TRENDA JONES V DETROIT MEDICAL CENTER
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STATE OF MICHIGAN
COURT OF APPEALS
TRENDA JONES, BOOKER T. JONES, and
MARGARET A. JONES, Co-Personal
Representatives of the Estate of JAMAR CORTEZ
JONES, deceased,
FOR PUBLICATION
May 20, 2010
Plaintiffs-Appellees/CrossAppellees,
v
No. 288710
Wayne Circuit Court
LC No. 03-327528-NH
DETROIT MEDICAL CENTER and SINAIGRACE HOSPITAL,
Defendants-Appellants,
Advance Sheets Version
and
DANNY F. WATSON, M.D., and WILLIAM M.
LEUCHTER, P.C.,
Defendants-Cross-Appellants
Before: HOEKSTRA, P.J., and BECKERING and SHAPIRO, JJ.
HOEKSTRA, P.J. (dissenting).
In this medical malpractice action, this Court granted defendants leave to appeal the trial
court’s order granting summary disposition to plaintiffs on the issue of proximate or legal cause
and denying defendants’ cross-motion for summary disposition. Because I would conclude that
reasonable persons could differ regarding whether the injuries of plaintiffs’ decedent, Jamar
Jones (hereafter Jones), were legally caused by the alleged negligence, I respectfully dissent.
In a medical malpractice action the plaintiff must establish proximate cause between the
defendant’s alleged breach of the standard of care and his or her injuries. Teal v Prasad, 283
Mich App 384, 391; 772 NW2d 57 (2009). “‘Proximate cause’ is a legal term of art that
incorporates both cause in fact and legal (or ‘proximate’) cause.” Craig v Oakwood Hosp, 471
Mich 67, 86; 684 NW2d 296 (2004). Proximate cause is generally a question for the jury.
Lockridge v Oakwood Hosp, 285 Mich App 678, 684; 777 NW2d 511 (2009). However,
“[w]hen the facts bearing upon proximate cause are not in dispute and reasonable persons could
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not differ about the application of the legal concept of proximate cause to those facts, the court
determines the issue.” Paddock v Tuscola & S B R Co, Inc, 225 Mich App 526, 537; 571 NW2d
564 (1997).
A court must first find that the defendant’s actions were a cause in fact of the plaintiff’s
injuries before it may find that the actions of the defendant were a proximate or legal cause of the
injuries. Craig, 471 Mich at 87. Cause in fact requires that “but for” the defendant’s actions, the
plaintiff’s injuries would not have occurred. Martin v Ledingham, 282 Mich App 158, 161; 774
NW2d 328 (2009). The trial court granted summary disposition to plaintiffs on the issue of
cause in fact. Defendants did not appeal this order in their application for leave to appeal;
therefore, the issue of cause in fact is not before us. Jones v Detroit Med Ctr, unpublished order
of the Court of Appeals, entered December 30, 2008 (Docket No. 288710); see also MCR
7.205(D)(4); Detroit Free Press, Inc v Southfield, 269 Mich App 275, 290; 713 NW2d 28
(2005).
At issue is legal or proximate cause. Legal causation involves “judg[ing] whether the
plaintiff’s injuries were too insignificantly related to or too remotely effected by the defendant’s
negligence.” Davis v Thornton, 384 Mich 138, 145; 180 NW2d 11 (1970). “To find proximate
cause, it must be determined that the connection between the wrongful conduct and the injury is
of such a nature that it is socially and economically desirable to hold the wrongdoer liable.”
Helmus v Dep’t of Transp, 238 Mich App 250, 256; 604 NW2d 793 (1999). Our Supreme Court
has defined a proximate cause as “a foreseeable, natural, and probable cause of the plaintiff’s
injury and damages.” Kaiser v Allen, 480 Mich 31, 38; 746 NW2d 92 (2008) (quotation marks
and citation omitted).
The concept of foreseeability pervades any discussion of proximate cause. See, e.g., id.;
Weymers v Khera, 454 Mich 639, 648; 563 NW2d 647 (1997) (“To establish legal cause, the
plaintiff must show that it was foreseeable that the defendant’s conduct may create a risk of harm
to the victim, and . . . that the result of that conduct and intervening causes were foreseeable.”)
(quotation marks, citation, and alternation omitted); Skinner v Square D Co, 445 Mich 153, 163;
516 NW2d 475 (1994) (“[L]egal cause or ‘proximate cause’ normally involves examining the
foreseeability of consequences, and whether a defendant should be held legally responsible for
such consequences.”); Nielsen v Henry H Stevens, Inc, 368 Mich 216, 220-221; 118 NW2d 397
(1962) (“To make negligence the proximate cause of an injury, . . . an ordinary prudent person
ought reasonably to have foreseen [that the injury] might probably occur as the result of his
negligent act.”).
However, our Supreme Court has instructed that in a case in which there is no intervening
cause, and there is none alleged in the present case, the foreseeability of the plaintiff’s injury is
not to be used as a test to determine whether proximate cause exists. McMillian v Vliet, 422
Mich 570, 576-577; 374 NW2d 679 (1985); Davis, 384 Mich at 147.
