Lynch v. State

Argued February 22, 2023.

Action to recover damages for the alleged medical malpractice of the named defendant et al., and for other relief, brought to the Superior Court in the judicial district of Hartford, where the action was withdrawn as against the defendant Claudio Benadiva et al.; thereafter, the court, Cobb, J., granted in part the named defendant's motion to strike; subsequently, the court, M. Taylor, J., denied the named defendant's motion to preclude certain evidence; thereafter, the case was tried to the court, M. Taylor, J.; subsequently, the court, M. Taylor, J., denied the named defendant's motion to dismiss and rendered judgment in part for the plaintiffs, from which the named defendant appealed. Affirmed.

Jeffrey R. Bobbin, with whom was Michael G. Rigg, for the appellant (named defendant).

James J. Healy, with whom were Karolina A. Dowd, Caitlyn S. Malcynsky and, on the brief, Michael J. Walsh, for the appellees (plaintiffs).

Robinson, C. J., and McDonald, D'Auria, Mullins, Ecker and Alexander, Js.

OPINION

ALEXANDER, J.

In this medical malpractice action arising from a therapeutic donor insemination (TDI) procedure, the named defendant, the state of Connecticut (state),^[1] appeals from the judgment of the trial court rendered in favor of the plaintiffs, Aaron Lynch (Aaron) and Jean-Marie Monroe-Lynch (Jean-Marie), individually and in their representative capacities as parents of their minor son, Joshua Isaac Monroe-Lynch (Joshua), and as the administrators of the estate of Shay Ashlan Monroe-Lynch (Shay). On appeal, the state contends that (1) the claims on which the plaintiffs prevailed at trial were barred by sovereign immunity, (2) Joshua and Shay did not suffer legally cognizable injuries necessary to support the trial court's award of damages, and (3) the testimony of the plaintiffs' primary causation expert was improperly admitted because it was not supported by a valid scientific methodology. The plaintiffs ask this court to resolve a split among Superior Court decisions and to recognize a cause of action for wrongful life. We conclude that it is unnecessary to reach the wrongful life issue and, finding no error, affirm the trial court's judgment.

The trial court's comprehensive memorandum of decision sets forth the following relevant facts and procedural history. Jean-Marie and Aaron are a married couple who wanted to have children but were unable to conceive without medical assistance. In the summer of 2013, the couple sought TDI services at the Center for Advanced Reproductive Services (CARS) at the University of Connecticut Health Center (UConn). Prior to their initial visit, CARS sent them a TDI patient information packet, which included general information about TDI risks and CARS approved sperm banks. The packet also included information about testing that TDI patients are required to undergo, including testing for cytomegalovirus (CMV), a type of herpes virus that has infected considerably more than 50 percent of the general population.

A blood test can reveal whether an individual has ever been infected with CMV. The presence of immunoglobulin M (IgM) antibodies is associated with an initial CMV infection. Generally, IgM antibodies remain in the blood for approximately six to nine months after infection, decreasing over time until they are no longer detectable. As the IgM antibodies decrease, they are replaced by immunoglobulin G (IgG) antibodies, which typically increase over time and stay in the body for the remainder of the person's life. A person who tests positive for IgG antibodies will not be continuously infectious but nonetheless will periodically shed "live," infectious virus through bodily fluids, including urine and seminal fluid. For most adults, symptoms of a CMV infection are mild. An initial infection during early pregnancy, however, can result in profound health

complications for the developing fetus.

In light of the risks to fetal health associated with a mother's initial exposure to CMV in early pregnancy, it is necessary for those providing TDI services to determine whether both the patient and the prospective sperm donor have ever been infected with CMV. Although semen collected at sperm banks is subjected to a process known as "washing" to remove CMV and other pathogens,^[2] there is no way of ensuring that all infectious agents, including CMV, are completely removed from the sperm and will not be introduced during a TDI procedure. The patient information packet that CARS sent to Jean-Marie stated that, "[i]f you have never been exposed to CMV, your test will come back negative, and then, you 'may only choose a CMV negative donor." (Emphasis added.) This restriction accords with the guidelines of the American Society for Reproductive Medicine (ASRM), the leading professional organization in reproductive medicine, which recommends that CMV positive donor sperm be used only for patients who are also CMV positive.^[3] Federal regulations require sperm banks to notify fertility clinics of a sperm donor's CMV status with each sperm shipment. See 21 C.F.R. § 1271.370 (2022).

