TIMOTHY J DOOLEY V ST JOSEPH MERCY HOSPAnnotate this Case
STATE OF MICHIGAN
COURT OF APPEALS
TIMOTHY J. DOOLEY and JUDY BARNES
July 7, 1998
ST. JOSEPH MERCY HOSPITAL, a division of
CATHERINE MCAULEY HEALTH SYSTEM, a
division of SISTERS OF MERCY HEALTH
Washtenaw Circuit Court
LC No. 94-001193-NH
ASSOCIATES IN GENERAL AND VASCULAR
SURGERY, P.C., NON-INVASIVE VASCULAR
TESTING, INC., and SETH W. WOLK, M.D.,
Before: Corrigan, C.J., and Jansen and Whitbeck, JJ.
Defendant appeals by right the judgment for plaintiffs on their claims for medical malpractice and
loss of consortium. We vacate the judgment, and remand for entry of judgment for defendant.
Plaintiff Timothy Dooley has a genetic blood clotting disorder that became apparent in
November 1992. His doctors treated him during his subsequent hospitalization with the anticoagulant
Heparin, but directed that he take another anticoagulant, Coumadin, after his discharge. Dooley took
Coumadin until June 1993. He returned to the hospital a month later, whereupon his physician again
treated his condition with Heparin. Dooley also underwent a venous duplex study on July 6 as part of
this treatment. His physician discharged him on July 13, again directing that he take Coumadin. The
next day, Dooley called his doctor because he was experiencing severe leg pain. The physician
eventually instructed Dooley to go to defendant’s noninvasive vascular laboratory for another venous
Jeanne Page, a registered vascular technician employed by defendant, performed a venous
duplex study on Dooley on July 19. She prepared a worksheet detailing her findings and called
Dooley’s doctor to report the test results. One of the doctor’s associates received the oral report and
directed Page to instruct Dooley to admit himself into the hospital. In accordance with defendant’s
policy, Dr. Seth A. Wolk then reviewed Page’s worksheet and prepared a written report detailing the
results within a day of the test. Dooley’s physicians, acting on their mistaken belief that an extension of
a clot existed, once again treated his condition with Heparin and eventually discharged him on July 30.
Dooley experienced nausea, weakness, and diarrhea after his discharge. Doctors later discovered that
Dooley had suffered an adrenal hemorrhage that destroyed his adrenal glands, leaving him with primary
Plaintiffs commenced this action for medical malpractice and loss of consortium, alleging that
Page inaccurately reported to Dooley’s physician that the July 19 venous duplex study showed an
“extension” of a blood clot, thereby setting off a chain of events that culminated in Dooley having a
reaction to Heparin that destroyed his adrenal glands. Plaintiffs further alleged that Dr. Wolk negligently
failed to review the videotape of the July 19 study when preparing his report and negligently failed to
compare the July 19 study with the July 6 study. Plaintiffs alleged that if Dr. Wolk had made the
comparison and reported that no change existed, Dooley’s doctors would not have treated him with
Heparin and Dooley’s adrenal glands would not have been destroyed. The jury returned a verdict for
plaintiffs, awarding Timothy Dooley $400,000 and Judy Dooley $200,000. The trial court subsequently
denied defendant’s motion for judgment notwithstanding the verdict (JNOV) on the ground that plaintiffs
failed to establish proximate causation between the alleged negligence and Dooley’s injury.
Defendant raises several issues, but we need only address one because it is dispositive. We
agree that the trial court erred in denying defendant’s motion for JNOV because plaintiffs failed to
present sufficient evidence to establish that defendant’s alleged negligence was a legal cause of Dooley’s
injury.1 In reviewing the trial court’s decision on a motion for JNOV, we view the evidence in a light
most favorable to the nonmoving party to determine whether reasonable jurors could reach different
conclusions. Zander v Ogihara Corp, 213 Mich App 438, 441; 540 NW2d 702 (1995).2 “If
reasonable jurors could honestly have reached different conclusions, neither the trial court nor this Court
may substitute its judgment for that of the jury.” Id.
A plaintiff must prove four factors to establish a claim for medical malpractice: (1) the
applicable standard of care, (2) breach of the standard of care by the defendant, (3) injury, and (4)
proximate causation between the breach and the injury. Locke v Pachtman, 446 Mich 216, 222; 521
NW2d 786 (1994). To establish proximate causation, “the plaintiff must prove the existence of both
cause in fact and legal cause.” Weymers v Khera, 454 Mich 639, 647; 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.” [Id. at 648, quoting Moning v
Alfono, 400 Mich 425, 439; 254 NW2d 759 (1977).]
