A doctor can be sued for allegedly causing a patient emotional distress even if there is a lack of evidence for physical negligence, the Supreme Court of Pennsylvania has ruled on Monday.

The court case involved a mother who accused her doctor for failing to prepare her for the shock of her newborn’s deformities, and experts say that the ruling creates a claim for noneconomic damages and opens the door for more lawsuits against physicians.

In June 2005 Jeanelle Toney filed a lawsuit claiming negligent and intentional infliction of emotional distress against Dr. Maheep Goyal and the Chester County Hospital.

Goyal, who had performed a pelvic ultrasound exam on Toney, said that Toney’s results were normal and did not reveal any fetal abnormalities in her unborn child and that the baby was normal and healthy.

However when Toney gave birth to her son he had numerous deformities: had had no arms below the elbows and no legs below the knee joints, suffered from an accessory tongue, had delayed growth of the jaw, had a ventral curvature of the penis and an umbilical hernia.

Goyal said that she was in shock when she saw her son’s abnormalities, and after delivery she suffered from grief, rage, nausea, hysteria, nervousness, sleeplessness, nightmares and anxiety, and continued to have emotional and mental distress.

"In light of the pleadings, it cannot be rationally argued that the defendants did not owe a duty of care directly to Toney. It is also entirely foreseeable that under the circumstances as alleged, Toney would suffer traumatic emotional distress during the birth of her son," the superior court wrote.

"As such, we find the elements of negligence and foreseeability to have been adequately pled," the court concluded. 

Dr. Goyal's attorney, Charles Fitzpatrick III, said told American Medical News that he can “guarantee” that there will be a rise in emotional distress suits. 

"The impact is: Not only are doctors going to get sued [by patients], but family members who are surprised by a loved one's condition are going to sue. It's expanding who can sue over these things," Fitzpatrick said. 

The Supreme Court of Pennsylvania cited several similar cases from other states like New Jersey, New York, Texas and Wyoming in making its decision, and courts in other states will probably use the Toney case to support their decisions in future cases, Anna Laakmann, a law professor at Penn State Dickinson School of Law in Pennsylvania told AMN.

"Courts will be influenced by other courts and other jurisdictions even if they are not obligated," Laakmann said. "This case is no different. Judges note not just the trends [in their state], but trends in other states."

However Toney’s attorney, Stephen Raynes, said that liability should be imposed even without physical contact because significant consequences to patients come directly from the quality and accuracy of what they are told by healthcare providers.

"The opinion upholding the judgment recognizes that although not every fiduciary relationship will give rise to a claim for damages, where the specific professional responsibility of an attending physician is to convey accurate information, then failure to do so can give rise to liability if the physician's breach results in unusual and extreme emotional distress on the part of the plaintiff," Raynes said in an email, according to AMN.

Laakmann said the Toney ruling raises awareness on how the doctor-patient relationship can be defined. 

"It says to doctors that courts have shown a willingness -- in this case and in others -- to describe the doctor-patient relationship as a fiduciary one," Laakmann said. "And with this comes certain legal obligations to care for the well-being of the patient. That [relationship] can, under certain circumstances, subject them to liability."

Generally states allow only two ways for individuals to sue for emotional distress without a physical impact, Laakmann said.

The first requires plaintiffs to prove that they were in the “danger zone” of a defendant acting negligently, like if a negligent driver almost hits a pedestrian with a vehicle, the pedestrian is permitted to make a claim for emotional distress despite no physical injury.

The second is if an individual sees a negligent act on a family member, like a doctor negligently operating on a relative.

Laakmann said the Pennsylvania case allowed a third exception to case law on emotional distress claims, and relaxes the boundaries between emotional distress and physical impact.

Experts say that the Pennsylvania ruling is part of a nationwide trend.

In 2006 the Court of Appeals of Texas said that the parents of a stillborn baby was permitted to sue Harris County Medical Examiner’s Office for mental distress  after the office lost the baby’s body during an autopsy, despite having no physical injury. 

Previously, a New York appeals court had also ruled that a couple was allowed to sue a fertility clinic for emotional distress after the clinic implanted the female plaintiff’s embryo in another woman, and although neither of the plaintiffs suffered physical injuries, the appeals court ruled that the couple had suffered substantial emotional injury due to the defendants’ breach of their duty of care.