condom or other method to protect her from the HIV virus. As a result of this wrongful transmission, Ms. Doe states that she suffers, and will continue to suffer, many consequences including physical illness, severe emotional distress, loss of enjoyment of life, extreme embarrassment, humiliation, shame, medical expenses, and lost wages and benefits. Moreover, Ms. Doe notes that she will eventually develop acquired immunodeficiency syndrome ("AIDS") and "suffer a slow, certain, and painful death." DISCUSSION In his motion to dismiss, defendant attacks each count on essentially the same ground: that defendant must have had "knowledge" of his HIV-positive status in order to have a duty under negligence [theory]. Count I of the Complaint alleges that defendant negligently breached a legal duty he owed to plaintiff Jane Doe not to transmit the HIV virus to her because he knew or should have known that he had the HIV virus. In order to state a claim for a cause of action arising from a tortious injury in the state of Michigan, such as that alleged by plaintiff Jane Doe in count I, a litigant must allege: (1) a legal duty owed by defendant to plaintiff; (2) a breach of that duty; (3) causation (proximate and causation in fact) between the breach of the duty and the injury; and (4) resultant damages. Additionally, as is somewhat obvious from these factors, courts often consider public policy implications in making a determination whether a legal duty exists in any given situation. Decision as to Count I Under Michigan law, courts generally use the following test to determine the existence of a "legal duty": (1) a balancing of the societal interest involved; (2) the severity of the risk; (3) the burden upon the defendant [to meet the duty]; (4) the likelihood of occurrence; and, (5) the relationship between the parties. A number of considerations arise when balancing these factors in the context of sexual transmission of the HIV virus. 13 *** In balancing these factors, I find that a defendant owes a plaintiff a legal duty to, at the very least, disclose the fact that s/he may have the HIV virus, if: (1) the defendant has actual knowledge that s/he has the HIV virus; (2) the defendant has experienced symptoms associated with the HIV virus; or (3) the defendant has actual knowledge that a prior sex partner has been diagnosed as having the HIV virus. When an individual has knowledge that rises to the level of one of these three fact scenarios, the burden on that individual in revealing his or her HIV virus information is minimal when compared to the high risks of the disease. As a general rule, an individual will not be held liable for risks which are not known, not apparent, or not foreseeable to him or her. In this case, if defendant had no actual knowledge of his own infection, had no symptoms of the HIV virus whatsoever, nor was he aware of any prior sex partner who had been diagnosed as having the HIV virus, I find that as a matter of law it was not foreseeable that he would pass the HIV virus to Ms. Doe simply because he had unprotected sex with multiple partners prior to his encounter with Ms. Doe. "High Risk" Plus is Relevant Nonetheless, I find that the fact that one may have engaged in "high risk" activity is relevant to a claim for wrongful transmission of the HIV virus. Certainly, my ruling that a defendant owes a plaintiff a legal duty to, at the very least, disclose the fact that s/he may have the HIV virus, if one of the factors set forth [above] is present, allows room for inquiry into a defendant's past sexual and/or other "high risk" activity. For instance, a plaintiff will need to inquire whether any prior sex partners of a defendant have been diagnosed as having the HIV virus; when such diagnosis was made; when defendant learned of the diagnosis, etc. I find that defendant's knowledge of his past "high risk" behavior may be relevant to this action. Questions 1. Do you believe that Magic Johnson should have had a duty to inform his partner that he had engaged in high risk sexual behavior? Why? Why not? 2. Under what conditions do you believe that an HIV positive person should reveal his or her infection before engaging in sex? 3. Comment: American law distinguishes between malfeasance and nonfeasance. Ordinarily, a defendant is liable for malfeasance, but not for nonfeasance. Example: I am not liable for failing to rescue someone who is drowning even though I am a very good swimmer, but if I negligently took the person out on a boat and the boat capsized, I will be liable for not making reasonable attempts to rescue the person. 14 McGinley Class Materials Thursday, July 12 10-11:30 class C. Causation 1. Actual Cause STEVEN ZUCHOWICZ, Plaintiff-Appellee Cross-Appellant, v. UNITED STATES OF AMERICA, Defendant-Appellant Cross-Appellee. Docket No. 97-6057, 97-6099 UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT 140 F.3d 381; 1998 U.S. App. LEXIS 5366; 49 Fed. R. Evid. Serv. (Callaghan) 495 October 22, 1997, Argued March 20, 1998, Decided JUDGES: Before: NEWMAN, ALTIMARI, and CALABRESI, Circuit Judges. OPINION BY: CALABRESI [Note to students: Judge Calabresi is a very prominent Italian American jurist. He left Italy as a child when his family fled during World War II. His family was Jewish and he was from Ferrara. He was a professor at Yale Law School, one of the best in the USA. He was known for his scholarly works on Torts. He eventually became the Dean of Yale Law School and was then appointed a Judge of the United States Court of Appeals for the Second Circuit. He continues to serve as a distinguished judge]. OPINION CALABRESI, Circuit Judge: This suit under the Federal Tort Claims Act, 28 U.S.C. § 1346(b), 2671-2680, was originally filed by Patricia Zuchowicz, who claimed to have developed primary pulmonary hypertension, a fatal lung condition, as a result of the defendant's negligence in prescribing an overdose of the drug Danocrine. 15 Following Mrs. Zuchowicz's death in 1991, her husband, Steven, continued the case on behalf of his wife's estate, claiming that the defendant was responsible for her death. After a bench trial, the district court awarded the plaintiff $ 1,034,236.02 in damages. I. Background A. Drug, Illness, and Death 1. The Overdose The facts, as determined by the district court, are as follows. On February 18, 1989, Mrs. Zuchowicz filled a prescription for the drug Danocrine at the Naval Hospital pharmacy in Groton, Connecticut. The prescription erroneously instructed her to take 1600 milligrams of Danocrine per day, or twice the maximum recommended dosage. The defendant has stipulated that its doctors and/or pharmacists were negligent and violated the prevailing standard of medical care by prescribing this wrong dosage. Mrs. Zuchowicz took the 1600 milligrams of Danocrine each day for the next month. Thereafter, from March 24 until May 30, she took 800 milligrams per day. While taking Danocrine she experienced abnormal weight gain, bloating, edema, hot flashes, night sweats, a racing heart, chest pains, dizziness, headaches, acne, and fatigue. On May 30, she was examined by an obstetrician/gynecologist in private practice who told her to stop taking the Danocrine. During the summer, she continued to experience severe fatigue and chest tightness and pain, and began having shortness of breath. In October 1989, she was diagnosed with primary pulmonary hypertension ("PPH"), a rare and fatal disease. At the time she was diagnosed with the disease, the median life expectancy for PPH sufferers was 2.5 years. Mrs. Zuchowicz was on the waiting list for a lung transplant when she became pregnant. Mrs. Zuchowicz gave birth to a son on November 21, 1991. She died one month later, on December 31, 1991. 2. Primary Pulmonary Hypertension Pulmonary hypertension is categorized as "primary" when it occurs in the absence of other heart or lung diseases. PPH is very rare. A National Institute of Health registry recorded only 197 cases of PPH from the mid-1980s until 1992. It occurs predominantly in young women. 