## Facts

- Ethel Lawrence visited a county health department prenatal clinic for a pregnancy test, tested positive, and received routine prenatal care through the clinic.
- She later went into labor at a hospital, underwent an emergency Caesarean section, and the child suffered fetal distress and prenatal asphyxia, resulting in permanent serious brain damage.
- Plaintiffs alleged the injury was preventable with standard procedures for a postmature fetus.
- Plaintiffs initially sued the clinic, hospitals, and physicians for negligence; the clinic obtained summary disposition on negligence based on governmental immunity, and plaintiffs did not appeal that immunity ruling.
- Plaintiffs then filed a third amended complaint asserting breach-of-contract counts against the clinic, alleging an agreement that the clinic would provide care within the applicable standard of care and that Lawrence would follow medical directions and not have an abortion.
- The trial court granted the clinic summary disposition under MCR 2.116(C)(8) for failure to state a claim.

## Issues

1. Whether allegations that a public prenatal clinic agreed to provide care within the applicable standard of care state an enforceable express or implied-in-fact contract claim distinct from medical malpractice.
2. Whether a plaintiff may avoid governmental immunity for a malpractice claim by pleading the claim as breach of contract without alleging a specific contractual promise of a particular result.

## Decision

- The Michigan Court of Appeals affirmed summary disposition for the clinic under MCR 2.116(C)(8).
- The court treated the pleaded “implied contract in law” theory as an attempted contract implied in fact, requiring contract elements shown by the parties’ conduct.
- The court held the alleged “promise” to provide services within the applicable standard of care did not create an enforceable contractual undertaking separate from the tort duty in malpractice.
- Because the contract counts merely restated a malpractice duty and alleged no specific promise or warranty of a particular result, plaintiffs failed to state a breach-of-contract claim.

## Legal Principles

- A medical provider’s general obligation to render non-negligent care sounds in tort; a contract claim in the medical context requires a contractual undertaking that is distinct from the ordinary standard-of-care duty.
- An alleged agreement to provide treatment consistent with the “applicable standard of care” is not a separate contractual promise; it mirrors the malpractice standard and does not support an independent contract action.
- A contract implied in fact is determined from the parties’ acts and conduct and requires the essential elements of an express contract; routine patient acceptance and treatment ordinarily do not show an intent to assume additional contractual liability.
- A plaintiff may not avoid governmental immunity (or other tort limits) through relabeling malpractice allegations as breach of contract absent a specific, outcome-oriented promise.

## Conclusion

The court affirmed dismissal because the pleaded contract theory did not allege a specific contractual promise beyond ordinary due care and therefore amounted to an impermissible attempt to restate a barred malpractice claim as breach of contract.


Lawrence v. Ingham Cnty. Health Dep't Family Planning/Pre-Natal Clinic, 160 Mich. App. 420, 408 N.W.2d 461 (Mich. Ct. App. 1987)