Heather Blouin v. Divya Koster, M.D.

Supreme Court

No. 2022-282-Appeal.
(PC 15-3817)

Heather Blouin et al. :

v. :

Divya Koster, M.D., et al. :

NOTICE: This opinion is subject to formal revision
before publication in the Rhode Island Reporter. Readers
are requested to notify the Opinion Analyst, Supreme
Court of Rhode Island, 250 Benefit Street, Providence,
Rhode Island 02903, at Telephone (401) 222-3258 or
Email opinionanalyst@courts.ri.gov, of any typographical
or other formal errors in order that corrections may be
made before the opinion is published.
Supreme Court

No. 2022-282-Appeal.
(PC 15-3817)

Heather Blouin et al. :

v. :

Divya Koster, M.D., et al. :

Present: Suttell, C.J., Robinson, Lynch Prata, and Long, JJ.

OPINION

Justice Long, for the Court. The plaintiffs, Jason Blouin, individually and

as father and next friend of Q.B., X.B., and D.B.; 1 along with Heather Blouin,

individually (collectively, plaintiffs), appeal from a Superior Court decision granting

summary judgment in favor of the defendants, Divya Koster, M.D. (Dr. Koster);

Joseph Singer, M.D. (Dr. Singer); Patricia Lynch-Gadaleta, PA-C; and Riverside

Pediatrics, Inc. (Riverside Pediatrics) (collectively, pediatric defendants); and partial

summary judgment in favor of the defendants, Karen L. McGoldrick, M.D. (Dr.

McGoldrick); Santina L. Siena, M.D. (Dr. Siena); and University OB-GYN, Inc.

(University OB-GYN) (collectively, obstetric defendants). The plaintiffs argue that

(1) the trial justice erroneously determined that the pediatric defendants did not owe

a duty of care to Heather Blouin (Mrs. Blouin) and Jason Blouin (Mr. Blouin)

1
We refer to these plaintiffs by their initials because they were minors at the time
the amended complaint was filed. We intend no disrespect.
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(collectively, plaintiff-parents); and that (2) the trial justice erroneously determined

that this Court’s holding in Ho-Rath v. Corning Incorporated, 275 A.3d 100 (R.I.

2022) (Ho-Rath III), barred X.B. and D.B.’s individual claims. 2 For the reasons set

forth in this opinion, we affirm the judgments of the Superior Court.

Facts and Procedural History
We, as do the parties, take the following facts from the amended complaint

and the statement of undisputed facts for purposes of the appeal before the Court.

This matter arises out of a medical malpractice action related to the allegedly

negligent births of X.B. and D.B., each of whom was born with cystic fibrosis, a life-

shortening genetic disorder that causes severe damage to the lungs and digestive

system. Heather Blouin and Jason Blouin are the parents of Q.B., X.B., and D.B.,

who were born in January 2006, September 2009, and September 2012 respectively.

For each pregnancy, Mrs. Blouin received medical care and treatment at University

OB-GYN.

Specifically, Dr. McGoldrick, an obstetrician and employee of University

OB-GYN, provided medical care and treatment to Mrs. Blouin during and in

between her pregnancies with Q.B. and X.B. The plaintiff-parents allege that Dr.

2
At the hearing on the summary judgment motions, counsel for plaintiffs conceded
that D.B. had not yet been conceived during the time period when Dr. Siena provided
care and treatment to Mrs. Blouin; accordingly, D.B., by and through his father as
next friend, does not challenge the portion of the trial justice’s decision granting Dr.
Siena’s motion for summary judgment.
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McGoldrick did not, at any time, offer them genetic screening or counseling related

to the risks or consequences that could result from parents genetically passing a

hereditary condition to their unborn children.

A few years after Q.B.’s healthy birth in 2006, Mrs. Blouin attended a routine

visit at University OB-GYN and informed Dr. McGoldrick of her intent to conceive

a second child. Dr. McGoldrick did not suggest or offer preconception screening or

counseling to the Blouin family at this time.