3. Danocrine Danocrine has been extensively studied and prescribed since the late 1960s for endometriosis. According to the testimony of plaintiff's expert Dr. W. Paul D'Mowski, who personally performed much of the initial research on the drug, Danocrine is safe and effective when administered properly. Based on studies by Dr. D'Mowski and others, Danocrine was approved by the Food and Drug Administration ("FDA") for use in dosages not to exceed 800 mg/day. Mrs. Zuchowicz was accidentally given a prescription instructing her to take twice this amount -- 1600 mg/day. According to Dr. D'Mowski no formal studies of the effects of Danocrine at such high doses have been performed, and very, very few women have received doses this high in any setting. B. The Expert Testimony 1. Dr. Matthay 16 Dr. Matthay testified that he was confident to a reasonable medical certainty that the Danocrine caused Mrs. Zuchowicz's PPH. When pressed, he added that he believed the overdose of Danocrine to have been responsible for the disease. His conclusion was based on the temporal relationship between the overdose and the start of the disease and the method of excluding other possible causes. Dr. Matthay further testified that the progression and timing of Mrs. Zuchowicz's disease in relation to her overdose supported a finding of drug-induced PPH. Dr. Matthay emphasized that, prior to the overdose, Mrs. Zuchowicz was a healthy, active young woman with no history of cardiovascular problems, and that, shortly after the overdose, she began experiencing symptoms of PPH such as weight gain, swelling of hands and feet, fatigue, and shortness of breath. II. Discussion B. Were the District Court's Factual Findings with Respect to Causation Clearly Erroneous? The case turns only on the difficulty of showing a but for cause. On whether, in other words, the plaintiff has sufficiently demonstrated: (a) that defendant's act in giving Mrs. Zuchowicz Danocrine was the source of her illness and death, and (b) that it was not just the Danocrine, but its negligent overdose that led to Mrs. Zuchowicz's demise. 3. Connecticut Law and Experts The expert must deal not in mere possibilities, but in "reasonable medical probabilities." At the same time, it is well-established that causation "may be proved by circumstantial evidence," and that "the causal relation between an injury and its later physical effects may be established by the direct opinion of a physician, by his deduction by the process of eliminating causes other than the traumatic agency, or by his opinion based upon a hypothetical question." 4. Was Danocrine a But For Cause of Mrs. Zuchowicz's Illness and Death? We hold that, on the basis of Dr. Matthay's testimony alone, the finder of fact could have concluded -- under Connecticut law -- that Mrs. Zuchowicz's PPH was, more likely than not, caused by Danocrine. The evidence presented showed that the experts had not only excluded all causes of secondary pulmonary hypertension, but had also ruled out all the previously known drug-related causes of PPH. In addition, Dr. Matthay testified, based on his expertise in pulmonary diseases, that the progression and timing of Mrs. Zuchowicz's illness in relationship to the timing of her overdose supported a finding of drug-induced PPH to a reasonable medical certainty. 5. Was the Overdose a But For Cause of Mrs. Zuchowicz's Illness and Death? To say that Danocrine caused Mrs. Zuchowicz's injuries is only half the story, however. In order for the causation requirement to be met, a trier of fact must be able to determine, by a preponderance of the evidence, that the defendant's negligence was responsible for the injury. In this case, defendant's negligence consisted in prescribing an overdose of Danocrine to Mrs. Zuchowicz. For liability to exist, therefore, it is necessary that the fact finder be able to conclude, more probably than not, that the overdose was the cause of Mrs. Zuchowicz's illness and ultimate death. The mere fact that the exposure to Danocrine was likely responsible for the disease does not suffice. The problem of linking defendant's negligence to the harm that occurred is one that many courts have addressed in the past. 17 If (a) a negligent act is deemed wrongful because that act increased the chances that a particular type of accident would occur, and (b) a mishap of that very sort did happen, this is enough to support a finding by the trier of fact that the negligent behavior caused the harm. Where such a strong causal link exists, it is up to the negligent party to bring in evidence denying but for cause and suggesting that in the actual case the wrongful conduct had not been a substantial factor. The case before us is a good example of the above-mentioned principles in their classic form. Moreover, it is often true that the higher the dosage the greater is the likelihood of such negative effects. At the approved dosages, the benefits of the particular drug have presumably been deemed worth the risks it entails. At greater than approved dosages, not only do the risks of tragic side effects (known and unknown) increase, but there is no basis on the testing that has been performed for supposing that the drug's benefits outweigh these increased risks. Under the circumstances, we hold that defendant's attack on the district court's finding of causation is meritless. Notes and Comments: 1. The suit in Zuchowicz was brought alleging a violation of a federal law, the Federal Tort Claims Act, because the defendant was the Naval Hospital, a federal entity. 2. The trial judge acted as the fact finder in this case. In other words, there was no jury and it was a bench trial. The court of appeals looks to see whether the trial judge’s factual findings were clearly erroneous. This is the standard of review for judges who sit as fact finders. If the judge’s factual findings are not clearly erroneous, they will be upheld, even if the court of appeals would decide a different way if it were conducting the trial. 2. Proximate Cause What is proximate cause? Read the following example: Assume that Dr. Miller performs a tubal ligation on a woman (sterilization procedure) so that she will not have any more children. He performs the operation negligently and a baby boy, James, is born. Fifteen years later, James sets fire to John Walsh’s house. Can John Walsh sue Dr. Miller for the harm caused by his negligence in performing the tubal ligation? It is true that Dr. Miller’s negligence is a but for cause of James’ existence and without James’ birth, he would not have burned the house, but the law would not hold Dr. Miller responsible for the damage to John Walsh’s house. This is because the law requires proximate cause as well as actual cause for there to a recovery. Proximate Cause is a limitation on liability. The courts look to see whether the injury was a foreseeable result of the negligence. Even if there is actual cause, a plaintiff will not prevail without a showing of proximate cause. The fire in Walsh’s house is not a foreseeable risk of Dr. Miller’s negligent performance of the tubal ligation. The following case is the most famous proximate cause case decided in the United States. Justice Cardozo was a famous American judge. He concludes that there was no duty to the plaintiff because her injury was not foreseeable. The dissent, authored by Justice Anderson, which appears in part below, is much closer to the current law of proximate cause. Although foreseeability is considered a 18 keystone today, and Anderson does not seem to care much about foreseeability, he makes important points about how to determine whether there is proximate cause. Palsgraf, Respondent, v. The Long Island Railroad Company, Apellant Court of Appeals of New York [In New York, this is the highest court]. 