Ketchup v. Howard
Ketchup v. Howard
Opinion of the Court
The common law doctrine of informed consent provides that physicians and dentists have a duty to inform patients of the known material risks of a proposed treatment or procedure and to inform patients of available treatment alternatives. All of the states except Georgia now recognize the informed consent doctrine.
Dr. A. J. Howard examined Joseph Ketchup and told him that he needed a root canal on one of his molars. The procedure was scheduled for a later date. Ketchup returned to Dr. Howard’s office on that date for the root canal procedure. Dr. Howard, without ever informing Ketchup of any risks involved with the procedure or of any alternative treatments, then performed the root canal.
Since his root canal, Ketchup has experienced continuous numbness of his lower lip, chin, and gum on the side where the root canal was performed. An endodontist and a neurologist have examined Ketchup and have concluded that the numbness is the result of dental neuropathy, caused by damage to a nerve during the root canal
Ketchup sued Dr. Howard for dental malpractice, alleging that Dr. Howard (1) negligently injected anesthetic agents while performing the root canal; (2) used improper materials to perform the root canal; and (3) failed to inform Ketchup of the risk of nerve damage resulting from the root canal. Dr. Howard moved for summary judgment, and the trial court granted his motion.
Ketchup appeals, contending the trial court erred in granting summary judgment on that portion of his claim based upon Dr. Howard’s failure to inform him of the risks of the procedure. While we conclude that Young v. Yarn wrongly declared that there is no duty to inform patients of the known material risks of a proposed course of treatment and must be overruled, we farther hold that Georgia’s recognition of the informed consent doctrine must apply prospectively. We therefore are constrained to affirm the trial court’s summary judgment ruling based on the law as it existed at the time of that ruling.
1. The court in Young v. Yarn construed only that part of the Georgia Medical Consent Law, Code § 88-2906, now OCGA § 31-9-6, which provides:
A consent to surgical or medical treatment which discloses in general terms the treatment or course of treatment in connection with which it is given and which is duly evidenced in writing and signed by the patient or other person or persons authorized to consent pursuant to the terms of this chapter shall be conclusively presumed to be a valid consent in the absence of fraudulent misrepresentations of material facts in obtaining the same.
In construing this language, the Young court found that a physician’s duty to inform the patient of the proposed treatment in general terms does not include a duty to disclose the risks of treatment. Thus, the court held, a patient cannot sustain an action based on a doctor’s failure to warn of the risks of treatment.
(a) In order to understand precisely how this court misapplied the rules of statutory construction, it is important to remember that “consent” in the medical sense involves two distinct legal principles, both derived from common law doctrine. The first principle involves
The second principle of consent in the medical context is “informed” consent, which addresses the autonomy of a competent patient to determine what medical treatment he will allow or refuse. As Justice Rehnquist noted in Cruzan v. Director, Mo. Dept. of Health,
Roscoe Pound eloquently described the judge’s task in interpreting a statute when he pointed out that the object of interpretation is to discover the rule which the lawmaker intended to establish or the intent with which the lawmaker made the rule. That is to say, to discover the sense which the lawmaker attached to the words so that others could derive from the words the same meaning the lawmaker intended to convey.
By looking to the plain language of that portion of the 1971 Georgia Medical Consent Law which the Young v. Yarn decision addressed,
The concept of informed consent is not mentioned or addressed by the statute. Certainly the statute does not state expressly or even imply that informed consent is not recognized in Georgia. In the absence of plain language to that effect, the court in Young v. Yarn went beyond the legislative intent in concluding that an action based on lack of informed consent will not lie in Georgia.
Furthermore, on the question of whether this court correctly interpreted the statute, we find the analysis of the Young v. Yarn opinion in a Mercer Law Review article
Moreover, a 1985 bar journal article
Furthermore, this court has held that this statute is indeed in derogation of the common law.
(b) Even if the legislature had intended to abolish the doctrine of informed consent by enacting OCGA § 31-9-6, it seems likely that the statute would have been declared unconstitutional had its impact on the constitutionally protected liberty interests discussed below been considered. Perhaps because Zant v. Prevatte,
In two of these cases, decided after Young v. Yarn, the Supreme Court of Georgia held that all persons have a liberty interest, protected by the Georgia Constitution, to make all decisions regarding their medical care, so long as they are legally competent.