In September 2009, Mrs. Blouin gave birth to X.B. Shortly thereafter, X.B.’s

newborn screening test (NST), a screening tool used to assist in early detection of

medical conditions, revealed nothing remarkable. However, over the next few years,

X.B. frequently visited Riverside Pediatrics and sought treatment for various

symptoms including a failure to thrive, diarrhea, a chronic cough, and nasal

congestion. The record reveals that plaintiff-parents brought X.B. to Riverside

Pediatrics upwards of fifteen times between October 2009 and December 2012.

Although X.B.’s symptoms persisted, and worsened, during this period, he did not

receive a diagnosis of cystic fibrosis until 2013.

On February 7, 2011, Mrs. Blouin saw Dr. Siena, a second obstetrician, for an

annual appointment during which she informed Dr. Siena that she was planning to

conceive a third child in the next three to four months. The plaintiffs allege that Dr.

Siena did not offer preconception screening or counseling. In September 2012, Mrs.

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Blouin gave birth to D.B. Due to D.B.’s NST revealing that he carried the cystic

fibrosis gene mutation, pediatrician Dr. Koster recommended that he undergo a

sweat test to determine whether he had elevated chloride levels, a well-known

marker of cystic fibrosis in the medical community. Although D.B. underwent three

separate sweat tests, which revealed elevated chloride levels, D.B.’s providers at

Riverside Pediatrics did not diagnose him with cystic fibrosis.

In December 2012, Mrs. Blouin called pediatrician Dr. Singer to request that

Q.B. and X.B. also undergo sweat testing, based on D.B.’s concerning test results.

Although Q.B.’s sweat test did not raise concerns, X.B.’s sweat test showed elevated

chloride levels. Thereafter, X.B. underwent a second sweat test revealing the same

elevated chloride levels; however, he was not diagnosed with cystic fibrosis at that

time.

On July 8, 2013, D.B. underwent an evaluation at the Rhode Island Hospital

Division of Cystic Fibrosis, where specialists confirmed that he had cystic fibrosis

and would need chest physical therapy to address his respiratory symptoms. Shortly

thereafter, X.B. also underwent an evaluation, received a diagnosis of cystic fibrosis,

and was referred for treatment to address his respiratory symptoms.

Following these diagnoses in 2013, Mrs. Blouin began to experience severe

anxiety and distress in response to the increased needs of X.B. and D.B. and her

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concerns about their health and well-being. Furthermore, after D.B.’s birth,

plaintiff-parents learned that they are carriers of the cystic fibrosis gene.

The plaintiffs filed suit on August 31, 2015, and amended their complaint in

2016. 3 In their amended complaint, plaintiffs alleged that the obstetric defendants

and the pediatric defendants were negligent in their diagnosis, treatment, and

provision of genetic counseling with respect to the Blouin family’s cystic fibrosis

diagnoses; plaintiff-parents also alleged that they “would not have conceived [X.B.