248 N.Y. 339; 162 N.E. 99; 1928 N.Y. LEXIS 1269; 59 A.L.R. 1253 February 24, 1928, Argued May 29, 1928, Decided [The plaintiff, Mrs. Palsgraff was injured when the employee of the railroad (called the “chauffeur” in the opinion below) pushed a man who was boarding a train to help him onto the train. The push caused the man to drop a package which contained fireworks. The package exploded on the tracks which caused a large scale at the other end of the station to fall on Mrs. Palsgraff. She sued]. Justice Anderson (dissenting) What we do mean by the word "proximate" is, that because of convenience, of public policy, of a rough sense of justice, the law arbitrarily declines to trace a series of events beyond a certain point. This is not logic. It is practical politics. Once again, it is all a question of fair judgment, always keeping in mind the fact that we endeavor to make a rule in each case that will be practical and in keeping with the general understanding of mankind. Here another question must be answered. In the case supposed it is said, and said correctly, that the chauffeur is liable for the direct effect of the explosion although he had no reason to suppose it would follow a collision. "The fact that the injury occurred in a different manner than that which might have been expected does not prevent the chauffeur's negligence from being in law the cause of the injury." But the natural results of a negligent act -- the results which a prudent man would or should foresee -- do have a bearing upon the decision as to proximate cause. We have said so repeatedly. What should be foreseen? No human foresight would suggest that a collision itself might injure one a block away. On the contrary, given an explosion, such a possibility might be reasonably expected. I think the direct connection, the foresight of which the courts speak, assumes prevision of the explosion, for the immediate results of which, at least, the chauffeur is responsible. It may be said this is unjust. Why? In fairness he should make good every injury flowing from his negligence. Not because of tenderness toward him we say he need not answer for all that follows his wrong. We look back to the catastrophe, the fire kindled by the spark, or the explosion. We trace the consequences -- not indefinitely, but to a certain point. And to aid us in fixing that point we ask what might ordinarily be expected to follow the fire or the explosion. This last suggestion is the factor which must determine the case before us. The act upon which defendant's liability rests is knocking an apparently harmless package onto the platform. The act was 19 negligent. For its proximate consequences the defendant is liable. If its contents were broken, to the owner; if it fell upon and crushed a passenger's foot, then to him. If it exploded and injured one in the immediate vicinity, to him also. Mrs. Palsgraf was standing some distance away. How far cannot be told from the record -- apparently twenty-five or thirty feet. Perhaps less. Except for the explosion, she would not have been injured. We are told by the appellant in his brief "it cannot be denied that the explosion was the direct cause of the plaintiff's injuries." So it was a substantial factor in producing the result -- there was here a natural and continuous sequence -- direct connection. The only intervening cause was that instead of blowing her to the ground the concussion smashed the weighing machine which in turn fell upon her. There was no remoteness in time, little in space. And surely, given such an explosion as here it needed no great foresight to predict that the natural result would be to injure one on the platform at no greater distance from its scene than was the plaintiff. Just how no one might be able to predict. Whether by flying fragments, by broken glass, by wreckage of machines or structures no one could say. But injury in some form was most probable. [Justice Anderson would have held the railroad responsible for Mrs. Palgraf’s injuries even though she was standing at a distance from the explosion]. *** D. Harm In a negligence action, the plaintiff must prove that he or she was harmed and that the defendant’s negligence was a cause of the harm. Harm includes economic and non-economic damages such as loss of future income, medical costs, future medical costs, pain and suffering, emotional distress. Key Terminology: Negligence Duty Breach of Duty Motion to Dismiss Breaches a legal duty Cause of action Knew or should have known Balancing factors Actual knowledge Foreseeable Duty to act as a reasonable person under the circumstances Duty to inform Actual cause 20 Bench trial Stipulate A reasonable medical certainty/A reasonable degree of scientific certainty But for cause Circumstantial evidence Proximate cause Economic damages Non-economic damages Special Problems in Negligence: Medical Malpractice and Health Care Reform III. Medical Malpractice A. Standard of Care In order to prove medical or other professional malpractice, the plaintiff must establish what the standard of care is. The standard of care is the duty to the patient. A breach of this duty is negligence. If the patient can prove that the breach of the duty was an actual and proximate cause of the plaintiff’s injuries, the plaintiff will prevail. Ordinarily, the standard of care is established through an expert who testifies what a reasonable physician under the circumstances would do. Usually doctors will be held to the standard of care of a physician with that physician’s specialty or expertise. Of course, a doctor without expertise in a particular area (a general practitioner) may be negligent if that doctor does not refer the patient to someone with specialized expertise. B. Expert Testimony The following statute codifies in part a common law doctrine called res ipsa loquitur. Res ipsa loquitur is a doctrine that provides that in some situations the plaintiff does not have to establish negligence by expert medical testimony because the “act speaks for itself.” In other words, it is obvious that there was negligence and it would be unjust for the plaintiffs to have to prove negligence. It began in medical malpractice cases in situations where the plaintiff could not testify because the plaintiff was unconscious due to anesthesia. The courts did not want to permit doctors to refuse to speak and therefore to escape liability. Nevada has codified this doctrine, but has also limited it in the following statute. N.R.S. 41A.100 [N.R.S. stands for “Nevada Revised Statutes.” These are statutes that apply to the state of Nevada]. 41A.100. Required evidence; exceptions; rebuttable presumption of negligence 1. Liability for personal injury or death is not imposed upon any provider of medical care based on alleged negligence in the performance of that care unless evidence consisting of expert medical tes21 timony, material from recognized medical texts or treatises or the regulations of the licensed medical facility wherein the alleged negligence occurred is presented to demonstrate the alleged deviation from the accepted standard of care in the specific circumstances of the case and to prove causation of the alleged personal injury or death, except that such evidence is not required and a rebuttable presumption that the personal injury or death was caused by negligence arises where evidence is presented that the personal injury or death occurred in any one or more of the following circumstances: (a) A foreign substance other than medication or a prosthetic device was unintentionally left within the body of a patient following surgery; (b) An explosion or fire originating in a substance used in treatment occurred in the course of treatment; (c) An unintended burn caused by heat, radiation or chemicals was suffered in the course of medical care; (d) An injury was suffered during the course of treatment to a part of the body not directly involved in the treatment or proximate thereto; or (e) A surgical procedure was performed on the wrong patient or the wrong organ, limb or part of a patient's body. 2. Expert medical testimony provided pursuant to subsection 1 may only be given by a provider of medical care who practices or has practiced in an area that is substantially similar to the type of practice engaged in at the time of the alleged negligence. 3. As used in this section, "provider of medical care" means a physician, dentist, registered nurse or a licensed hospital as the employer of any such person. *** [Following is a media description of a terrible event happening during an operation to put in a pacemaker. Consider whether the above statute would be applicable in this case]. 