In Cruzan, the United States Supreme Court held that the Due Process Clause of the Fourteenth Amendment to the federal constitution protects that identical liberty interest.
As the Supreme Court noted in. Cruzan, the common law doctrine of informed consent is a corollary to this constitutionally pro
It has been credibly argued that this court’s decision in Young v. Yarn effectively and inappropriately placed the real right to make treatment decisions completely with the patient’s physician. A physician with that right could, for example, induce or encourage a patient to undergo a risky yet unnecessary surgery without making known either the attendant risks or available alternatives. This would leave the uninformed patient without a remedy, even if the procedure resulted in death or disfigurement, unless the physician negligently performed the surgery.
2. Courts define and apply the legal duties professionals have to their patients and clients, but do not attempt to define standards of care. The recognized legal duty a medical professional owes to his or her patient is to exercise that degree of skill and care ordinarily employed by members of the same medical profession under the same or substantially similar circumstances.
As interpreted by this court in Young v. Yarn and its progeny, OCGA § 31-9-6 effectively substitutes the judgment of this court for that of the medical profession as to the standard of care on the issue of informed consent. To understand this, one needs only look at the
The first AMA Code of Medical Ethics was written in 1847. Section 1 of the 1998-1999 edition, entitled Fundamental Elements of the Patient-Physician Relationship, provides “[t]he patient has the right to receive information from physicians and to discuss the benefits, risks, and costs of appropriate treatment alternatives.”
The 1992 Code of Medical Ethics, as prepared by the Council on Ethical and Judicial Affairs of the American Medical Association, sets forth the medical profession’s standard on informed consent. It reads as follows: “The patient’s right of self-decision can be effectively exercised only if the patient possesses enough information to enable an intelligent choice. The patient should make his own determination on treatment. The physician’s obligation is to present the medical facts accurately to the patient or to the individual responsible for his care and to make recommendations for management in accordance with good medical practice. The physician has an ethical obligation to help the patient make choices from among the therapeutic alternatives consistent with good medical practice. Informed consent is a basic social policy for which exceptions are permitted (1) where the patient is unconscious or otherwise incapable of consenting and harm from failure to treat is imminent; or (2) when risk-disclosure poses such a serious psychological threat of detriment to the patient as to be medically contraindicated. Social policy does not accept the paternalistic view that the physician may remain silent because divulgence might prompt the patient to forego needed therapy.*61 Rational, informed patients should not be expected to act uniformly, even under similar circumstances, in agreeing to or refusing treatment.”31
Similar language in the ADA Code of Ethics also reflects the standard of care for the dental profession. Part III, Section 1 of the American Dental Association Code of Ethics, entitled Principle: Patient Autonomy, provides “[t]he dentist has a duty to respect the patient’s rights to self-determination and confidentiality,” and Section 1A provides “[t]he dentist should inform the patient of the proposed treatment, and any reasonable alternatives, in a manner that allows the patient to become involved in treatment decisions.”
These AMA and ADA ethical standards embrace the doctrine of informed consent, as does the law in all 49 of Georgia’s sister states. Yet in decisions such as Hyles v. Cockrill
3. Subsequent to the Young v. Yarn decision, the legislature enacted OCGA § 31-9-6.1, which requires medical professionals to provide information to their patients concerning the risks of some, but not all, medical procedures. That Code section is limited to surgical procedures performed under general anesthesia, spinal anesthesia, or major regional anesthesia, diagnostic amniocentesis, and diagnostic procedures which involve intravenous or intraductal injection of contrast material. Because the legislature is presumed to act with full knowledge of the existing state of the law, the enactment of OCGA § 31-9-6.1, a limited form of informed consent, can be seen as expanding the applicability of the doctrine of informed consent in Georgia from its status immediately following the Young v. Yarn decision. Because we have concluded that the Young v. Yarn case was wrongly decided, OCGA § 31-9-6.1 cannot be said to have any limit
In fact, OCGA § 31-9-6.1 is helpful in determining the standard by which to measure the duty on the part of a physician or dentist to inform his or her patient of risks inherent in proposed medical treatment. There are two major standards being applied in Georgia’s sister states. One is the professional medical standard, sometimes referred to as the traditional standard. The other is the lay standard, sometimes referred to as either the materiality of risk or prudent patient standard.