3
The plaintiffs’ original complaint included claims against Linda Shalon, M.D., and
her employer, Rhode Island Hospital. By stipulation of the parties, all claims against
Dr. Shalon and Rhode Island Hospital have been dismissed. The amended complaint
alleges thirty-six counts. Specifically, plaintiffs’ claims include plaintiff-parents’
wrongful-conception claim against Dr. McGoldrick (count 1); plaintiff-parents’
wrongful-conception claim against Dr. Siena (count 5); plaintiff-parents’ wrongful-
conception claims against the pediatric defendants (counts 2, 3, and 4); X.B.’s
wrongful-life claim against Dr. McGoldrick (count 6); D.B.’s wrongful-life claim
against Dr. McGoldrick (count 7); D.B.’s wrongful-life claim against Dr. Siena
(count 8); D.B.’s wrongful-life claims against the pediatric defendants (counts 9, 10,
and 11); Mrs. Blouin’s loss of consortium claims against the obstetric defendants
(counts 12 and 13); Mrs. Blouin’s loss of consortium claims against the pediatric
defendants (counts 14, 15, and 16); Mr. Blouin’s loss of consortium claims against
the obstetric defendants (counts 17 and 18); Mr. Blouin’s loss of consortium claims
against the pediatric defendants (counts 19, 20, and 21); Q.B.’s loss of consortium
claims against the obstetric defendants (counts 22 and 23); Q.B.’s loss of consortium
claims against the pediatric defendants (counts 24, 25, and 26); Mrs. Blouin’s
respondeat superior claims against Riverside Pediatrics and University OB-GYN
(counts 27 and 28); Mr. Blouin’s respondeat superior claims against Riverside
Pediatrics and University OB-GYN (counts 29 and 30); Q.B.’s respondeat superior
claims against Riverside Pediatrics and University OB-GYN (counts 31 and 32);
X.B.’s respondeat superior claims against Riverside Pediatrics and University OB-
GYN (counts 33 and 34); and D.B.’s respondeat superior claims against Riverside
Pediatrics and University OB-GYN (counts 35 and 36).
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and D.B.]” had they received information about their status as cystic fibrosis carriers

sooner; and they sought damages for the costs of extraordinary medical,

psychological, education, residential, and other expenses that they have incurred and

will continue to incur as a result of the alleged negligence by defendants. All

defendants moved to dismiss the amended complaint pursuant to Rule 12(b)(6) of

the Superior Court Rules of Civil Procedure. A justice of the Superior Court heard

and denied defendants’ motions to dismiss, with the exception of plaintiff-parents’

claims for wrongful-conception of X.B. against pediatricians Dr. Koster and Dr.

Singer, due to plaintiff-parents’ concession that these two providers could not be

liable for X.B.’s birth because they did not begin treating him until after his birth.

The Superior Court ultimately set a trial date for September 2022; however, the

obstetric defendants moved for partial summary judgment in response to this Court’s

May 2022 opinion in Ho-Rath III, in which this Court determined “that there is no

duty owed to a child born with physical defects who alleges that, because of

negligence, his or her parents either (1) decided to conceive the child in ignorance

of the risk of impairment, or (2) were deprived of information that would have

caused them to terminate the pregnancy.” 4 Ho-Rath III, 275 A.3d at 108. The

pediatric defendants also filed a motion for summary judgment.

4
Dr. McGoldrick sought summary judgment for X.B. and D.B.’s wrongful-life
claims and the related derivative loss of consortium claims against her (counts 6, 7,
12, 17, and 22); Dr. Siena sought summary judgment for D.B.’s wrongful-life and
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In support of their motions for summary judgment, both the pediatric

defendants and the obstetric defendants argued that plaintiffs’ wrongful-life claims,

and the associated derivative claims for loss of consortium, were subject to dismissal

based on Ho-Rath III. As to the wrongful-conception claims, the pediatric

defendants drew the trial justice’s attention to two key undisputed facts: (1) X.B.,

and not plaintiff-parents, or D.B., was the patient of the pediatric defendants during

the time frame of the alleged negligence, and (2) plaintiff-parents have not claimed

that they consulted with the pediatric defendants regarding genetic screening or

prenatal care. Consequently, the pediatric defendants asserted that the duty owed to

plaintiff-parents was to properly treat X.B. and to inform plaintiff-parents, as

healthcare proxies, of the risks and benefits of treating X.B., rather than to provide

genetic counseling to plaintiff-parents.