Proximate cause, or legal cause, involves considerations of policy akin to the issue of duty.
McMillan v State Highway Comm, 426 Mich 46, 51; 393 NW2d 332 (1986). Regarding the
interrelationship between duty and legal causation, our Supreme Court in McMillan, supra at 51-52,
quoted extensively from Prosser & Keeton, Torts (5th ed), § 42, pp 272-274:
“Unlike the fact of causation, with which it is often hopelessly confused, this is
primarily a problem of law. It is sometimes said to depend on whether the conduct
has been so significant and important a cause that the defendant should be legally
responsible. But both significance and importance turn upon conclusions in terms
of legal policy, so that they depend essentially on whether the policy of the law
will extend the responsibility for the conduct to the consequences which have in
It is quite possible to state every question which arises in connection with
‘proximate cause’ in the form of a single question: was the defendant under a
duty to protect the plaintiff against the event which did in fact occur?” [Emphasis
Proximate causation is for the court to decide when reasonable jurors could not differ about the
application of undisputed facts to the legal concept. McMillan, supra at 63, n 8.
In this case, the trial court denied defendant’s motion, reasoning that “there was sufficient
evidence upon which the jury in this case could have and did find both malpractice and proximate
cause.” We disagree. We conclude that reasonable jurors could not differ about whether Dooley’s
adrenal hemorrhage was a foreseeable consequence of defendant’s alleged negligence in reporting the
results of the venous duplex study. Although defendant could arguably foresee that the report would
induce Dooley’s physician to hospitalize him and administer Heparin, plaintiffs presented no evidence to
establish that defendant could foresee that the change in Dooley’s medication would cause an adrenal
The expert witnesses agreed that Dooley had a rare and unpredictable reaction to Heparin.
Defendant’s expert, Dr. David Schteingart, explained that Dooley’s condition is “relatively rare” and
adrenal insufficiency related to anticoagulants is “very rare.” He testified that an adrenal hemorrhage is
a “rare” cause of adrenal insufficiency. Plaintiffs’ expert, Dr. Blake Tyrrell, stated that Dooley had an
“idiosyncratic” reaction to Heparin and that Dooley’s medical history did not suggest that he would
have been at risk for a hemorrhage while taking either Coumadin or Heparin. Dr. Tyrrell testified that
because Dooley’s reaction was idiosyncratic, he could not predict whether Dooley would have had the
same reaction during later hospitalizations. Dr. Tyrrell explained that Dooley’s reaction was “extremely
unusual” and that he could have experienced the hemorrhage while taking Coumadin.
The record does not support plaintiffs’ assertions that Dooley’s doctors mistreated his condition
because of defendant’s alleged negligence or that Heparin poses different risks than Coumadin. The
expert witnesses agreed that Dooley’s doctors rendered either proper or permissible treatment.
Although the expert witnesses made isolated references to Heparin as “more potent acutely” and
Heparin treatment as “aggressive,” “aggressive anticoagulation,” and “additional therapy,” the record is
devoid of evidence that Heparin poses a higher risk of hemorrhage than Coumadin. Plaintiffs’ own
expert, Dr. Tyrrell, testified that Dooley’s physicians could properly use either Coumadin or Heparin to
treat his condition. Dooley’s physicians, Drs. William Patton and Ronald Sanda, testified that a risk of
hemorrhage exists with both drugs. Further, no evidence suggests that plaintiff’s reaction resulted from
a higher dose of Heparin.
We conclude on the basis of this evidence that plaintiffs failed to establish the legal cause
component of proximate causation. Dooley had an extremely rare and unpredictable complication from
the use of anticoagulants, a type of drug that he must take because of a genetic condition. Defendant’s
alleged negligence did not increase the risk Dooley already faced from this needed medication.
Accordingly, the trial court erred in denying defendant’s motion for JNOV because reasonable jurors
could not differ about whether Dooley’s adrenal hemorrhage was a foreseeable consequence of
defendant’s alleged negligence. Weymers, supra at 647; Zander, supra at 441. We therefore vacate
the judgment and remand for entry of judgment for defendant.
Vacated and remanded. We do not retain jurisdiction. Defendant, being the prevailing party,
may tax costs under MCR 7.219.
/s/ Maura D. Corrigan
/s/ William C. Whitbeck
Plaintiff Judy Barnes Dooley’s derivative claim for loss of consortium fails because it stands or falls
with the primary claim for medical malpractice. Long v Chelsea Community Hosp, 219 Mich App
578, 589; 557 NW2d 157 (1996).
Our recitation of the pertinent facts of this case is consistent with this requirement.