## Facts

- Jamie Scafidi’s pregnancy involved a preexisting obstetrical condition that created a substantial risk of premature labor, premature birth, and neonatal death.
- Dr. F. U. Seiler, an obstetrician, treated Jamie Scafidi during the onset of preterm labor.
- Plaintiffs alleged Seiler negligently failed to properly treat and arrest early labor, increasing the risk of premature birth and the infant’s death.
- Medical proofs presented both (a) the independent risk from the preexisting condition and (b) alleged negligent management that could have worsened that risk.
- A central factual dispute was whether the alleged negligence increased the risk of the very harm threatened by the preexisting condition and materially contributed to the outcome.

## Issues

1. In a malpractice case involving a preexisting condition that itself threatened the same ultimate harm, must the jury be instructed on causation under an “increased risk/substantial factor” standard rather than traditional but-for proximate cause?
2. When both a preexisting condition and negligence contribute to the ultimate harm, should damages be apportioned as the value of the “lost chance” attributable to negligence, and is a burden-shifting apportionment instruction required?

## Decision

- The Supreme Court of New Jersey affirmed the Appellate Division’s reversal of the defense verdict and remanded for a new trial.
- The Court held that the jury must be charged under an increased-risk causation standard when negligent treatment combines with a preexisting condition to produce the ultimate harm.
- The Court ruled that, if evidence shows the harm might have occurred even with proper care, damages must be limited to the value of the lost chance that proper treatment would have avoided the harm.
- The Court agreed that a *Fosgate*-style burden-shifting apportionment instruction was not required in this setting, because proportional “lost chance” damages address apportionment.

## Legal Principles

- In preexisting-condition malpractice cases, proximate cause is satisfied if the plaintiff proves: (a) a preexisting condition created a risk of the injury, (b) defendant’s negligence increased that risk, and (c) the increased risk was a substantial factor in producing the ultimate injury.
- The increased-risk standard applies even when the preexisting condition could have been sufficient to cause the ultimate harm without negligence.
- When the record supports that the injury might have occurred absent negligence, recoverable damages are limited to the percentage probability that proper treatment would have avoided the injury (the value of the lost chance), rather than the full value of the ultimate harm.
- Trial courts should instruct juries to focus on whether negligent treatment increased the risk posed by the preexisting condition and whether that increase was a substantial factor in the outcome, with damages reflecting only the incremental loss of a favorable outcome attributable to negligence.

## Conclusion

The court required an increased-risk/substantial-factor causation instruction in malpractice cases involving preexisting conditions and limited recovery to proportionate lost-chance damages when the harm could have occurred even with proper treatment, remanding for a new trial under those standards.


Scafidi v. Seiler, 119 N.J. 93, 574 A.2d 398 (N.J. 1990)