Under the professional standard, the physician is required to disclose those risks which a reasonable and prudent medical practitioner would disclose under the same or similar circumstances. In most cases, the questions of whether and to what extent a physician or dentist has a duty to disclose a particular risk must be determined through expert testimony which establishes the standard of care on the issue and the physician’s or dentist’s departure from that standard.
In contrast, under the lay standard the physician’s disclosure duty is to be measured by the patient’s need for information rather than by the standards of the medical profession. While expert testimony would be required to establish that the risk which allegedly caused the injury is one which is known or should be known, the lay standard would not ordinarily require expert testimony regarding medical standards to establish the physician’s duty to disclose; rather, it is for the jury to determine whether a reasonable person in the patient’s position would have considered the risk significant in making the decision to have or reject the proposed treatment.
As the South Carolina Court of Appeals pointed out in Hook v. Rothstein,
Though OCGA § 31-9-6.1 is a limited codification of the common law doctrine of informed consent as previously discussed, it expresses
4. Courts rightly have a preference for following precedent and adhering to the doctrine of stare decisis, but obviously must be willing to overrule prior decisions when necessary. As Chief Justice Ben-ham noted in his dissent in Etkind v. Suarez,
[t]he rule of stare decisis is a wholesome one, but should not be used to sanctify and perpetuate error. We deprecate and distrust rash innovation as much as the most conservative magistrates ought, but it has never been the doctrine of any court of last resort that the law is to be a refuge and safe asylum for all the errors that creep into it. Courts, like individuals, but with more caution and deliberation, must sometimes reconsider what has been already carefully considered, and rectify their own mistakes.41
The overruling of previous decisions raises many theoretical issues, one of which is the application of the new rule to other cases. Having decided to overrule the Young v. Yarn decision and its progeny, we must now decide the breadth of application of the new decision. There are four possibilities: full retroactive application; partial retroactive application; partial prospective application; and pure prospective application. The choice of which to employ turns upon whether the defendant, and those in the same position, justifiably
The overruling of the precedent may bring about a much needed change in the law, but the attendant retroactive feature produces evils which often, in immediate effect, outweigh the advantages attained. Uncertainty in the law results [from full retroactive application].42
Prospective application provides a solution to these problems.
Consequently, the prospective application of this ruling will not affect the instant case. Even though it is undisputed that Dr. Howard did not inform Ketchup of the risk of dental neuropathy prior to performing the root canal procedure, because Georgia law did not then recognize any such duty upon dentists to warn patients of such risks or of available alternatives,
5. Contrary to the position taken by the special concurrence, the Supreme Court of Georgia has never held that the principle announced in Young v. Yarn was correct.
In Robinson v. Parrish,
In Albany Urology Clinic v. Cleveland,
6. Finally, in his brief, Ketchup argues that Dr. Howard failed to inform him of the general nature of the root canal procedure and, therefore, violated OCGA § 31-9-6, which sets out the requirements for establishing valid consent to a procedure. However, Ketchup’s complaint does not allege that Dr. Howard failed to inform him of the general nature of a root canal procedure or that Dr. Howard did not have Ketchup’s consent to perform the root canal procedure.
Rather, Ketchup sued Dr. Howard for dental malpractice, claiming that Dr. Howard breached the standard of care in performing the root canal and in failing to advise him of potential complications of the root canal. Insofar as the brief and enumeration of error attempt to broaden the allegations in Ketchup’s complaint to include an allegation that Dr. Howard failed to inform Ketchup of the general nature of the root canal procedure and therefore did not have Ketchup’s consent to perform the root canal procedure, the attempt is impermissible.
Judgment affirmed.
Appendix.
1. Alabama: A physician must inform his patient of all material risks associated with a medical procedure. Otwell v. Bryant, 497 S2d 111, 117-118 (Ala. 1986); Fain v. Smith, 479 S2d 1150, 1152 (Ala. 1985). Expert testimony is required to establish whether the physician disclosed all risks which a medical doctor practicing in the same general line of practice in the nation would have disclosed. Ala. Code § 6-5-484; Wells v. Storey, 1999 Ala. LEXIS 361, Civil Action No. CV-96-391 (November 24, 1999); Hawkins v. Carroll, 676 S2d 338 (Ala. App. 1996); Baker v. Chastain, 389 S2d 932, 935 (Ala. 1980). The standard used is whether a reasonable person in the patient’s position would have decided to undergo the procedure if adequately informed of all significant perils. Otwell, supra; Fain, supra at 1154-1155.