Conversely, plaintiffs asserted that the overlap between the time of the

negligent acts and the existence of X.B. and D.B. as fetuses distinguished the factual

background of their action from Ho-Rath III. Regarding the wrongful-conception

claims, plaintiffs highlighted deposition testimony from an expert witness, Robert

W. Mills, M.D., that pediatricians owe a duty to parents in cases such as this.

Additionally, plaintiff-parents argued that the factors set forth in Banks v. Bowen’s

derivative loss of consortium claims against her (counts 8, 13, 18, and 23);
University OB-GYN sought summary judgment for the respondeat superior claims
against it (counts 28, 30, 34, and 36).
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Landing Corp., 522 A.2d 1222 (R.I. 1987), sufficiently demonstrated a duty running

from the pediatric defendants to plaintiff-parents.5

On July 26, 2022, the trial justice issued a bench decision granting the

pediatric defendants’ motion for summary judgment on all counts and granting the

obstetric defendants’ motions for partial summary judgment as to X.B. and D.B.’s

claims of wrongful life against Dr. McGoldrick, D.B.’s claim of wrongful life

against Dr. Siena, X.B. and D.B.’s related claims of respondeat superior against

University OB-GYN, the derivative loss of consortium claims of plaintiff-parents

and Q.B. against Dr. McGoldrick, the derivative loss of consortium claims of

plaintiff-parents and Q.B. against Dr. Siena, and the derivative loss of consortium

claims against University OB-GYN. The trial justice concluded that the pediatric

defendants owed no legally cognizable duty to plaintiff-parents and that the

wrongful-conception claims failed accordingly. Additionally, the trial justice

determined that this Court’s holding in Ho-Rath III controlled the outcome on

5
The factors set forth in Banks v. Bowen’s Landing Corp., 522 A.2d 1222 (R.I.
1987), include the following:

“(1) the foreseeability of harm to the plaintiff, (2) the
degree of certainty that the plaintiff suffered an injury, (3)
the closeness of connection between the defendant’s
conduct and the injury suffered, (4) the policy of
preventing future harm, and (5) the extent of the burden to
the defendant and the consequences to the community for
imposing a duty to exercise care with resulting liability for
breach.” Banks, 522 A.2d at 1225.
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defendants’ motions for summary judgment as to the claims for wrongful life.

Thereafter, the trial justice entered judgment in favor of the pediatric defendants and

partial judgment in favor of the obstetric defendants pursuant to Rule 54(b);

plaintiffs timely appealed to this Court.

On appeal, plaintiffs assign two errors: (1) the trial justice erred in failing to

recognize the duty running from the pediatric defendants to plaintiff-parents,

specifically the duty of informed consent and disclosure; and (2) the trial justice

erred in failing to distinguish this case from the facts in Ho-Rath III and thereby

dismissing the wrongful-life claims brought by X.B. and D.B.

Standard of Review

This Court reviews a trial justice’s decision granting summary judgment de

novo. Tiernan v. Magaziner, 270 A.3d 25, 30 (R.I. 2022). “Although complaints

sounding in negligence generally are not amenable to summary judgment and should

be resolved by fact finding at the trial court, the existence of a duty is a question of

law.” Berard v. HCP, Inc., 64 A.3d 1215, 1218 (R.I. 2013). In the absence of a

showing by the plaintiff that a duty of care exists, the trial justice is left with no

choice but to grant summary judgment. Id. Moreover, the nonmovant’s burden to

prove the existence of a genuine issue of material fact “cannot rest upon mere

allegations or denials in the pleadings, mere conclusions or mere legal opinions.”

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DeCurtis v. Visconti, Boren & Campbell Ltd., 252 A.3d 765, 770 (R.I. 2021)

(quoting Credit Union Central Falls v. Groff, 966 A.2d 1262, 1267 (R.I. 2009)).

Analysis

The plaintiffs’ thirty-six-count amended complaint sounds in negligence. The

counts at issue on appeal are premised on two theories of liability grounded in the

duty of care allegedly owed to plaintiffs by various health care providers. First,

plaintiff-parents contend that the pediatric defendants owed them a duty to timely

diagnose X.B. with cystic fibrosis so that they, the biological parents of X.B., could

make informed decisions about whether to have another child.6 Second, X.B.

contends that Dr. McGoldrick and University OB-GYN, whose medical care of Mrs.