22 23 24 C. Policy Supporting Medical Malpractice The policy behind medical malpractice is to compensate victims and to deter negligent behavior. Courts often talk about the need to encourage more careful behavior and the need to reform how professionals behave is a central theme in medical malpractice litigation. An important question is whether the law is actually encouraging and causing the types of behaviors it hopes to encourage. Doctors often criticize the law and argue that it encourages decisions that lead to very high costs – needless tests, etc. Consider these issues when you read the policy section below. D. The Rising Costs of Health Care: Policy Considerations Below is a sample of news articles and opinion pieces written about the rising cost of health care and its alleged link to medical malpractice litigation. The New York Times, February 22, 2010 Monday HEADLINE: How the G.O.P. Can Fix Health Care BYLINE: By NEWT GINGRICH. NEWT GINGRICH, former speaker of the House of Representatives and founder of the Center for Health Transformation, a health-care policy consulting firm BODY: CAT scans, blood tests, ultrasounds, Caesarean sections -- in many instances, these diagnostic tools and procedures are vital for treating patients. Too often, however, such procedures are ordered unnecessarily and drive up the cost of medicine for patients, taxpayers and insurance carriers. A new Gallup poll, commissioned by Jackson Healthcare, indicates that doctors believe an astounding one in four health care dollars is now spent on unnecessary care. Doctors order these procedures to protect against frivolous suits filed by trial lawyers seeking an easy payout, particularly after a doctor makes a simple mistake. Seventy-three percent of the doctors surveyed said they had practiced defensive medicine in the past year. As a result, American patients not only endure extra hours of tests and treatments but also pay more for health care. If President Obama and Congress are serious about reducing health care costs, then the more than 25 $600 billion a year in unnecessary care should be at the top of the list. Congress must give states the incentive to reform their civil justice systems so that lawyers will think twice before suing doctors for frivolous cases. There is a place for health courts that address only medical malpractice cases, and a need for caps on damages for ''pain and suffering'' that have nothing to do with lost wages or actual damages. Doctors who incorporate best medical practices should be protected from lawsuits altogether. These reforms would allow doctors to stop playing defense, and make it possible for patients and taxpayers to better afford health care. *** The New York Times, March 10, 2005 HEADLINE: False Diagnosis BYLINE: By Bernard Black, Charles Silver, David Hyman and William Sage. Bernard Black and Charles Silver are law professors at the University of Texas at Austin. David Hyman is a professor of law and medicine at the University of Illinois. William Sage is a law professor at Columbia. BODY: MEDICAL malpractice litigation reform is a high priority for President Bush, who contends that juries are running amok, multimillion-dollar settlements are on the rise and greedy trial lawyers are filing frivolous suits. The results, Mr. Bush and others argue, include skyrocketing insurance prices, abandoned medical practices, defensive medicine and a crisis of access to care. Their proposed solution: caps on jury awards to patients and on lawyers' contingent fees. No one disputes that insurance premiums have risen significantly. The question is whether a crisis in states' tort systems accounts for the increase. Consider Mr. Bush's home state of Texas, America's second most populous state and the third largest in terms of total health care spending. After studying a database maintained by the Texas Department of Insurance that contains all insured malpractice claims resolved between 1988 and 2002, we saw no evidence of a tort crisis. Adjusting for inflation and rising population, we arrived at the following findings: Large claims (with payouts of at least $25,000 in 1988 dollars) were roughly constant in frequency. The percentage of claims with payments of more than $1 million remained steady at about 6 percent of all large claims. The number of total paid claims per 100 practicing physicians per year fell to fewer than five in 2002 from greater than six in 1990-92. Mean and median payouts per large paid claim were roughly constant. Jury verdicts in favor of plaintiffs showed no trend over time. The total cost of large malpractice claims was both stable and a small fraction (less than 1 percent) of total health care expenditures in Texas. 26 In short, as far as medical malpractice cases are concerned, for 15 years the Texas tort system has been remarkably stable. Texas's situation is not unique. One study of Florida's experience from 1990 to 2003 also found declines in paid claims per 100 practicing physicians as well as per 100,000 population. Over the same period in Missouri, the total number of malpractice claims fell by about 40 percent and the number of paid claims dropped almost by half. Malpractice premiums have risen sharply in Texas and many other states. But, at least in Texas, the sharp spikes in insurance prices reflect forces operating outside the tort system. The medical malpractice system has many problems, but a crisis in claims, payouts and jury verdicts is not among them. Thus, the federal ''solution'' that Mr. Bush proposes is both overbroad and directed at the wrong problem. *** Limiting non-economic damages in Medical Malpractice cases The following statute was passed by Nevada citizens in response to a petition that was put on the ballot. It limits non-economic damages in medical malpractice cases. This resulted from a very political debate in which many including former President Bush and the American Medical Association took the position that there was a litigation explosion that was a primary cause of rising health care costs. There was concern that medical doctors would leave the state because they were having trouble getting reasonable medical malpractice insurance. Nev. Rev. Stat. Ann. § 41A.035 (2009) 41A.035. Limitation on amount of award for noneconomic damages. In an action for injury or death against a provider of health care based upon professional negligence, the injured plaintiff may recover noneconomic damages, but the amount of noneconomic damages awarded in such an action must not exceed $350,000. Questions 1. What are non-economic damages? What are economic damages? 2. Are any particular groups of plaintiffs harmed more by the restriction on non-economic damages? Key Terminology Standard of care Medical malpractice Res ipsa loquitur Rebuttable presumption Compensate victims Deter negligent behavior 27 District court Informed consent Conflicting evidence Credible evidence McGinley Class Materials Friday, July 13, 2012 15-16:30 IV. Vicarious Liability Employers are liable for the torts committed by their employees that occur within the scope of the employee’s employment. This is called respondeat superior. The employer need not be at fault or negligent to be liable for the negligence of the employee. The purpose of respondeat superior is to: 1. Prevent injuries; 2. Assure compensation to victims; and 3. Spread the loss caused by the business equitably. In other words, the law presumes that respondeat superior will make the employer pay more attention to how its employees perform their jobs to assure that the employees are not acting negligently. When there is negligence of an employee, the employee will often not have sufficient money or insurance to pay the victim, so respondeat superior assures that the victim will be compensated through the greater resources of the employer. Finally, there is loss-spreading because companies will charge their customers for their products or services enough to cover the cost of insurance and damage payments to plaintiffs. Thus, those who use the products or services will pay to compensate the victim through the cost of the product or service. Case law establishes the boundaries of what “within the scope of employment” means. The courts have interpreted this phrase fairly broadly. Behavior can occur within the scope of employment even if the employer would not, or did not, condone the behavior. V. Strict Liability As we have seen, ordinarily a defendant will be liable for fault that is measured by the defendant’s intent or negligence. While negligence is the predominant form of tort liability, there are still a number of situations where the defendant will be strictly liable. Strict liability is liability of the defendant without fault. In essence, American law holds defendants strictly liable for injuries caused if the activity in which the defendant is a engaging is unreasonably dangerous or a nuisance. Examples—Nuisance – when the defendant’s use of his or her land substantially and unreasonably invades the plaintiff’s interest in his or her land and affects the plaintiff’s use and enjoyment of his or her property. E.g. – the defendant blasts very loud music in a residential neighborhood E.g. – the defendant operates a pig farm in a residential neighborhood and the smell is awful. Remedies would include damages but also injunctive relief. 