2. Alaska'. Alaska Stat. § 09.55.556 (a) provides:
A health care provider is liable for failure to obtain informed consent of a patient if the claimant establishes by a preponderance of the evidence that the provider has failed to inform the patient of the common risks and reasonable alternatives to the proposed treatment or procedure.
A physician must disclose the risks and benefits which a reasonable patient would need to know in order to make an intelligent and
3. Arizona: Whether a physician is under a duty to warn a patient of the possibility of a specific adverse result of a proposed treatment depends upon the circumstances of the particular case and the general practices of the physician’s profession in the state of Arizona, and the custom of the medical profession to warn must be established by expert medical testimony. Potter v. Wisner, 170 Ariz. 331 (823 P2d 1339) (App. 1991); Riedisser v. Nelson, 111 Ariz. 542 (534 P2d 1052, 1054-1055) (1975); see also ARS § 12-563. The patient must show that he would not have gone through with the procedure if the risk were known. Hales v. Pittman, 118 Ariz. 305 (576 P2d 493, 499-500) (1978); Riedisser, supra at 1055.
4. Arkansas: Ark. Stat. § 16-114-206 (b) (1) (1987) states that information regarding risks and alternatives must be given except in emergencies. The statute applies to both physicians and dentists. The standard used to measure nondisclosure is whether a reasonable person in the patient’s position would have withheld consent to the treatment or procedure had the material risks been disclosed. Aronson v. Harriman, 321 Ark. 359 (901 SW2d 832, 840) (1995).
5. California: A physician must disclose available choices with respect to proposed therapy and the dangers inherently and potentially involved in each. Cobbs v. Grant, 8 Cal.3d 229 (502 P2d 1, 10) (1972). The test for determining whether a potential peril must be divulged is its materiality to the patient’s decision, not the custom of physicians practicing in the community. Arato v. Avedon, 5 Cal.4th 1172 (858 P2d 598) (1992); Cobbs, supra at 10-11. Material information is that which the physician knows or should know would be regarded as significant by a reasonable person in the patient’s position when deciding whether to accept or reject the recommended procedure. Arato, supra; Truman v. Thomas, 27 Cal.3d 285 (611 P2d 902, 905) (1980). In determining causation, the jury must decide what a prudent person in the patient’s position would have decided if adequately informed of all significant perils. Cobbs, supra at 11-12.
6. Colorado: Colorado requires that substantial risks of a particular procedure or treatment must be disclosed to the patient. A substantial risk is one that would be medically significant to the patient’s decision and is known, or ought to be known, by the physician. The substantiality of a particular risk must be determined on the basis of expert testimony demonstrating the extent of information given by reasonably careful physicians practicing the same specialty in the same or similar community. Gorab v. Zook, 943 P2d 423, 427 (Colo. 1997); Mallett v. Pirkey, 466 P2d 466, 472-473 (Colo. 1970).
7. Connecticut: A physician must disclose, in language a lay person can understand, information that he has or should have concerning
8. Delaware: While 18 Del. Code § 6852 contains a provision dealing specifically with the subject of informed consent by health care providers, this chapter excludes dentists. However, informed consent claims in Delaware involving a dentist are governed by common law. Molnar v. Rafetto, 1990 Del. Super. LEXIS 394, Civil Action No. 87C-AP-109 (October 31, 1990). A physician must disclose specific known risks, subject to the exception of the existence of any emergency and further subject to the exception that there is no duty to disclose when disclosure would be likely to bring about harmful results. The duty to disclose depends on the factual circumstances and the general practice followed by the medical profession in the locality; the custom of the medical profession to warn must be established by expert medical testimony. Coleman v. Garrison, 327 A2d 757 (Del. 1974), overruled in part, Garrison v. Med. Center of Del., 571 A2d 786 (Del. 1989).
9. Florida: Fla. Statute § 766.103 (3) (a) (2) notes that reasonable care on the part of a physician in obtaining the informed consent for treatment consists of providing the patient information sufficient to give a reasonable person a general understanding of the proposed procedure, the medically acceptable alternative procedures, and the substantial risks and hazards inherent in the proposed procedure which are recognized by other physicians in the same or similar community who perform similar procedures. A physician is not under a duty to elucidate upon all the possible risks, but only those of a serious nature. See also Fla. Statute § 381.026. Expert testimony is required to establish whether a reasonable physician in the community would make the pertinent disclosures under the same or similar circumstances. Ritz v. Fla. Patient’s Compensation Fund, 436 S2d 987, 990-991 (Fla. App. 1983); Thomas v. Berrios, 348 S2d 905, 907 (Fla. App. 1977).
