## Facts

- Loretta L. Tetuan had a Dalkon Shield intrauterine device (IUD) inserted by her physician on September 14, 1971 to avoid pregnancy.
- Her physician did not identify the device by brand and did not warn her about infection risks, advising only that her periods might be heavier.
- The Dalkon Shield used a black multifilament tail string; evidence supported that the string could “wick” bacteria into the uterus, contributing to pelvic infection risks.
- Evidence indicated the manufacturer, A.H. Robins Co., knew early that the device had elevated pregnancy failure rates and serious infection-related complications, including pelvic inflammatory disease and septic abortions.
- Despite adverse reports, Robins conducted aggressive marketing portraying the device as safe and superior and distributed materials and patient information that allegedly misstated safety and effectiveness and omitted known risks.
- Evidence showed internal consideration of safer design alternatives and an alleged later effort to destroy records related to the wicking problem.
- Tetuan developed serious pelvic infection and ongoing pain and disability; removal of the device and antibiotic treatment did not resolve her injuries.
- Tetuan sued on multiple theories, including negligence, strict liability, breach of warranty, fraud, and gross and wanton negligence.
- A jury awarded $1.7 million compensatory damages and $7.5 million punitive damages; Robins appealed.

## Issues

1. Whether the evidence supported findings of negligence and liability based on marketing, labeling, and warnings for the Dalkon Shield.
2. Whether Robins breached a duty to warn under the learned-intermediary doctrine by failing to provide physicians adequate and truthful risk information.
3. Whether alleged violations of the Kansas Food, Drug, and Cosmetic Act (including misbranding and misleading advertising) could be treated as evidence of negligence and presented to the jury.
4. Whether the evidence met Kansas standards for punitive damages (willful, wanton, or reckless conduct) and whether the punitive award was excessive.
5. Whether challenged jury instructions and asserted trial errors required reversal.

## Decision

- The Kansas Supreme Court affirmed the judgment for Tetuan, including compensatory and punitive damages.
- The court held the record supported findings that Robins failed to exercise reasonable care in testing, design-related decisions, marketing, and warnings.
- The court upheld submission of statutory misbranding concepts to the jury as relevant to negligence, including an instruction referencing the Kansas Food, Drug, and Cosmetic Act.
- Applying the learned-intermediary framework, the court concluded the jury could find Robins inadequately warned physicians and that the failure to warn was a proximate cause of Tetuan’s injuries.
- The court held the evidence supported punitive damages based on willful and wanton conduct, including continued safety representations amid known serious risks and evidence of suppression or destruction of relevant information.
- The court found no reversible instructional error when the instructions were considered as a whole and where objections were not properly preserved or prejudice was not shown.

## Legal Principles

- A prescription medical-device manufacturer must provide physicians accurate, complete, and non-misleading risk information; inadequate warnings or misleading promotional communications may constitute negligence.
- Under the learned-intermediary doctrine, the manufacturer’s duty to warn generally runs to prescribing physicians; liability may follow where the manufacturer’s omissions or misrepresentations deprive physicians of material risk information.
- Statutory standards addressing misbranding and misleading labeling/advertising may be used as evidence bearing on the standard of care and negligence when properly submitted and supported by the pleadings and proof.
- Punitive damages may be awarded under Kansas law upon proof of willful, wanton, or reckless disregard for others’ rights, including conscious continuation of dangerous marketing practices and conduct showing awareness of wrongdoing.
- Appellate review defers to the jury’s factual determinations when supported by substantial evidence and will not reverse for non-prejudicial instructional imperfections viewed in the context of the entire charge.

## Conclusion

The Kansas Supreme Court upheld a substantial verdict against the Dalkon Shield’s manufacturer, concluding that evidence of misleading marketing, inadequate physician warnings, and disregard of known serious risks supported negligence and willful-and-wanton misconduct, and that the punitive award and jury instructions were sustainable under Kansas law.


Tetuan v. A.H. Robins Co., 241 Kan. 441, 738 P.2d 1210 (Kan. 1987)