28 E.g. – the defendant builds a golf course next to a residential community and the balls enter through the windows of residents in the community NB – Many of the nuisances have been controlled by zoning laws. Unreasonably dangerous activities – blasting of dynamite, dumping of waste, environmental toxins, etc., will also lead to strict liability. Historically, certain defendants such as common carriers (trains, airplanes, etc.) and hotels are strictly liable for injury to their customers. VI. Products Liability A plaintiff may sue for injuries caused by defective products if the products are negligently manufactured or designed. This suit is a common negligence action. A plaintiff may also sue for injuries caused by defective products using strict liability. In the U.S., different states apply the products liability law differently. The first recognition of strict products liability throughout the states occurred in 1965 with the Restatement (Second) of Torts. It made a manufacturer and seller of a product strictly liable for defects in manufacture, design and warnings. Note that the Restatement uses the “unreasonably dangerous” standard from other strict liability cases and applies it to products. A. Restatement (Second) of Torts 1965 § 402A Special Liability of Seller of Product for Physical Harm to User or Consumer (1) One who sells any product in a defective condition unreasonably dangerous to the user or consumer or to his property is subject to liability for physical harm thereby caused to the ultimate user or consumer, or to his property, if (a) the seller is engaged in the business of selling such a product, and (b) it is expected to and does reach the user or consumer without substantial change in the condition in which it is sold. (2) The rule stated in Subsection (1) applies although (a) the seller has exercised all possible care in the preparation and sale of his product, and (b) the user or consumer has not bought the product from or entered into any contractual relation with the seller. Section 402A does not distinguish between manufacturing and design defects. Early on, however, the courts did distinguish between them. A manufacturing defect or “production flaw” can occur even if the design is not defective. Under 402A the courts used the “consumer expectations test” to determine whether a product’s design is defective. As we will see below in the Honda case, under the new Restatement of Products Liability (Third), a defect in design requires a balancing test under the risk/utility test. 29 The following case is an example of the Consumer Expectations Test: LEICHTAMER ET AL., APPELLEES, v. AMERICAN MOTORS CORP. ET AL., APPELLANTS No. 80-1354 Supreme Court of Ohio 67 Ohio St. 2d 456; 424 N.E.2d 568; 1981 Ohio LEXIS 602; 21 Ohio Op. 3d 285; CCH Prod. Liab. Rep. P9036 August 5, 1981, Decided PRIOR HISTORY: APPEAL from the Court of Appeals for Stark County. This litigation arises out of a motor vehicle accident which occurred on April 18, 1976. On that date, Paul Vance and his wife, Cynthia, invited Carl and Jeanne Leichtamer, brother and sister, to go for a ride in the Vance's Jeep Model CJ-7. The Vances and the Leichtamers drove together to the Hall of Fame Four-Wheel Club, of which the Vances were members. The Vances were seated in the front of the vehicle and the Leichtamers rode in the back. The club, located near Dundee, Ohio, was an "off-the-road" recreation facility. The course there consisted of hills and trails about an abandoned strip mine. While the Vance vehicle was negotiating a double-terraced hill, an accident occurred. The hill consisted of a 33-degree slope followed by a 70-foot long terrace and then a 30-degree slope. Paul Vance drove over the brow of the first of these two slopes and over the first flat terrace without incident. As he drove over the brow of the second hill, the rear of the vehicle raised up relative to the front and passed through the air in an arc of approximately 180 degrees. The vehicle landed upside down with its front pointing back up the hill. This movement of the vehicle is described as a pitch-over. The pitch-over of the Jeep CJ-7, on April 18, 1976, killed the driver, Paul Vance, and his wife, Cynthia. Carl Leichtamer sustained a depressed skull fracture. The tail gate of the vehicle presumably struck Jeanne Leichtamer. Jeanne Leichtamer is a paraplegic as a result of the injury. Carl and Jeanne Leichtamer, appellees, subsequently sued American Motors Corporation, American Motors Sales Corporation and Jeep Corporation, appellants, for "enhanced" injuries they sustained in the accident of April 18, 1976. The amended complaint averred that the permanent trauma to the body of Jeanne Leichtamer and the other injuries to her brother, Carl, were causally related to the displacement of the "roll bar" on the vehicle. DISPOSITION: Judgment affirmed OPINION BY: BROWN Appellants assert that the instructions of law given to the jury by the trial court improperly submitted the doctrine of strict liability in tort as a basis for liability. The scope of this review is limited 30 to the question of whether an instruction on strict liability in tort should have been given. For the reasons explained herein, we answer the question in the affirmative. The doctrine of strict liability evolved to place liability on the party primarily responsible for the injury occurring, that is, the manufacturer of the defective product. Any distinction based upon the source of the defect undermines the policy underlying the doctrine that the public interest in human life and safety can best be protected by subjecting manufacturers of defective products to strict liability in tort when the products cause harm. We turn to the question of what constitutes an unreasonably dangerous defective product. Section 402A subjects to liability one who sells a product in a "defective condition unreasonably dangerous" which causes physical harm to the ultimate user. The concept of "unreasonable danger," as found in Section 402A, provides implicitly that a product may be found defective in design if it is more dangerous in use than the ordinary consumer would expect. Another way of phrasing this proposition is that "a product may be found defective in design if the plaintiff demonstrates that the product failed to perform as safely as an ordinary consumer would expect when used in an intended or reasonably foreseeable manner." Thus, we hold a cause of action for damages for injuries "enhanced" by a design defect will lie in strict liability in tort. In order to recover, the plaintiff must prove by a preponderance of the evidence that the "enhancement" of the injuries was proximately caused by a defective product unreasonably dangerous to the plaintiff. A product will be found unreasonably dangerous if it is dangerous to an extent beyond the expectations of an ordinary consumer when used in an intended or reasonably foreseeable manner. *** The Third Restatement, which was adopted in 1998, has not been accepted by all courts in all states. It does have a following, however. It makes it much more difficult to prove a design defect because it uses a risk/utility test instead of a consumer expectation test. The plaintiff has the burden of proving that the risk of harm was foreseeable and that it could have been avoided by a reasonable alternative design. This proof often requires expensive expert testimony. Restatement 3d of Torts: Products Liability, § 2 (1998) § 2 Categories of Product Defect A product is defective when, at the time of sale or distribution, it contains a manufacturing defect, is defective in design, or is defective because of inadequate instructions or warnings. A