10. Hawaii: HRS § 671-3 creates a statutory medical tort for the rendering of professional services without informed consent. However, this statute does not apply to dentists. Therefore, a breach of
11. Idaho: The issue of informed consent is governed by Idaho Code § 39-4304: Consent shall be valid if the person giving it is sufficiently aware of pertinent facts respecting the need for, the nature of, and the significant risks ordinarily attendant upon such a patient receiving care, as to permit the giving or withholding of such consent to be a reasonably informed decision. Disclosure must be made which would ordinarily be made and given under the same or similar circumstances by a like physician of good standing practicing in the same community. The patient must show that a reasonable person would not have consented to the proposed procedure had a full and adequate disclosure been made at the time consent was originally given. Sherwood v. Carter, 119 Idaho 246 (805 P2d 452, 457-461, 465) (1991).
12. Illinois: A physician has a duty to inform patients of the foreseeable risks and results of a given procedure and the reasonable alternatives to that procedure that a reasonable physician in the same or similar circumstances would have disclosed. Weekly v. Solomon, 156 Ill. App.3d 1011 (510 NE2d 152, 156) (1987). Expert testimony is required to establish the reasonableness standard; this may be done by showing the standard in the physician’s community, a similar community, or a national or international standard. See id. at 155-156; Sheahan v. Dexter, 136 Ill. App.3d 241 (483 NE2d 402, 407) (1985); Guebard v. Jabaay, 117 Ill. App.3d 1 (452 NE2d 751, 757) (1983). Causation is determined by looking at what a prudent person in the patient’s position would have decided if adequately informed of all significant perils. Lowney v. Arciom, 232 Ill. App.3d 715 (597 NE2d 817, 819) (1992); Guebard, supra at 757-758.
13. Indiana: A physician must disclose material risks associated with a medical procedure. Expert testimony is necessary to establish whether a physician has complied with the standard of a reasonably
14. Iowa: A physician recommending a particular procedure generally has the duty to disclose to the patient all material risks involved with the procedure. The physician’s duty to disclose is measured by the patient’s need to have access to all information material to making a truly informed decision regarding the proposed medical procedure. The plaintiff must show that disclosure of the risk would have led a reasonable patient in the plaintiff’s position to reject the medical procedure or choose a different course of treatment. Pauscher v. Iowa Methodist Med. Center, 408 NW2d 355, 358-360 (Iowa 1987).
15. Kansas: In the absence of an emergency, a physician has a duty to disclose the risks and dangers incident to a proposed medical procedure which a reasonable medical practitioner would make under the same or similar circumstances. Causation is determined by looking at what a prudent person in the patient’s position would have decided if suitably informed of all perils bearing significance. Funke v. Fieldman, 212 Kan. 524 (512 P2d 539) (1973).
16. Kentucky: A physician is required to disclose risks which he knows or should have known at the time he recommended the treatment to the patient. Holton v. Pfingst, 534 SW2d 786 (Ky. App. 1975).
17. Louisiana: Physician must disclose any material consequences which would influence the treatment decision of a reasonable person. Hondroulis v. Schumacher, 553 S2d 398, 403-404 (La. 1997).
18. Maine: The duty to inform is measured by reference to the reasonable medical practitioner in the same field. Downer v. Veilleux, 322 A2d 82, 89-91 (Me. 1974); Woolley v. Henderson, 418 A2d 1123, 1128 (Me. 1980).
19. Maryland: The proper test for measuring the physician’s duty is whether such information would be material to the reasonable patient’s decision. Sard v. Hardy, 281 Md. 432 (379 A2d 1014, 1020) (1977).
20. Massachusetts: Physician must disclose material risks as measured by the patient’s need for information in making a decision. Harnish v. Children’s Hosp. Med. Center, 387 Mass. 152 (439 NE2d 240, 243) (1982).
21. Michigan: A claim of uninformed consent may or may not require expert testimony, depending on facts of case. If the need for the information is within the general knowledge of laymen, then expert testimony is not needed; but if laymen would not necessarily know what information should be given in a particular case, then expert testimony is needed. Paul v. Lee, 455 Mich. 204 (568 NW2d 510) (1997).