Blouin overlapped with X.B.’s existence as a fetus, owed him a duty to timely

diagnose plaintiff-parents as cystic fibrosis carriers, or the fetus as afflicted with

cystic fibrosis; 7 and D.B. contends that the pediatric defendants, whose medical care

6
Q.B. also asserts derivative claims for damages against the pediatric defendants
pursuant to this theory of liability.
7
We recognize that D.B. also asserts a wrongful-life claim against Dr. McGoldrick.
However, plaintiffs have not adequately argued or supported the basis for this claim
in their brief. Nevertheless, it is clear to us that, given plaintiffs’ concession that
Ho-Rath III may have abrogated D.B.’s claim for wrongful life against Dr. Siena
because D.B. was not yet conceived on February 7, 2011, when Dr. Siena provided
care and treatment to Mrs. Blouin, the same analysis applies to D.B.’s wrongful-life
claim against Dr. McGoldrick, who provided care and treatment to Mrs. Blouin prior
to Mrs. Blouin’s February 7, 2011 appointment with Dr. Siena. Therefore, our
conclusions in this opinion are dispositive as to D.B.’s wrongful-life claim against
Dr. McGoldrick.
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of X.B. overlapped with his existence as a fetus, owed him a duty to timely diagnose

X.B. with cystic fibrosis.

To prevail in a lawsuit based in negligence, a plaintiff must establish four

elements: (1) a legally cognizable duty owed by defendant to plaintiff; (2) breach of

that duty; (3) that the conduct proximately caused the consequent injury; and (4)

actual loss, damage, or injury. Woodruff v. Gitlow, 91 A.3d 805, 811 (R.I. 2014).

“Only when a party properly overcomes the duty hurdle in a negligence action is he

or she entitled to a factual determination on each of the remaining elements * * *.”

Berard, 64 A.3d at 1219 (quoting Holley v. Argonaut Holdings, Inc., 968 A.2d 271,

274 (R.I. 2009)). This Court does not apply a “bright-line rule” when deciding the

existence of legal duty in a particular case. Laprocina v. Lourie, 250 A.3d 1281,

1288 (R.I. 2021). Rather, we have long approached the question ad hoc by

evaluating all relevant factors. Ferreira v. Strack, 636 A.2d 682, 685 (R.I. 1994). In

Banks, we outlined five factors that may be relevant to deciding whether a defendant

owes a duty to a plaintiff:

“(1) the foreseeability of harm to the plaintiff, (2) the
degree of certainty that the plaintiff suffered an injury, (3)
the closeness of connection between the defendant’s
conduct and the injury suffered, (4) the policy of
preventing future harm, and (5) the extent of the burden to
the defendant and the consequences to the community for
imposing a duty to exercise care with resulting liability for
breach.” Banks, 522 A.2d at 1225.

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Relevant factors also include “the relationship of the parties, the scope and burden

of the obligation to be imposed upon the defendant, public policy considerations,

and notions of fairness.” Laprocina, 250 A.3d at 1288-89 (quoting Carlson v. Town

of South Kingstown, 131 A.3d 705, 709 (R.I. 2016)).

Duty of Pediatric Defendants to Plaintiff-Parents

The plaintiff-parents’ first theory of liability is a novel one in Rhode Island.

It implicates the duty that a pediatric care provider owes not to a minor patient, but

to nonpatient biological parents as health care proxies of a minor patient.

Specifically, the first theory of liability presents the following issue for our

consideration: Whether pediatric care providers have a duty to timely diagnose a

minor patient with a genetic disorder so that nonpatient biological parents can make

informed decisions about their own undisclosed reproductive health care. We hold

that pediatric care providers have no such duty.