product: (a) contains a manufacturing defect when the product departs from its intended design even though all possible care was exercised in the preparation and marketing of the product; (b) is defective in design when the foreseeable risks of harm posed by the product could have been reduced or avoided by the adoption of a reasonable alternative design by the seller or other distributor, or a predecessor in the commercial chain of distribution, and the omission of the alternative design renders the product not reasonably safe; 31 (c) is defective because of inadequate instructions or warnings when the foreseeable risks of harm posed by the product could have been reduced or avoided by the provision of reasonable instructions or warnings by the seller or other distributor, or a predecessor in the commercial chain of distribution, and the omission of the instructions or warnings renders the product not reasonably safe. In the following case, the court used the Restatement Third’s definition of a product that is defectively designed. This definition is less consumer-friendly. How would this case have come out if the court had used the consumer expectations test? HONDA OF AMERICA MANUFACTURING, INC. AND HONDA R&D CO., LTD., Appellants v. BRIAN NORMAN, INDIVIDUALLY AND AS SOLE ADMINISTRATOR OF THE ESTATE OF KAREN LESLIE VIVIENNE NORMAN, DECEASED, AND MARY NORMAN, INDIVIDUALLY, Appellees NO. 01-00-01263-CV COURT OF APPEALS OF TEXAS, FIRST DISTRICT, HOUSTON 104 S.W.3d 600; 2003 Tex. App. LEXIS 1263; CCH Prod. Liab. Rep. P16,518 February 6, 2003, Opinion Issued OPINION This is a products liability suit. A jury awarded Brian Norman, individually and as sole administrator of the estate of Karen Leslie Vivienne Norman, deceased, and Mary Norman, individually, (the Normans) $ 65 million in compensatory damages in a suit the Normans brought against Honda of America Manufacturing, Inc. and Honda R&D Co., Ltd., after the Normans' daughter, Karen Norman, drowned in her Honda Civic automobile. The jury found that a design defect in the car's seatbelt was the producing cause of Karen's death. In five issues, Honda argues (1) the evidence was legally and factually insufficient to prove causation; (2) the evidence was legally and factually insufficient to prove a safer alternative design; (3) the trial court abused its discretion in admitting unqualified and unreliable expert testimony; (4) the trial court abused its discretion in admitting evidence of other incidents; and (5) the evidence was legally and factually insufficient to support the jury's award of "grossly excessive damages, which were influenced by improper motivations." We reverse and render a take-nothing judgment. Facts and Procedural Background The Accident At approximately 2:00 a.m. on December 2, 1992, Karen attempted to back her car up to turn around, and she accidentally backed down a boat ramp into the water in Galveston Bay. Her pas32 senger, Josel Woods, was not wearing a seatbelt and was able to get out of the car by crawling out the passenger side window. After escaping, Woods reached back into the sinking car to get her purse. Woods testified that Karen was calm and did not appear scared. As Woods was swimming to the ramp, she heard Karen say, "Help me. I can't get my seatbelt undone." Woods testified that, after she reached the ramp, she heard Karen yell to her again that she could not get out of her seatbelt. A dive team located Karen's car at 8:53 a.m. All of the windows were rolled up, including the one Woods testified she had escaped through, and all the doors were closed. Karen's body was found in the back seat. An autopsy revealed Karen's blood-alcohol level was .17. The Car At the time of the accident, Karen's four-door 1991 Honda Civic was equipped with a two-point passive restraint system--an automatic seatbelt that was mechanically drawn up over the shoulder when the door was closed--supplemented with a manual lap belt. The automatic seatbelt fastened itself with no action on behalf of the occupant. Robert Hellmuth, a former National Highway Traffic Safety Administration employee, testified that, in 1990, all cars were required to have either a passive belt system or an air bag. The shoulder belt on both front seats was attached to a "mouse" that ran along a rail above the door. When the door was closed, the mouse moved from its starting position, near the front of the car, along the length of the door and then part-way down the pillar between the front and back doors, pulling the belt over the shoulder of the driver. When the door was opened or the ignition was turned off, the mouse moved forward, allowing the occupant to get out of the car. The shoulder belt could be manually disengaged by pressing an emergency release button located at the juncture of the belt and the mouse. Like most seatbelts, the shoulder belt was naturally taut across the body, but it was easy to spool out more belt to allow the occupant to lean forward and/or sideways. If the car experienced rapid deceleration (such as that encountered here when the car hit the water) or substantial tilting of the vehicle, however, the belt's emergency locking retractor would engage, preventing spooling of the belt and holding the occupant in her seat. The Lawsuit The Normans sued Honda, alleging that the seatbelt system in Karen's car was defectively designed and prevented her from getting out of the sinking car. The case was retried after the original trial resulted in a hung jury. The Normans contend that the emergency locking retractor locked as Karen backed down the ramp and that she pulled on the door latch, causing the mouse to move and then stall and the seatbelt to pin her to her seat. Because she was pinned to the seat, Karen was unable to reach the emergency release button located over her left shoulder. The Normans argue that the evidence showed the seatbelt system was defectively designed because (1) the mouse was able to move even when the retractor was locked, allowing the seatbelt to pin an occupant in the seat; (2) the seatbelt, when fully extended, could not be released easily and rapidly by pressing the emergency release button; and (3) the emergency release button was improperly located, in that Honda failed to provide an easy and rapid way to get out of the seatbelt under conditions it knew would occur. The jury found that Karen was 25% contributorily negligent, awarded Karen's parents $ 60 million in actual damages, and awarded $ 5 million to Karen's estate. The trial court reduced the 33 award to $ 20 million for Karen's mother and $ 18 million for Karen's father, and it denied Honda's motion for remittitur as to the estate. Design Defect Safer Alternative Design The Normans had to prove that an economically and technologically feasible alternative seat belt and release system was available and would have prevented or significantly reduced the risk of Karen's death without substantially reducing the utility to the "intended users" of the product--namely, all automobile drivers. If no evidence is offered that a safer design existed, a product is not unreasonably dangerous as a matter of law. The jury charge read, in part, as follows: Was there a design defect in the seat belt restraint system at the time it left the possession of Honda that was a producing cause of the occurrence in question? A "design defect" is a condition of the product that renders it unreasonably dangerous as designed, taking into consideration the utility of the product and the risk involved in its use. For a design defect to exist, there must have been a safer alternative design. "Safer alternative design" means a product design, other than the one actually used, that in reasonable probability 1. would have prevented or significantly reduced the risk of the occurrence in question without substantially impairing the product's utility and 2. was economically and technologically feasible at the time the product left the control of Honda acting by and though [sic] its agents and/or employees by the application of existing or reasonably achievable scientific knowledge. Two of the Normans' experts, Thomas Horton, a mechanical engineer, and Kenneth Ronald Laughery, a human factors expert, testified that there were three potential alternative seatbelt system designs: (1) the mouse