On appeal from the Superior Court of New Jersey, Law Division, Hudson County.
J.h. Coleman and Bilder. The opinion of the court was delivered by Bilder, J.A.D.
The opinion of the court was delivered by
This is a medical malpractice action. Plaintiff generally claimed that defendant Dr. Morris Feldman was negligent in a failure to order chest x-rays when he treated plaintiff's decedent for a cough; that the negligence delayed the diagnosis and treatment of lung cancer; and that this resulted in a lost chance of a better prognosis and, perhaps, survival. Following a four day trial, the jury found that defendant was negligent and that his negligence increased the risk of harm to plaintiff's decedent and was a substantial factor in producing injury and/or death to her. It fixed damages at $100,000 for pain, suffering, disability, impairment and lost chance of survival and $70,000 for wrongful death (modified by the court to $39,101.97). Defendant appeals from the denial of his motions for new trial or remittitur. He contends the plaintiff's proofs as to proximate cause were insufficient to raise a jury question and that the damage award was deficient in failing to show the percentage of lost chance attributable to his negligence, and, in any event, was excessive.
The background facts are essentially uncontroverted. From May 1974, plaintiff's decedent Miriam Roses had been, at least intermittently, a patient of defendant. On December 15, 1983
and again on April 24, 1984, she visited him with complaints of a cough -- a condition which he described as a non-productive cough. On neither date were chest x-rays taken. On March 20, 1985, she sought medical care at Christ Hospital emergency room. A chest x-ray taken at that time revealed the presence of a five centimeter tumor diagnosed shortly thereafter as a poorly differentiated adenocarcinoma -- a form of lung cancer. An April 2, 1985, CAT scan showed the tumor to be six centimeters in diameter. A bone scan later that month, on April 19, 1985, disclosed that the cancer had metastasized to her rib. She received radiation and chemotherapy. She died June 8, 1987 of carcinomatous meningitis, a cancer in the spinal fluid that surrounds the brain and spinal cord.
Plaintiff's expert, Dr. Richard Robinson, an oncologist, testified that defendant's failure to take chest x-rays was a deviation from standard medical practice and that if such x-rays had been taken, both x-rays, or at worst the April 1984 x-ray, would have disclosed the presence of the tumor and led to a diagnosis of the lung cancer. He founded this opinion on a backward extrapolation of the 1985 tumor observation based upon a doubling rate which has been developed for Mrs. Roses' type of lung tumor.*fn1 He postulated a doubling rate of 100 days and concluded that the six centimeter tumor observed on April 2, 1985 would have been at least two centimeters in size in December 1983, some 500 days before. This, in his opinion, would have been visible on an x-ray if one had been taken at that time. He acknowledged that doubling rates are not precise but are found to lie within a range. In any event, he concluded, the tumor would certainly have been visible by Mrs. Roses' second visit to defendant in April 1984.
On appeal, defendant's contentions as to liability are not directed at the finding of negligence but to the proofs as to proximate cause as it related to the increased risk and ultimate injury. In this regard, Dr. Robinson opined that the diagnostic delay increased the chances of metastasis and decreased the chances of surgical intervention, but he was unable to quantify the changes or to express a view as to when the metastasis occurred. He could only say that the smaller the cancer, the less likely the metastasis; that it was less likely that metastasis had already occurred in April of 1984 and that she still had a chance of having a tumor that could have been receptible*fn2 at that time. Defendant contends these are essentially lay views -- no more than common sense -- and insufficient to support a finding of a causal relationship between the delayed diagnosis and the final result of the already existing lung cancer, a type of cancer with a substantial death rate. He argues that there is a dearth of evidence that the failure to perform the x-ray in April 1984 was a substantial factor in bringing about Mrs. Roses' ultimate harm -- that there was no evidence to show that an earlier diagnosis would have made any difference.