This Court has generally exercised restraint in using the labels often

associated with birth-related torts. See Ho-Rath III, 275 A.3d at 106 (“We are of the

opinion that characterizing the suit as one for ‘wrongful life’ does not confer upon

it a different legal status or require a different legal analysis from any other

negligence or medical-negligence action.”); Emerson v. Magendantz, 689 A.2d 409,

411, 413 (R.I. 1997) (recognizing a cause of action for the negligent performance of

a sterilization procedure in cases where a patient subsequently conceives and

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delivers a child and determining that public policy “would preclude the granting of

rearing costs for a healthy child whose parents have decided to forego the option of

adoption and have decided to retain the child as their own with all the joys and

benefits that are derived from parenthood”). Cf. Plowman v. Fort Madison

Community Hospital, 896 N.W.2d 393, 398 (Iowa 2017) (“Courts categorize three

distinct types of claims. * * * ‘Wrongful pregnancy’ is a medical negligence action

‘brought by the parents of a healthy, but unplanned, child against a physician who

negligently performed a sterilization or abortion.’ * * * ‘Wrongful birth’ is an action

‘brought by parents of a child born with birth defects.’ * * * ‘Wrongful life’ is a

claim ‘brought by the child suffering from such birth defects.’”) (quoting Nanke v.

Napier, 346 N.W.2d 520, 521 (Iowa 1984)); Mark Strasser, Yes, Virginia, There Can

Be Wrongful Life: On Consistency, Public Policy, and the Birth-Related Torts, 4

Geo. J. Gender & L. 821, 821 (2003) (“The paradigmatic cases of wrongful

conception and wrongful pregnancy involve the negligence of a health care

professional resulting in the birth of a healthy infant. The paradigmatic cases of

wrongful birth and wrongful life involve the negligence of a health care professional

resulting in the birth of a child with severe handicaps. In cases involving wrongful

conception, wrongful pregnancy, and wrongful birth, the parents seek compensation

for themselves, whereas in a wrongful life case, the child through a next friend seeks

compensation for himself or herself.”).

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Our review of relevant caselaw in other jurisdictions reveals that very few

state supreme courts have considered what duty, if any, a pediatric care provider

owes to nonpatient biological parents in the context of birth-related torts. See

Tomlinson v. Metropolitan Pediatrics LLC, 412 P.3d 133, 142-43 (Or. 2018); Molloy

v. Meier, 679 N.W.2d 711, 718-19 (Minn. 2004); Lininger v. Eisenbaum, 764 P.2d

1202, 1206-08 (Colo. 1988); Schroeder v. Perkel, 432 A.2d 834, 839-40 (N.J. 1981);

cf. M.A. v. United States, 951 P.2d 851, 856 (Alaska 1998). Of the cases identified,

only three recognize a duty to timely diagnose a minor patient with a genetic disorder

so that the biological parents can make informed decisions about their own

undisclosed reproductive health care. In Molloy, the Supreme Court of Minnesota

held that the duty of a pediatric care provider regarding genetic testing and diagnosis

extends beyond the minor patient to biological parents who relied on the diagnosis

in their decision to conceive another child. Molloy, 679 N.W.2d at 719. In reaching

this result, the court reasoned, in part, that “courts have drawn upon the prevailing

standard of care to define the duties physicians owe in the context of genetic

counseling.” Id. at 718.

In Tomlinson, the Supreme Court of Oregon held that the professional

relationship between pediatric care providers and a minor patient’s biological

parents gave rise to an obligation to protect the interests of the biological parents.

Tomlinson, 412 P.3d at 143. In reaching that conclusion, the court considered three

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aspects of the nature of the professional relationship: (1) the mutual expectation of

service and reliance between the parties; (2) the lack of any interference in or

impairment of the loyalty owed to the minor patient; and (3) the identifiability of the

biological parents as potential plaintiffs. Id. at 142-43. The court also deemed

persuasive the Molloy reasoning regarding the standard of care. Id. at 144.