“It appears that the modern trend of judicial opinion is in favor of
eliminating foreseeable consequences as a test of proximate cause, except where
an independent, responsible, intervening cause is involved. The view is that once
it is determined that a defendant was negligent, he is to be held responsible for
injurious consequences of his negligent act or omission which occur naturally and
directly, without reference to whether he anticipated, or reasonably might have
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foreseen such consequences. . . . There is no need for discussing proximate cause
in a case where the negligence of the defendant is not established, but when his
negligence has been established, the proximate result and amount of recovery
depend upon the evidence of direct sequences, and not upon defendant’s
foresight.” [Davis, 384 Mich at 147, quoting 38 Am Jur, Negligence, §§ 58, 709,
710.]
Indeed, the Michigan Model Civil Jury Instructions define legal or proximate cause as “a
natural and probable result of the negligent conduct.” M Civ JI 15.01. The words “natural” and
“probable,” rather than legal terms of art, are words susceptible of ordinary comprehension and
need not be defined for a jury. See People v Martin, 271 Mich App 280, 352-353; 721 NW2d
815 (2006), aff’d 482 Mich 851 (2008). Accordingly, being instructed on proximate cause,
jurors would afford the terms “natural” and “probable” their ordinary meanings. In the context
of determining proximate cause, “natural” means “in accordance with the nature of things; to be
expected,” and “probable” means “likely to occur or prove true.” Random House Webster’s
College Dictionary (1992).
In the complaint, plaintiffs alleged two distinct acts of negligence. First, plaintiffs
claimed that Dr. Danny Watson breached the applicable standard of care by prescribing
carbamazepine1 on the basis of the limited personal medical history provided by Jamar Jones.
According to plaintiffs, Watson should not have prescribed carbamazepine without performing
additional diagnostic tests to confirm the preliminary diagnosis of a seizure disorder. Second,
plaintiffs alleged that Watson breached the applicable standard of care by failing to inform Jones
of the possibility of an allergic reaction, the signs of an allergic reaction, and the necessity to
immediately seek medical attention for an allergic reaction.
In determining that reasonable minds could not differ that Watson’s conduct was a
proximate cause of Jones’s injuries, the majority focuses on whether the injuries were
foreseeable. For example, it reasons that, because Jones died as a result of Stevens-Johnson
syndrome, which is a known side effect of taking carbamazepine, and because Jones contracted
Stevens-Johnson syndrome from taking carbamazepine, which was prescribed by Watson, the
injuries were foreseeable. Respectfully, I disagree with the approach taken by the majority. The
issue is not simply whether reasonable minds cannot differ that a straight line can be drawn from
point A, the defendant’s alleged negligence, to point F, the plaintiff’s injuries. Rather, for a
plaintiff to prevail on the issue of proximate cause at the summary disposition stage, it must be
shown that reasonable minds cannot differ that the injuries were the natural and probable
consequence of the defendant’s negligence. In other words, reasonable minds could not differ
that the injuries were “expected” and “likely to occur” or on whether the injuries were too
insignificantly related or too remotely affected by the alleged negligence. Davis, 384 Mich at
145. Further, consideration must also be given to whether the connection between the alleged
1
Watson prescribed Tegretol, but the prescription was filled with carbamazepine, the generic
form of Tegretol. No allegation has been made, however, that any difference between the drugs
is relevant to this case.
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negligence and the injuries is of such a nature that it is socially and economically desirable to
hold the defendant liable. Helmus, 238 Mich App at 256.
Reviewing the trial court’s decision de novo and the evidence in the light most favorable
to defendants, Lee v Detroit Med Ctr, 285 Mich App 51, 58-59; 775 NW2d 326 (2009), I would
conclude that this case presents issues that must be resolved at trial. It is undisputed that
Stevens-Johnson syndrome is a known, but very rare, side effect of taking carbamazepine. One
expert testified that only one in a million of those who take carbamazepine develop StevensJohnson syndrome. In addition, there is no claim by plaintiffs that carbamazepine is not an
anticonvulsant commonly prescribed for a seizure disorder. Under these circumstances, I am of
the opinion that reasonable minds could differ regarding whether Jones’s injuries were the
natural and probable result of Watson’s alleged negligence of failing to perform additional
diagnostic tests to confirm the preliminary diagnosis of a seizure disorder. Admittedly, the link
between Watson’s alleged failure to warn Jones of an allergic reaction to carbamazepine and
Jones’s injuries is much closer than the link between the injuries and Watson’s alleged failure to
confirm the preliminary diagnosis. However, given the rarity of Stevens-Johnson syndrome, I
believe that even on this claim it was within the province of the jury to determine whether the
connection between Watson’s alleged negligence and Jones’s injuries was of such a nature that it
is desirable to hold defendants liable. Accordingly, I would conclude that the trial court erred by
granting summary disposition to plaintiffs on the issue of proximate cause.
Defendants also argue that it was error for the trial court to deny their cross-motion for
summary disposition. They argue that because Stevens-Johnson syndrome is a rare and
unpredictable side effect of taking carbamazepine, plaintiffs cannot establish that taking
carbamazepine was a foreseeable, natural, and probable cause of Jones’s death. Defendants rely
primarily on Dooley v St Joseph Mercy Hosp, unpublished opinion per curiam of the Court of
Appeals, issued July 7, 1998 (Docket No. 198024). I agree with the majority that Dooley is
factually distinguishable. In addition, the record shows that although Stevens-Johnson syndrome
is a rare side effect, it is a known side effect. Consequently, reasonable minds could differ
regarding whether it is a natural and probable consequence that, if a physician prescribes a
medication with a known rare side effect, a patient will suffer the side effect. Therefore, I would
also conclude that defendants are not entitled to summary disposition.
/s/ Joel P. Hoekstra
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