Liability for Bad Blood in Louisiana

Liability for Bad Blood in Louisiana Edward P. Richards Director, Program in Law, Science, and Public Health Harvey A. Peltier Professor of Law Louisiana State University Law Center Baton Rouge, LA 70803-1000 richards@lsu.edu http://biotech.law.lsu.edu

Hepatitis C • Remember non-A/non-B hepatitis? • Another variant was characterized in the 1990s • Hepatitis C • Liver disease • General debility • Spread by transfusions • Long latency - can show up 30 years later

Other Modes of Transmission for Hepatitis C (and B) • sharing and equipment used to inject drugs • unsterile tattooing, body piercing and skin penetration procedures • household practices (such as sharing razor blades and toothbrushes) • occupational procedures (eg, needlestick and sharps injuries) • certain sexual activities • mother to baby.

What are the Scientific Issues in a Hepatitis C Claim? • How can it be negligent to fail to prevent an unknown disease? • When did the standard for screening blood change? • Is hepatitis C affecting the same people as hepatitis B?

What are the Legal Issues in a Hepatitis C Claim? • Before the blood shield law? • SOL or prescription? • Discovery rule? • What is the state had not adopted products liability then? • Post-blood shield? • Post-MMA?

The Future for Hepatitis • Good vaccine for hepatitis A & B • Now required for kids, not just "persons at risk" • In the long term, both will decline dramatically in the community • No vaccine for C yet, no good data on prevalence or other risk factors • There is a D, but seems to be limited to co-infection with B • E, F, G...???

Key Cases • This discussion is based on the controlling case law as of 10 Nov 2009: • David v. Our Lady of the Lake Hospital, Inc., 849 So.2d 38 (La. 2003) • Day v. Morehouse General Hospital, 865 So.2d 924 (La.App. 2004) • As with all legal analysis, this may be changed by subsequent legislation or court decisions

Background • In the 1960s, states started applying contract notions of warranties to create a type of non-negligence based fault for injuries caused by products • The Restatement of Torts 2nd, section 402a, introduced the notion of strict liability for injuries caused by defective products • The LA SC did not accept strict liability until 1971: • Weber v. Fidelity & Cas. Co. of N.Y., 259 La. 599, 250 So. 2d 754 (1971)

First LA Blood Shield Law - 1764 (1968) • Notwithstanding the provisions of Section A.2. of this Article, the implied warranties of merchantability and fitness shall not be applicable to a contract for the sale of human blood, blood plasma or other human tissue or organs from a blood bank or reservoir of such other tissues or organs. Such blood, blood plasma or tissue or organs shall not for the purposes of this Article be considered commodities subject to sale or barter but shall be considered as medical services.

First LA Blood Shield Law - 1764 • What does the legislative intent seem to be? • Why didn't the law include products liability claims? • What should the effect of this be on a 402a strict liability claim?

Construction of 1764 • This blood-shield statute withstood constitutional challenges in appellate courts of three circuits: • Juneau v. Interstate Blood Bank, Inc. of Louisiana, 333 So.2d 354 (La.App. 3 Cir.), writ denied, 337 So.2d 220 (La. 1976); • Koppenol v. St. Tammany Parish Hospital, 341 So.2d 1242 (La.App. 1 Cir.), writ denied, 343 So.2d 1067 (La. 1977); and • Adams v. New Orleans Blood-Bank, Inc., 343 So.2d 363 (La.App. 4 Cir. 1977). • The first circuit noted that by the late 1970's, 47 states had adopted similar statutes and in each instance where constitutionality was challenged the statute was upheld. See, Koppenol, 341 So.2d at 1245.

Does 1764 Apply to Strict Liability? • Juneau, 333 So.2d at 358 • (in enacting Article 1764(B) the legislature intended for the furnishing of blood to be considered a service for all purposes, not just for the warranty of fitness in a sale); • Koppenol, 341 So.2d at 1245 • (the legislature considered and weighed the necessity and need for blood against the risk of contracting hepatitis and concluded the need outweighed the risk; the legislature saw fit in Article 1764(B) to exclude this type of injury from the application of warranty (express and implied) and from strict liability, as in RESTATEMENT (SECOND) OF TORTS § 402A (1965)

What is the Policy? • The court held that to permit the application of strict liability in these blood cases would instill in the medical profession fear of the use of blood until foolproof tests could be devised, an untenable result. • The court cited with approval the provision in LSA-C.C. art. 1764(B) that blood is not a "commodity," but is a medical service, saying this "public policy statute" recognized the life-saving need for use of blood in some cases.

MMA - 1975

DeBattista v. Argonaut-Southwest Insurance Company, 403 So.2d 26 (La. 1981) • Court said that 1764 only applied to contractual warranties, not strict liability • Why did it not mention strict liability? • Justice Dennis, writing for the majority, concluded that blood contaminated with hepatitis virus is defective, i.e., unreasonably dangerous to normal use because the risks involved in receiving a transfusion of blood in this condition are greater than a reasonable consumer would expect. • What about Comment K?

Legislative Response • By Act 611 of 1981, a new civil code article designated as Article 2322.1, and by Act 331 of 1981, a new section designated as LSA-R.S. 9:2797 were enacted, • providing that strict liability "shall not be applicable to physicians, hospitals ... or nonprofit community blood banks ... in the ... transfusion ... of human blood ... which results in transmission of viral diseases ... undetectable by appropriate medical and scientific laboratory tests." • Both acts limited the effectiveness of the provisions to causes of action arising after the effective dates of the acts.

