Doctor can be sued for emotional distress despite lack of physical negligence

A physician can be sued for allegedly causing a patient emotional distress, even when no physical impact led to the distress, the Supreme Court of Pennsylvania has ruled.

The case centers on a mother's accusation that her physician failed to prepare her for the shock of her newborn's deformities. The court's decision creates a claim for noneconomic damages and opens the door for more lawsuits against physicians, legal experts say.

"The really troubling thing about this case is that nothing could have been done to change the [baby's] condition," said Daniel Rovner, an attorney for Chester County Hospital, one of the defendants. "There was no treatment, nothing medically that could have been done. The bigger picture is that the plaintiff's bar is going to use this as an attempt to expand the law to explain emotional distress."

Jeanelle Toney went to Pennsylvania radiologist Maheep Goyal, MD, in March 2003 for a pelvic ultrasound. Dr. Goyal informed her that the results were normal and did not reveal any fetal abnormalities to her unborn child, according to court documents.

In July 2003, Toney delivered a boy with profound deformities, including partial arms and legs. Toney sued Dr. Goyal and Chester County Hospital in 2005 for negligent infliction of emotional distress, alleging that Dr. Goyal did not prepare her for the shock of witnessing the birth. Toney said she experiences ongoing grief, rage, nightmares, nausea, hysteria and insomnia. The lawsuit did not include a medical negligence claim.

Dr. Goyal and the hospital requested that the suit be dismissed because the plaintiff did not state a valid claim. Toney must prove she was subjected to a physical impact to recover damages for emotional distress, they said. Admission or denial of wrongdoing in the case was never addressed, said Charles Fitzpatrick III, Dr. Goyal's attorney.

A trial court threw out the suit. The plaintiff appealed. The Superior Court of Pennsylvania reversed the decision.

A physical impact is not necessary for an emotional distress claim when there is a breach of fiduciary duty, the superior court said. Doctors have a legal and ethical responsibility to care for patients' well-being and, under the circumstances, it was reasonably foreseeable that Toney would endure emotional distress during the birth of her son, the court said.

The Supreme Court of Pennsylvania on Dec. 22 affirmed. The six justices were evenly split. One justice recused herself. Because of the division, the superior court's decision was upheld.

In January, attorneys for Dr. Goyal and the hospital petitioned the state high court for re-argument. At this article's deadline, the court had not said whether it will rehear the case.

Ruling may impact other claims

In unique relationships, liability can be imposed properly even without physical contact, said Stephen Raynes, Toney's attorney. Significant consequences to patients flow directly from the quality and accuracy of what is communicated by medical professionals, he said.

"The opinion upholding the judgment recognizes that although not every fiduciary relationship will give rise to a claim for damages, where the specific professional responsibility of an attending physician is to convey accurate information, then failure to do so can give rise to liability if the physician's breach results in unusual and extreme emotional distress on the part of the plaintiff," Raynes said in an email.

Raynes does not anticipate a measurable increase in emotional distress lawsuits against doctors, he said. The justices affirmed the lower court's decision through a narrow scope, he noted, meaning that only rare circumstances would merit such emotional distress claims.

Fitzpatrick, Dr. Goyal's attorney, disagrees. He said a rise in emotional distress suits are highly probable -- narrow scope or not.

"I can guarantee that's what's going to happen," he said. "The impact is: Not only are doctors going to get sued [by patients], but family members who are surprised by a loved one's condition are going to sue. It's expanding who can sue over these things."

In making its decision, the Supreme Court of Pennsylvania cited several similar cases from other states, including New Jersey, New York, Texas and Wyoming. Courts in other states probably will use the Toney case to support their decisions in comparable cases, said Anna Laakmann, a law professor at Penn State Dickinson School of Law in Pennsylvania.

"Courts will be influenced by other courts and other jurisdictions even if they are not obligated," she said. "This case is no different. Judges note not just the trends [in their state], but trends in other states."

Court makes exception

Historically, most states allow only two ways for plaintiffs to sue for emotional distress without a physical impact, Laakmann said.

The first refers to a plaintiff being in the "danger zone" of a defendant acting negligently. For example, if a negligent driver almost hits a pedestrian with a vehicle, the pedestrian can make a claim for emotional distress despite no physical injury.

The second way is if a person witnesses a negligent act on a family member, such as a surgeon negligently operating on a relative.

In the Pennsylvania case, judges allowed a third exception to traditional case law on emotional distress claims, Laakmann said. The ruling is part of a nationwide trend toward courts relaxing the boundaries between emotional distress and physical impact, she said.

For example, the Court of Appeals of Texas said in 2006 that the parents of a stillborn baby could sue the Harris County Medical Examiner's Office for causing mental anguish after the office allegedly lost the baby's body during an autopsy. The court said the county's relationship with the parents constituted a "special relationship" under which mental anguish damages were allowable in the absence of physical injury.

In another case, the Appellate Division of the Supreme Court of the State of New York allowed a couple to sue a fertility clinic for emotional distress after the clinic implanted the female plaintiff's embryo in another woman. Although neither plaintiff was physically injured by the implantation, both suffered emotional injury due to the defendants' breach of their duty of care, the court said.

The Toney ruling raises awareness about how the doctor-patient relationship can be defined, Laakmann said.

"It says to doctors that courts have shown a willingness -- in this case and in others -- to describe the doctor-patient relationship as a fiduciary one," she said. "And with this comes certain legal obligations to care for the well-being of the patient. That [relationship] can, under certain circumstances, subject them to liability."