could be on a timer; (2) the release button could be located on the hip level, as in Toyota cars; and (3) there could be two release buttons - one near the hip and one over the shoulder. To prove that the mouse timer constituted a safer alternative design to the overhead manual seatbelt release in the Honda, the Normans had to show that (1) a mouse timer existed or that the scientific knowledge to produce it was reasonably achievable, and (2) a mouse timer was economically and technologically feasible at the time Karen's car left Honda's control. On cross-examination, however, Horton admitted that he had never drawn up schematics for a mouse timer system. Nor did Horton give any testimony to support a finding that, considering all relevant risks, his alternative design would be safer than the one employed by Honda in that it would not "under other circumstances impose an equal or greater risk of harm." Horton further testified that he was not critical of Honda for the location of the emergency release button. In fact, he testified that he was "not going to express [an opinion] in this case" with respect to the location or functioning of Honda's emergency release button. We conclude, based on the record, that the Normans failed to prove that a timer- controlled mouse was a safer alternative design to the seatbelt system in Karen's Honda. (2) Toyota alternative--right hip release only 34 The Normans contend that, because of her small frame, Karen positioned the driver's seat close to the steering wheel, which made it difficult, if not impossible, for her to activate the release button found over her left shoulder on the car frame. The Normans argue that Kenneth Laughery testified that placing a release button over the left shoulder of the driver was not sufficient. Laughery testified that, before 1991, at the same time the Honda system in Karen's car was designed, Toyota was using a release mechanism in the form of a lever control at the lower right side of the driver that released the emergency locking retractor. While the use of an alternative design by another manufacturer may establish technological feasibility, we have held that, as a matter of law, it does not establish economic feasibility. The existence of a technological advancement goes to technological feasibility, while the cost of applying that technology to a particular design goes to economic feasibility. Evidence of use in the marketplace alone is not sufficient to establish economic feasibility under Texas law. To establish economic feasibility, the plaintiff must introduce proof of the "cost of incorporating this technology." We conclude, based on the record, that the Normans presented no evidence from which the jury could reasonably find that the Toyota hip-release design would have prevented or significantly reduced the risk of Karen's death without imposing an equal or greater risk of harm under all relevant circumstances. All of the responsive testimony from the Normans' own expert witness--as from Honda's--was to the contrary. The Normans, therefore, failed to prove that the right-hip release system was a safer alternative than the shoulder-release system in Karen's Honda. We reverse and render a take-nothing judgment. D. Warning Defects Luis LIRIANO, Plaintiff-Appellee, v. HOBART CORPORATION, Defendant-Appellant, 616 MELROSE MEAT CORPORATION, s/h/a SUPER ASSOCIATED, Third-Party Defendant-Appellant. Docket No. 96-9641(L); 97-7449(CON) UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT 170 F.3d 264; 1999 U.S. App. LEXIS 3634; CCH Prod. Liab. Rep. P15,466 October 20, 1997, Argued March 9, 1999, Decided JUDGES: Before: NEWMAN, CALABRESI, and CUDAHY, * Circuit Judges. Judge Newman concurs in a separate opinion. OPINION 35 CALABRESI, Circuit Judge: We affirm the decision of the district court granting judgment and damages for the plaintiff. BACKGROUND Luis Liriano was severely injured on the job in 1993 when his hand was caught in a meat grinder manufactured by Hobart Corporation ("Hobart") and owned by his employer, Super Associated ("Super"). The meat grinder had been sold to Super with a safety guard, but the safety guard was removed while the machine was in Super's possession and was not affixed to the meat grinder at the time of the accident. The machine bore no warning indicating that the grinder should be operated only with a safety guard attached. Liriano sued Hobart under several theories, including failure to warn. Hobart brought a third-party claim against Super. The United States District Court for the Southern District of New York (Shira A. Scheindlin, J.) dismissed all of Liriano's claims except the one based on failure to warn, and the jury returned a verdict for Liriano on that claim. It attributed five percent of the liability to Hobart and ninety-five percent to Super. The district court then held a partial retrial limited to the issue of whether and to what extent Liriano was responsible for his own injury. On that retrial, the jury assigned Liriano one-third of the fault. Hobart and Super appealed, arguing that as a matter of law, there was no duty to warn, and (2) that even if there had been a duty to warn, the evidence presented was not sufficient to allow the failure-to-warn claim to reach the jury. DISCUSSION [Hobart argued that the danger was so obvious that there was no duty to warn]. A. Sufficiency of the Evidence A warning can convey at least two types of messages. One states that a particular place, object, or activity is dangerous. Another explains that people need not risk the danger posed by such a place, object, or activity in order to achieve the purpose for which they might have taken that risk. Thus, a highway sign that says "Danger - Steep Grade" says less than a sign that says "Steep Grade Ahead Follow Suggested Detour to Avoid Dangerous Areas." If the hills or mountains responsible for the steep grade are plainly visible, the first sign merely states what a reasonable person would know without having to be warned. The second sign tells drivers what they might not have otherwise known: that there is another road that is flatter and less hazardous. A driver who believes the road through the mountainous area to be the only way to reach her destination might well choose to drive on that road despite the steep grades, but a driver who knows herself to have an alternative might not, even though her understanding of the risks posed by the steep grade is exactly the same as those of the first driver. Accordingly, a certain level of obviousness as to the grade of a road might, in principle, eliminate the reason for posting a sign of the first variety. But no matter how patently steep the road, the second kind of sign might still have a beneficial effect. As a result, the duty to post a sign of the second variety may persist even when the danger of the road is obvious and a sign of the first type would not be warranted. One who grinds meat, like one who drives on a steep road, can benefit not only from being told 36 that his activity is dangerous but from being told of a safer way. As we have said, one can argue about whether the risk involved in grinding meat is sufficiently obvious that a responsible person would fail to warn of that risk, believing reasonably that it would convey no helpful information. But if it is also the case - as it is - that the risk posed by meat grinders can feasibly be reduced by attaching a safety guard, we have a different question. Given that attaching guards is feasible, does reasonable care require that meat workers be informed that they need not accept the risks of using unguarded grinders? Even if most ordinary users may - as a matter of law - know of the risk of using a guardless meat grinder, it does not follow that a sufficient number of them will - as a matter of law - also know that protective guards are available, that using them is a realistic possibility, and that they may ask that such guards be used. It is precisely these last pieces of information that a reasonable manufacturer may have a duty to convey even if the danger of using a grinder were itself deemed obvious. Consequently, a jury could reasonably find that there exist people who are employed as meat grinders and who do not know (a) that it is feasible to reduce the risk with safety