On June 30, 2016, the decedent, at 12 weeks’ gestation, presented to Planned Parenthood for an elective abortion, which Dr. Laura Castleman performed. During that same visit, the decedent also underwent an IUD placement. Although the decedent experienced pain with the procedure, Planned Parenthood records indicate that the procedure was “completed without complication,” and the decedent “was discharged in good condition” after tolerating snacks and fluids and reduction in post-procedure pain. Experts later opined that the decedent suffered a uterine perforation during her procedure at Planned Parenthood.
On the evening of July 2, 2016, the decedent arrived at Bronson Hospital “complaining of constant and severe lower abdominal pain since the abortion procedure 2 days prior, and nausea and vomiting.” Dr. Woelzlein was the emergency medicine physician who treated the decedent. Dr. Woelzlein: (1) administered intravenous (IV) fluids, anti-nausea medication, and pain medication; (2) performed a pelvic examination, which revealed “a ‘scant amount of vaginal blood in vaginal vault. No clots’ ”; and (3) ordered lab work and an ultrasound, “with transvaginal if necessary.” A transabdominal ultrasound was performed, which Dr. Cento interpreted, concluding that there was “[a]bnormal thickening and heterogeneity of the endometrial cavity due to the presence of clot and/or retained products of conception.” A transvaginal ultrasound was not performed. Dr. Woelzlein ultimately diagnosed the decedent with an “incomplete miscarriage and pelvic pain.” At approximately 12:35 a.m. on July 3, 2016, Dr. Woelzlein discharged the decedent from the hospital with: (1) prescriptions for pain (Norco) and anti-nausea (Zofran) medications, and (2) instructions to follow up with her primary care physician or Planned Parenthood in three days, “after the holiday weekend.” The decedent was “stable,” no longer actively vomiting, and agreeable to the entire treatment plan when she was discharged; however, she communicated that her pain level measured a 7 out of 10 at that time.
At approximately 12:30 a.m. on July 4, 2016, the decedent’s mother found her unconscious and unresponsive in her mother’s bedroom. Dr. Elizabeth Douglas, a deputy medical examiner, performed the decedent’s autopsy, determining that the decedent’s manner of death was an accident, and her cause of death was “[c]omplications of intrauterine pregnancy including pulmonary emboli related to uterine vein thrombosis and uterine perforation status post early vacuum aspiration and intrauterine contraception placement.” Multiple expert witnesses provided deposition testimony regarding the decedent’s cause of death.
In 2021, plaintiff filed a complaint against defendants, jointly and severally, alleging that the decedent died as a result of defendants’ failure to follow the applicable standard of care during her treatment. Thereafter, each defendant moved for summary disposition, arguing that plaintiff could not prove causation. Plaintiff’s general theory was that compliance with the applicable standards of care would have led to timely recognition and treatment of the uterine perforation and its thrombotic complications, more probably than not preventing the decedent’s pulmonary embolism and death. Conversely, defendants generally contended that: (1) even if the decedent’s uterine vein thrombosis had developed by the time that she was in the hospital, a transvaginal ultrasound may not have detected it; (2) plaintiff had not offered any evidence to establish that the alleged standards of care would have resulted in detection of the decedent’s lower extremity deep vein thrombosis; and (3) plaintiff failed to establish that defendants’ compliance with the alleged standards of care would have altered the ultimate outcome, i.e., the decedent’s death by pulmonary embolism.
The circuit court granted summary disposition in favor of each defendant. The circuit court reasoned that no expert could definitively identify the source of the decedent’s pulmonary emboli that caused her death: the decedent’s uterine veins or lower extremities. The circuit court explained that even if the decedent’s uterine vein thrombosis had developed by the time that she was in the hospital, and a transvaginal ultrasound had been ordered, expert testimony established that her uterine vein thrombosis may not have been detected. Moreover, the trial court found that plaintiff failed to present any testimony stating that application of plaintiff’s proposed standard of care could have identified the decedent’s lower extremity deep vein thrombosis. Plaintiff appealed.
The State of Michigan Court of Appeals stated in its unpublished August 4, 2026 Opinion: “We conclude that there were genuine issues of material fact on the question of causation and that the trial court erred in granting defendants-appellees summary disposition on this ground. The trial court’s determination rests on the conclusion that causation cannot be established because the precise origin of the fatal emboli cannot be known. But plaintiff was not required to identify a particular clot and then trace that clot’s progression through the decedent’s body. Instead, plaintiff only needed to establish “a reasonable likelihood of probability” and “a fair amount of certainty.” Id. (quotation marks and citation omitted). Viewed in the light most favorable to plaintiff, the expert testimony permitted a reasonable jury to find that timely recognition of the uterine perforation and resulting treatment more probably than not would have prevented the fatal pulmonary embolism, regardless of the precise origin of the thrombi. Accordingly, the record raises a triable issue.
We reverse the trial court’s orders granting summary disposition in favor of defendants-appellees, and we remand for further proceedings consistent with this opinion.”
Source Estate of Cree Erwin-Sheppard v. Southwestern Michigan Emergency Services, PC, COA 37362.
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