## Facts

- In July 1982, twelve-year-old Calvin Grant underwent heart surgery at a Washington, D.C. hospital and received five units of whole blood supplied by the American National Red Cross.
- The five units were obtained from five different donors and were screened using Red Cross procedures in place in 1982.
- The Red Cross did not perform alanine aminotransferase (ALT) testing on donor blood in 1982.
- By 1982, the medical community recognized “non-A, non-B” hepatitis; elevated ALT was considered a possible indicator, but with substantial limitations.
- Evidence indicated ALT testing would have missed a large majority of infected carriers and would have disqualified a significant number of uninfected donors due to false positives.
- In 1989, scientists identified hepatitis C; a specific screening test became available in 1990.
- In 1993, Grant was diagnosed with hepatitis C.
- DNA testing later confirmed Grant was infected during the 1982 transfusion and that stored blood from one donor tested positive for hepatitis C.
- Grant sued the Red Cross for negligence, alleging failure to implement ALT testing increased his risk of infection (claimed increase of roughly 30–40%).

## Issues

1. Whether, in a negligence action alleging inadequate blood-donor screening, proximate causation may be established by a “loss of chance” theory rather than the traditional “more likely than not” standard.
2. Whether prior District of Columbia precedent recognizing loss-of-chance concepts in a medical-malpractice setting authorized extending that approach to a blood-bank screening claim.

## Decision

- The D.C. Court of Appeals affirmed summary judgment for the American National Red Cross.
- The court held that District of Columbia negligence law generally requires proof that the defendant’s conduct more likely than not caused the injury.
- Grant conceded he could not show ALT testing would probably have prevented his infection; his evidence supported, at most, a probability below 50%.
- The court declined to recognize loss of chance as an independent, compensable injury on these facts and declined to treat prior medical-malpractice precedent as authorizing a broader change in causation doctrine.
- Because Grant could not satisfy the governing proximate-causation standard, no triable issue of material fact existed.

## Legal Principles

- In District of Columbia negligence cases, proximate causation ordinarily requires proof that the defendant’s conduct probably caused the harm (a greater-than-50% likelihood).
- Evidence that a defendant’s conduct merely increased risk, or reduced a less-than-even chance of avoiding harm, is insufficient absent recognition of loss-of-chance liability in the relevant context.
- Loss-of-chance reasoning discussed in prior medical-malpractice cases does not automatically extend to non-malpractice negligence claims involving institutional screening policies and probabilistic proof.
- Summary judgment is proper where the plaintiff’s proffered evidence cannot meet the applicable causation standard as a matter of law.

## Conclusion

The court affirmed summary judgment for the Red Cross because the plaintiff could not prove that the absence of ALT testing in 1982 more likely than not caused his hepatitis C infection, and the court declined to expand District of Columbia causation doctrine to allow recovery for a lost chance of avoiding infection in this blood-screening negligence case.


Grant v. Am. Nat'l Red Cross, 745 A.2d 316 (D.C. 2000)