Background
Cree Erwin-Sheppard, age 24, underwent an elective abortion and placement of an intrauterine contraceptive device at Planned Parenthood while 12 weeks pregnant. Although the procedure was recorded as completed without complication, experts later opined that she suffered a uterine perforation.
Two days later, Erwin-Sheppard went to Bronson Battle Creek Hospital with constant, severe lower-abdominal pain, nausea, and vomiting. Emergency physician Devin J. Woelzlein ordered laboratory testing and an ultrasound. A transabdominal ultrasound was performed, but no transvaginal ultrasound was completed. The reviewing radiologist reported clot or retained products of conception, and Erwin-Sheppard was discharged with a diagnosis of incomplete miscarriage and pelvic pain. She was found unconscious the next day and died from pulmonary emboli associated with uterine vein thrombosis and uterine perforation.
Her estate alleged that the medical providers’ failures to meet the applicable standards of care prevented timely diagnosis and treatment of the perforation and related thrombosis. The circuit court granted summary disposition to the defendants, reasoning that the estate could not establish causation because its experts could not identify the precise source of the fatal emboli or show that the proposed care would necessarily have detected the thrombosis.
The Court’s Holding
The Michigan Court of Appeals reversed. It held that the estate presented sufficient expert testimony to create a genuine issue of material fact as to whether timely recognition and treatment of the uterine perforation more probably than not would have prevented Erwin-Sheppard’s fatal pulmonary embolism.
The court explained that the estate did not have to identify a particular clot and trace its movement through Erwin-Sheppard’s body. Its experts testified that proper care could have led to hospitalization, surgery, ligation of the affected uterine vein, anticoagulation, or specialist treatment, and that these measures more likely than not would have prevented the embolism and death. Viewed in the estate’s favor, that testimony supported a reasonable inference of causation regardless of whether the fatal thrombi originated in the uterine veins or lower extremities.
Because reasonable jurors could differ on causation, the circuit court could not resolve that factual dispute at the summary-disposition stage. The appellate court reversed the orders entered for the appellees and remanded for further proceedings.
Key Takeaways
- A medical-malpractice plaintiff need not identify and trace the precise clot that caused a fatal pulmonary embolism when expert testimony otherwise supports a probable causal chain.
- Evidence that timely diagnosis, surgery, specialist referral, or anticoagulation more likely than not would have prevented death can create a triable causation issue.
- A court deciding summary disposition may not weigh competing expert testimony or require certainty beyond Michigan’s more-probable-than-not causation standard.
Why It Matters
The decision clarifies that uncertainty about the exact physiological mechanism of an injury does not automatically defeat medical-malpractice causation. A plaintiff may reach a jury by presenting nonspeculative expert testimony establishing a reasonable probability that appropriate care would have produced a different outcome.
The opinion also reinforces the limits of summary disposition: when expert testimony supports competing reasonable inferences about whether alleged breaches caused the injury, those inferences must be resolved by the factfinder rather than the court.