At the commencement of her TDI treatment, in September, 2013, Jean-Marie tested negative for both IgM and IgG antibodies. On May 11, 2014, Jean-Marie underwent a successful intrauterine insemination (IUI) procedure using sperm from CMV positive donor No. 013673 and became pregnant with twins. Claudio Benadiva, the physician who performed the IUI procedure on Jean-Marie, did not check the CMV status of donor No. 013673 prior to using the sperm.^[4] As a result, Benadiva was unaware that he was inseminating a CMV negative patient with sperm from a CMV positive donor.^[5] Because he was unaware, he did not seek or obtain Jean-Marie's informed consent for the procedure.

Although some organizations proscribe any insemination of CMV negative patients with sperm from CMV positive donors, the trial court found that the standard of care may permit such inseminations, but only if the patient is appropriately counseled as to the risks of congenital CMV and gives her full, informed consent. Such counseling must include a discussion of the "devastating neurological and cognitive outcomes" associated with a congenital CMV infection in utero.

Throughout her pregnancy, Jean-Marie received prenatal care from both a maternal fetal medicine team and an obstetrics and gynecology team at UConn (prenatal care providers). In June, 2014, when she was approximately five weeks pregnant, Jean-Marie presented at the emergency department of the Hospital of Central Connecticut in New Britain complaining of a rash of unknown origin and respiratory issues. The next day, she went to UConn's emergency department

complaining of a persistent rash on her abdomen and facial swelling, symptoms that are consistent with an acute CMV infection. CARS was informed of these symptoms, and they were recorded in her medical chart.

Jean-Marie was classified as having a high-risk pregnancy, and she was scheduled for regular ultrasounds to closely monitor her progression. In October, 2014, when she was twenty-two weeks pregnant, Jean-Marie underwent an ultrasound that revealed that the twins both had small heads and hyperechoic bowels-conditions associated with an in utero CMV infection. Notwithstanding these ultrasound findings and in violation of the standard of care, Jean-Marie's maternal fetal medicine physician, Garry Turner, did not perform any serology tests, amniocentesis, or other follow-up steps to rule out a CMV infection; nor did he inform Jean-Marie about these findings. Compounding these errors, a copy of the abnormal ultrasound result was not included in Jean-Marie's medical record, which led to an additional failure to diagnose her and the twins with CMV.

In January, 2015, Jean-Marie, who was then thirty-seven weeks pregnant, went to UConn for a regularly scheduled nonstress test. During the visit, she was informed that one of the twins, Shay, had died in utero. A cesarean section was immediately performed to deliver both twins. At the time of delivery, Jean-Marie had an IgM antibody level of 51.5, which is consistent with a current or recent CMV infection. Shay's autopsy revealed that she had died from a severe CMV infection. Joshua was born with severe health complications as a result of his own congenital CMV. Specifically, Joshua is unable to eat, communicate, or attend to any of his personal needs in a normal or independent manner. For the rest of his life, he will have to be fed through a gastrostomy tube. In addition, he suffers from global developmental delay and cognitive, hearing, and motor deficits, including related diagnoses of epilepsy, autism, and cerebral palsy. Joshua will require constant services and care for the remainder of his life, including physical and occupational therapies and a home health aide.

Pursuant to General Statutes (Rev. to 2015) § 4-160 (b),^[6] Jean-Marie and Aaron sought permission from the Claims Commissioner to sue the state for medical malpractice, both individually and in their representative capacities as Joshua's parents and as the administrators of Shay's estate. Their notice of claim stated that the injuries arose out of the fertility treatments and prenatal care Jean-Marie had received from UConn medical providers. A physician's statement was included with the notice of claim, describing the physician's reasons for concluding that the standard of care relating to the plaintiffs' fertility treatment claims had been breached. After reviewing the plaintiffs' claims, the Claims Commissioner found that the requirements of § 4-160 (b)

had been met and granted the plaintiffs' request for permission to sue the state for medical malpractice.

The plaintiffs subsequently commenced this...