Branch v. Willis-Knighton Medical Center, 636 So.2d 211 (La. 1994) • Transfusion was in 1976 • The majority in Branch held the three-year prescription provision in LSA-R.S. 9:5628 did not apply to "strict tort liability actions arising out of the sale of blood in a defective condition unreasonably dangerous to the user or consumer." Branch, 92-3086 at 7, 636 So.2d at 214. • Justice Dennis reasoned the earmarks of the statute indicated the legislature intended to deal only with actions traditionally classified under the generally prevailing meaning of "medical malpractice."

Boutte v. Jefferson Parish Hospital Service District No. 1, 759 So.2d 45 (La. 2000) • The court's rationale was that Boutte differed because when that plaintiff's transfusions were administered, the MMA's definition of medical malpractice had been revised by La. Acts 1976, No. 183 to include • "all legal responsibility of a health care provider arising from defects in blood." LSA-R.S. 40:1299.41(8). • Therefore, it was unnecessary to overrule Branch in order to find Boutte's cause of action was barred by the three-year prescription applicable to medical malpractice cases.

Williams v. Jackson Parish Hospital, 798 So.2d 921 (La. 2001) • The divided court concluded that Branch correctly held all pre-1982 (pre-blood shield statutes) claims against hospitals in strict products liability arising out of defective blood transfusions (DeBattista claims) are not traditional medical malpractice claims and are not governed by LSA-R.S. 9:5628, but by LSA-C.C. art. 3492. • Justice Knoll dissented ... she pointed out that the transfusion of blood is an integral part of the physician's care of the patient and the "sale" of blood cannot be dissected reasonably from treatment.

David v. Our Lady of the Lake Hospital, Inc., 849 So.2d 38 (La. 2003)

LSA-R.S. 9:5628 • A. No action for damages for injury or death against any ... hospital duly licensed under the laws of this state, whether based upon tort, or breach of contract, or otherwise, arising out of patient care shall be brought unless filed within one year from the date of the alleged act, omission, or neglect, or within one year from the date of discovery of the alleged act, omission, or neglect; however, even as to claims filed within one year from the date of such discovery, in all events such claims must be filed at the latest within a period of three years from the date of the alleged act, omission, or neglect.

Plain Language Meaning • "or otherwise, arising out of patient care" • What is the significance of "or otherwise"?

Is Blood Part of Patient Care? • The language "tort ... arising out of patient care" clearly encompasses delictual actions based on strict liability for blood sold and used in transfusions. • It is clear and well-established that strict liability is a legal theory which may form the basis of a tort action and, as such, is simply a subspecies of the fault recognized in LA. CIV. CODE ANN. art. 2315. • Patients do not buy and sell blood as a pure commercial transaction; rather, blood is bought and used as an integral part of the care afforded patients at the time of medical treatment.

What does the Court Tell the Dissenters? • However harsh the application of LA.REV.STAT. ANN. § 9:5628, mincing words and linguistic gymnastics should not be utilized to disregard the statutory language. • Rather, litigants should seek redress from the Legislature to change the law. • Has there ever been any doubt about the legislative intent?

The Ruling • Accordingly, we hold plaintiff's claim of strict liability in tort for the transfusing of blood contaminated with hepatitis C filed against the private hospital, which was not a qualified health care provider at the time of the blood transfusion, is prescribed pursuant to the provisions of LSA-R.S. 9:5628. • All previous holdings inconsistent with this holding are hereby overruled.

CALOGERO, Chief Justice, Dissents • I see no reason, other than a court reconfigured in part and excluding one of the justices who was in the majority in Williams because recused in this case, for choosing to reconsider the reasons espoused in Williams, to which I continue to adhere. ... Recall that, as Williams held, the application of 9:5628 depends on whether the two restrictions set forth in this special prescription statute are met: • (1) the defendant must fall within one of the categories of enumerated providers, and • (2) the claim asserted must meet the statutory, conduct-based standard, i.e., the action, whether in tort, in breach of contract, or otherwise, must arise out of patient care. • It is this second requirement which is the focus of the current dispute.

What is a Strict Liability Claim? • A DeBattista claim is not an action arising from patient care; instead, it is a strict products liability claim arising from the sale of a defective product, blood. Because the DeBattista claim is not a traditional medical malpractice claim, it is not the type of claim "based upon tort, breach of contract or otherwise, arising out of patient care" to which the prescriptive periods of La. Rev. Stat. 9:5628 are directed. Instead, such claims, to the extent that they are not now covered by La. Rev. Stat. 9:5628.1, should be governed by the general tort prescriptive periods found in La. Civ. Code art. 3492. • Accordingly, in my view, the Williams court correctly overruled Boutte, and today's majority errs in overruling Williams.

JOHNSON, J., Dissenting. • In the instant case, Our Lady of the Lake Hospital was not a "qualified health care provider" at the time of plaintiff's blood transfusion under either the private or public Medical Malpractice Acts. It did not pay any premiums on a policy of insurance under either Act. Therefore, the general rules of tort law, including prescription, should apply. Accordingly, Our Lady of the Lake Hospital should not be allowed to avail itself of the prescriptive period provided for in La. R.S. 9:5628.

What is the Right Policy? • What would be the impact of allowing these claims? • What would be the prospective effect? • What would you tell hospital and blood bank clients if such claims were allowed? • Is there any question about legislative policy? • Should that matter to the court?

Day v. Morehouse General Hospital, 865 So.2d 924 (La.App. 2004) • A question of symmetry in retrospective application of laws: • Strict liability was not recognized in LA when the patient received the transfusion (1967) • The blood shield law used by the court was not in effect in either • Should plaintiff be able to make a strict liability claim 30 years later but not be subject to the blood shield law in effect at the time?

Liability for Bad Blood in Louisiana