Background
Cree Erwin-Sheppard died days after undergoing an elective abortion and placement of an intrauterine contraceptive device at Planned Parenthood. Experts later opined that the procedure perforated her uterus. Two days after the procedure, she went to Bronson Battle Creek Hospital with severe abdominal pain, nausea, and vomiting. An emergency physician ordered an ultrasound, but no transvaginal ultrasound was performed, and she was discharged with a diagnosis of incomplete miscarriage and pelvic pain.
Erwin-Sheppard was found unconscious the following day. The medical examiner attributed her death to complications including pulmonary emboli related to uterine-vein thrombosis and uterine perforation. Her estate sued the healthcare providers involved in the procedure, imaging, and emergency treatment, alleging that compliance with the applicable standards of care would have led to timely diagnosis and treatment. The circuit court granted summary disposition to the defendants because the estate’s experts could not definitively identify whether the fatal emboli originated in the uterine veins or the lower extremities.
The Court’s Holding
The Court of Appeals reversed the summary-disposition orders and remanded for further proceedings. It held that the circuit court demanded more certainty than Michigan’s medical-malpractice causation standard requires. The estate did not have to identify and trace a particular clot through Erwin-Sheppard’s body; it needed evidence supporting a reasonable probability that the alleged negligence caused her death.
Viewed in the estate’s favor, the expert testimony could permit a reasonable jury to find that timely recognition of the uterine perforation and resulting surgery, observation, specialist consultation, or anticoagulation more probably than not would have prevented the fatal pulmonary embolism, regardless of where the thrombi originated. Because that testimony created a genuine factual dispute over causation, the issue could not be resolved on summary disposition.
Key Takeaways
- A medical-malpractice plaintiff need not identify the precise physiological path of an injury when the evidence supports a reasonable probability of causation.
- Expert testimony that timely diagnosis and treatment more likely than not would have prevented death can establish a triable causation issue.
- A court deciding summary disposition may not weigh conflicting medical evidence or require certainty beyond the governing “more probably than not” standard.
Why It Matters
The decision clarifies that uncertainty about the exact origin of a fatal embolus does not necessarily defeat medical-malpractice causation. Where experts connect the alleged breaches to delayed treatment and explain how appropriate intervention probably would have prevented the death, causation ordinarily remains a question for the jury.
The opinion also cautions trial courts against converting factual uncertainty into a heightened evidentiary burden at the summary-disposition stage.