Background
Cree Erwin-Sheppard, age 24, underwent an elective abortion and IUD placement at Planned Parenthood while 12 weeks pregnant. Experts later opined that the procedure perforated her uterus. Two days later, she went to Bronson Battle Creek Hospital with constant, severe abdominal pain, nausea, and vomiting. Emergency physician Devin J. Woelzlein ordered testing and an ultrasound, but no transvaginal ultrasound was performed. After being diagnosed with an incomplete miscarriage and pelvic pain, she was discharged while reporting pain of 7 out of 10.
Erwin-Sheppard was found unconscious the following day and died. The medical examiner attributed her death to complications including pulmonary emboli related to uterine vein thrombosis and uterine perforation. Her estate sued the medical providers, alleging that compliance with the applicable standards of care would have led to timely diagnosis and treatment and prevented her death. The circuit court granted summary disposition to the defendants because experts could not definitively identify whether the fatal emboli originated in the uterine veins or lower extremities and because certain diagnostic measures might not have detected the thrombosis.
The Court’s Holding
The Court of Appeals reversed the summary-disposition orders and remanded for further proceedings. It held that the expert testimony created genuine issues of material fact concerning whether the defendants’ alleged breaches more probably than not caused Erwin-Sheppard’s death.
The estate was not required to identify and trace the particular clot that produced the fatal embolism. Viewed in the estate’s favor, the evidence permitted a reasonable jury to find that timely recognition of the uterine perforation and appropriate treatment—including surgery, anticoagulation, or both—more probably than not would have prevented the pulmonary embolism and death, regardless of where the thrombi originated.
Key Takeaways
- A medical-malpractice plaintiff need not identify the precise physiological path of an injury when expert evidence supports a reasonable probability of causation.
- Experts testified that timely diagnosis, surgical care, and anticoagulation could more likely than not have prevented the fatal pulmonary embolism.
- A court deciding summary disposition may not weigh conflicting medical evidence or resolve factual disputes that belong to the jury.
Why It Matters
The decision emphasizes that Michigan’s “more probable than not” causation standard does not require absolute medical certainty or proof excluding every possible alternative. Circumstantial and expert evidence may establish causation when it supports a reasonable probability rather than mere possibility.
For malpractice litigants, the opinion illustrates that uncertainty about the exact biological mechanism of death does not warrant summary disposition when the combined expert testimony supports a finding that proper care likely would have changed the outcome.