Finally, in Schroeder the Supreme Court of New Jersey recognized an

independent duty running from pediatric care providers to the nonpatient biological

parents of a minor patient who should have been informed that their child had cystic

fibrosis after considering the foreseeability of harm, to the nonpatient biological

parents, of failing to disclose material information. Schroeder, 432 A.2d at 839-40.

The plaintiffs cite to these three cases in arguing that the foreseeability-of-

harm factor under Banks supports a duty of care in this case. The plaintiffs assert

that the harms they suffer—lost wages; loss of both earning capacity and consortium;

and extraordinary medical expenses associated with caring for two children born

with cystic fibrosis—were a foreseeable consequence of the pediatric defendants’

failure to timely diagnose X.B. and disclose the cystic fibrosis diagnosis to plaintiffs.

Once X.B. received a diagnosis of cystic fibrosis, they argue, it was foreseeable that

any future child of theirs had a twenty-five percent chance of being born with the

same disorder. The plaintiffs quote the following excerpt from Schroeder in support

of their foreseeability-of-harm argument:

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“The defendants should have foreseen that parents of
childbearing years, such as Mr. and Mrs. Schroeder,
would, in the absence of knowledge that Ann suffered
from cystic fibrosis, conceive another child. They should
have foreseen also that a second child could suffer from
cystic fibrosis and that, if so afflicted, would sustain
certain medical expenses.” Schroeder, 432 A.2d at 839-
40.

We are unpersuaded by the reasoning of the Schroeder court. The pediatric

defendants certainly owed a duty of care to X.B., their minor patient; and they were

under an obligation to communicate with plaintiff-parents as health care proxies for

X.B. That obligation existed so that plaintiff-parents could make informed decisions

about X.B. and for the benefit of X.B.’s care: pediatric care providers disclose timely

and accurate information to the parents of their minor patients so that the parents can

be good parents to their patient-children. However, there is no allegation that the

delayed cystic fibrosis diagnosis caused any greater harm to X.B. than if he had been

diagnosed sooner. 8 Moreover, although plaintiff-parents were in their childbearing

years, there is no evidence that they discussed their reproductive health with the

pediatric defendants. Thus, notwithstanding that “biological parents * * * who are

already in communication with a physician about their child’s medical condition,

reasonably may expect to receive warnings about potential risks to them that are

germane to the physician’s medical diagnosis of the child[,]” Tomlinson, 412 P.3d

8
Counsel for plaintiffs conceded at oral argument that the delay in diagnosis did not
cause harm to X.B.
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at 143, we are loath to extend that expectation into an obligation and particularly not

for the purpose of involving a pediatric care provider in the undisclosed reproductive

health care of a minor patient’s biological parents, even if the parents are of

childbearing years.

We are also unpersuaded by plaintiff-parents’ reference to expert testimony

by Dr. Mills that the standard of care includes timely diagnosis of a genetic condition

and disclosure to a minor patient’s biological parents for purposes of informed

reproductive decision-making. Even accepting that testimony in the light most

favorable to plaintiffs, as we must, “the existence of a duty is a question of law.”

Berard, 64 A.3d at 1218. Therefore, Dr. Mills’s opinion about the standard of care

has no legal significance for purposes of determining whether there is a legally

cognizable duty; Molloy does not persuade us otherwise. See Molloy, 679 N.W.2d at

718 (reasoning that prevailing standard of care may inform duty of care as it relates

to genetic counseling).

We acknowledge that plaintiff-parents have incurred, and will continue to

incur, significant economic, emotional, and psychological costs in the aftermath of