guards, (b) that such guards are made available with the grinders, and (c) that the grinders should be used only with the guards. Moreover, a jury can also reasonably find that there are enough such people, and that warning them is sufficiently inexpensive, that a reasonable manufacturer would inform them that safety guards exist and that the grinder is meant to be used only with such guards. Thus, even if New York would consider the danger of meat grinders to be obvious as a matter of law, that obviousness does not substitute for the warning that a jury could, and indeed did, find that Hobart had a duty to provide. It follows that we cannot say, as a matter of law, that Hobart had no duty to warn Liriano in the present case. Key Terminology Vicarious liability Respondeat superior Strict liability Nuisance Unreasonably Dangerous Activities Products liability Manufacturing defects Design defects Legally or factually insufficient evidence Court abused its discretion Contributory negligence Motion for Remittitur Technological feasibility Economic feasibility Warning defects VII. Remedies C. Compensatory Damages D. Punitive Damages From Mark B. Greenlee, Kramer v. Java World: Images, Issues, and Idols in the Debate over 37 Tort Reform, 26 Cap. U. L. Rev. 701 (1997) (footnotes omitted). B. Liebeck v. McDonald's Restaurants In February 1992, Stella Liebeck ordered coffee at the drive-thru window of a McDonald's located in Albuquerque, New Mexico. At the time, she was 79 years old. She was a passenger in her grandson's car. After receiving the order, her grandson pulled the car forward and stopped to allow Liebeck to add cream and sugar to her coffee. She placed the cup between her knees. As she removed the lid, the contents of the cup spilled into her lap. The coffee was extremely hot-somewhere between 180 and 190 degrees. It was absorbed by the sweatpants she was wearing, causing third degree burns on her thighs, buttocks, and groin. Third degree burns extended through the full thickness of the skin to the subcutaneous fat, muscle, or bone. Ms. Liebeck was hospitalized for eight days during which time she underwent skin grafts. She was permanently disfigured and disabled for two years following the accident. She informed McDonald's of her injuries and asked that McDonald's pay her medical bills of approximately $11,000. They refused. Subsequently, she retained S. Reed Morgan as her attorney. His request for $ 90,000 to cover her medical expenses and pain and suffering was likewise rejected by McDonald's. In 1993, Mr. Morgan filed a complaint on behalf of Ms. Liebeck alleging that the coffee she purchased was defective, first, because of its excessive heat and, second, because of inadequate warnings. In addition, punitive damages were sought based upon the allegation that McDonald's sold the coffee with conscious indifference for the safety of its customers. As the trial approached, Mr. Morgan offered to settle the case for $300,000, but would have settled for half as much. Just days before the trial, a mediator recommended a $ 225,000 settlement. McDonald's refused these attempts at settlement. The case went to trial in August 1994. Apparently, McDonald's believed that most people would blame the accident on Liebeck's carelessness rather than on the temperature of the coffee. A good deal of the testimony at the trial dealt with the temperature of the coffee and the injuries that would be caused by coffee served at various temperatures. During the trial, Christopher Appleton, McDonald's quality assurance manager, testified via videotape that McDonald's actively enforces a requirement that coffee be served at 185 degrees, plus or minus five degrees. He also admitted that its coffee was not "fit for consumption" because it would cause scald injuries to the mouth and throat if drunk by the consumer: A McDonald's expert stated that any coffee hotter than 130 degrees could produce third degree burns; therefore, it did not matter whether McDonald's coffee was hotter. But Charles Baxter, the plaintiff's expert in thermodynamics as applied to skin burns, testified that liquids will cause full thickness burns to skin in two to three seconds at 190 degrees, in 12 to 15 seconds at 180 degrees, and in 20 seconds at 160 degrees. Lila Laux, plaintiff's warnings expert, testified that although people know coffee is hot, they do not know how severe burns can be and that McDonald's should have included warnings of the risk of severe burns. McDonald's documents produced at trial revealed that there had been 700 complaints of coffee burns in the prior decade. McDonald's knew that its coffee was very hot, but their market research told them that customers "want hot coffee, they want it steamy hot, and they expect to get it that way." After weighing all the evidence, the jury determined that Liebeck's injuries merited an award of $ 38 200,000 compensatory damages and $ 2.7 million in punitive damages for a total of $ 2.9 million. However, the compensatory damages figure was reduced, because the jury found Liebeck's comparative negligence to be 20 percent because she placed the coffee in her lap. Thus, the compensatory damage award was reduced to $ 160,000. In addition, the jury awarded Liebeck $ 2.7 million in punitive damages, based on its finding of willful, reckless, malicious, or wanton conduct. The figure was derived from evidence the jury heard about McDonald's daily coffee revenues of $ 1.3 million. The punitive damages represented approximately two days of McDonald's coffee revenues. However, this amount was reduced by the trial court to $ 480,000 or three times the compensatory damages for a combined award of $ 640,000 in damages. Judge Scott ordered a post-verdict settlement conference that resulted in a confidential settlement of the case for an undisclosed amount. The case was dismissed with prejudice on November 28, 1994. The following notice is now posted at many McDonald's drive-thrus: "Coffee, tea and hot chocolate are VERY HOT!" and the lids of cups are embossed with a warning: "HOT! HOT! HOT!" C. Legislation Spilled coffee and other anecdotal evidence has been used to support a variety of legislative tort reform proposals. A majority of states have statutory or judicial prohibitions or limitations on punitive damages. Two states have adopted a fixed ceiling. Many other states limit punitive damages to the higher of a multiple of compensatory damages, such as three times compensatory damages, or a fixed amount, such as $ 250,000. Other states limit punitive damages to the lesser of a multiple of compensatory damages or a fixed amount. One state limits punitive damages to the defendant's annual gross income. Several states provide for higher caps in cases of severe injury or in cases where the defendant's actions were intentional, malicious, or motivated by financial gain. There are also states that provide for different caps depending upon whether the defendant is a large or small employer. In addition, many states have imposed evidentiary standards for the imposition of punitive damages or the applicability of higher ceilings thereon, such as clear and convincing evidence or proof beyond a reasonable doubt of intentional, malicious, or reckless conduct. A number of states provide for bifurcated trials upon request of either party or of the defendant. Several states have enacted laws redirecting a portion of punitive damages to a state fund. Punitive damages are not the only area of legislation. Many states have statutory caps on non-economic damages and statutes of repose which bar suits after a specified number of years from the date the product is placed in commerce. There are also state laws and proposals to change state laws which eliminate, in whole or part, joint and several liability for non-economic damages, provide for payment of legal fees by the party losing a case, limit contingency fees, pre-judgment interest, require disclosure of settlements, impose strict statutes of limitation, limit collateral benefits, penalize those who file frivolous suits, require structured settlements, and limit jury awards based on settlement offers. Key Terminology Comparative negligence Anecdotal evidence Tort reform proposals 39 Statutory caps Non-economic damages Contingency fees Statutes of limitation Bad faith 40