X.B. and D.B.’s cystic fibrosis diagnoses. Nevertheless, we cannot conclude that

the relevant Banks factors, or the additional factors identified in Laprocina, support

the imposition of a duty on the part of the pediatric defendants to have timely

diagnosed X.B. with cystic fibrosis so that plaintiff-parents could have made an

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informed decision about their own reproductive healthcare. The nexus between the

failure to timely diagnose X.B. with cystic fibrosis and the harm to plaintiff-parents

is attenuated; the pediatric defendants’ inaction simply was not sufficiently likely to

have resulted in plaintiff-parents’ extraordinary economic, emotional, and

psychological injuries. Banks, 522 A.2d at 1225, 1226-27. Moreover, the burden of

such a duty would significantly outweigh whatever degree of foreseeability the

pediatric defendants might have had regarding plaintiff-parents’ decision to

conceive and bear another child. Laprocina, 250 A.3d at 1289. It would

unreasonably expand the pediatric defendants’ zone of obligation to nonpatient

biological parents of childbearing age and alter the pediatric defendants’ medical

practice to include genetic screening and counseling. Id. The complex policy

implications of such burden-shifting are immense; decisions about who most

appropriately bears those costs are best left to the Legislature.

Accordingly, we conclude that the trial justice did not err in determining that

the pediatric defendants owed no legally cognizable duty to plaintiff-parents and that

their wrongful-conception claims, as well all related derivative claims, including

Q.B.’s, fail as a result.

Duty of Obstetric Defendants to X.B. and Pediatric Defendants to D.B.

Under the second theory of liability at issue in this appeal, X.B. and D.B.

assert that the trial justice erred in determining that Ho-Rath III abrogated their

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individual claims because, they argue, unlike the plaintiff in Ho-Rath III, the harm

to X.B. caused by Dr. McGoldrick and University OB-GYN’s failure to diagnose

him as being afflicted or his parents as carriers of cystic fibrosis was foreseeable

once X.B.’s conception was known, and it was equally foreseeable to the pediatric

defendants that the failure to diagnose an elder sibling with cystic fibrosis would

result in harm to D.B. We disagree.

In Ho-Rath III, this Court rejected the contention that, in the context of a child-

plaintiff’s claim, life, even a life with severe impairments or illnesses, constitutes a

legally recognized injury. Ho-Rath III, 275 A.3d at 108. We determined that, absent

an injury, there was “no future harm to be prevented by the imposition of a duty

upon [the] defendants.” Id.

The claims brought by X.B. and D.B. are no different from the claim brought

by the plaintiff in Ho-Rath III. The temporal difference that the plaintiffs

highlight—the amount of time that elapsed between the alleged inaction on the part

of the defendants and when the existence of X.B. and D.B. as fetuses was known—

does not alter our determination that Ho-Rath III controls the outcome in the instant

case.9 Ho-Rath III, 275 A.3d at 108.

9
Moreover, we are unpersuaded by the plaintiffs’ attempt to invoke the law of the
case doctrine in an effort to avoid our application of the rule announced in Ho-Rath
III to their pending appeal.
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Conclusion

Based on the foregoing, we affirm the trial justice’s decision granting the

pediatric defendants’ motion for summary judgment on the wrongful-conception

claims and all of the defendants’ motions for summary judgment on the wrongful-

life claims. We affirm both judgments entered pursuant to Rule 54(b) and remand

the record in this case.

Justice Goldberg did not participate.

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STATE OF RHODE ISLAND
SUPREME COURT – CLERK’S OFFICE
Licht Judicial Complex
250 Benefit Street
Providence, RI 02903

OPINION COVER SHEET

Title of Case Heather Blouin et al. v. Divya Koster, M.D., et al.

No. 2022-282-Appeal.
Case Number
(PC 15-3817)

Date Opinion Filed August 20, 2024

Justices Suttell, C.J., Robinson, Lynch Prata, and Long, JJ.

Written By Associate Justice Melissa A. Long

Source of Appeal Providence County Superior Court

Judicial Officer from Lower Court Associate Justice Netti C. Vogel

For Plaintiffs:

Ingrid Alexandra Halstrom, Esq.
For Defendants:
Attorney(s) on Appeal
Robert P. Landau, Esq.
Cassandra Allnutt DeAngelis, Esq.
Joshua Carlin, Esq.

SU-CMS-02A (revised November 2022)