22. Minnesota: Patient must show the risks and alternative treatments that a physician is required to know and that a reasonable physician should have known that a patient in similar circumstances
23. Mississippi: Physician must disclose known risks material to a prudent patient in determining whether to undergo the proposed treatment. Expert testimony is not necessarily required if the information is a matter within knowledge of laymen. Hudson v. Parvin, 582 S2d 403, 410 (Miss. 1991).
24. Missouri: To prove nondisclosure, the patient must produce expert testimony to show what disclosures a reasonable physician would have made under similar circumstances. Wilkerson v. Mid-America Cardiology, 908 SW2d 691, 696 (Mo. App. 1995).
25. Montana: Physician has duty to make disclosures that a reasonable physician under similar circumstances would make so a patient can make an intelligent decision about whether to submit to the treatment. Collins v. Itoh, 160 Mont. 461 (503 P2d 36) (1972).
26. Nebraska: The extent of the doctor’s duty is measured by the standard of the reasonable medical practitioner under the same or similar circumstances. Robinson v. Bleicher, 251 Neb. 752 (559 NW2d 473) (1997).
27. Nevada: Nevada employs the “professional” standard, under which a doctor has a duty to disclose information that a reasonable practitioner in the same field of practice would disclose. Smith v. Cotter, 107 Nev. 267 (810 P2d 1204) (1991).
28. New Hampshire: A doctor has a duty to inform his patient of reasonable risks involved in a procedure. Folger v. Corbett, 118 N.H. 737 (394 A2d 63) (1978). The standard is defined by reference to the standards and practices of the medical profession, the average medical practitioner, and other relevant circumstances. Smith v. Cote, 128 N.H. 231, 240 (513 A2d 341) (1986).
29. New Jersey: A physician should describe the material risks inherent in a procedure or treatment. The test for measuring the materiality of a risk is whether a reasonable patient would consider the risk material. Matthies v. Mastromonaco, 160 N.J. 26, 37 (733 A2d 456) (1999).
30. New Mexico: New Mexico has adopted an “objective” standard; the extent of disclosure required is based on the knowledge or skill of an ordinary patient or physician. Gerety v. Demers, 92 N.M. 396, 410-411 (589 P2d 180) (1978).
31. New York: The doctor has a duty to disclose to the patient the reasonably foreseeable risks and benefits involved as a reasonable practitioner under similar circumstances would disclose. N.Y. CLS Pub. Health § 2805 (d) (1999).
32. North Carolina: A doctor must disclose risks in accordance with the standards of practice among members of the same profession
33. North Dakota: An integral part of the physician’s overall obligation to a patient is the duty to disclose the material risks of which the physician knows or should know. Kershaw v. Reichert, 445 NW2d 16 (N.D. 1989); Winkjer v. Herr, 277 NW2d 579, 588 (N.D. 1979).
34. Ohio: Patients must be told of risks which a reasonably prudent physician would disclose. Turner v. Children’s Hosp., 76 Ohio App.3d 541, 554-555 (602 NE2d 423) (1991).
35. Oklahoma: A physician has a duty to fully disclose all material risks, based on what the patient needs to know in order to make a decision. Smith v. Reisig, 1984 OK 56 (686 P2d 285) (1984); Scott v. Bradford, 1979 OK 165 (606 P2d 554, 557-558) (1979).
36. Oregon: A physician must explain any risks, and if the patient requests further information, the physician must disclose in substantial detail material risks, unless it would be detrimental to the patient. ORS § 677.097. The test as to the further explanation is based on the standard of practice of the reasonable medical practitioner. Tiedemann v. Radiation Therapy Consultants, 299 Ore. 238 (701 P2d 440) (1985).
37. Pennsylvania: A physician must advise a patient of material risks which a reasonable person would have considered significant in deciding whether to have the operation. Sinclair v. Block, 534 Pa. 563, 568 (633 A2d 1137) (1993).
38. Rhode Island: Physician must disclose risks that would be material to a reasonable person in the patient’s position. Under this reasonable patient approach, a patient claiming uninformed consent need not support his claim with an expert opinion. Wilkinson v. Vesey, 110 R.I. 606 (295 A2d 676) (1972).
39. South Carolina: Physician must disclose risks that a reasonable medical practitioner would disclose under the same circumstances. Under this reasonable physician approach, a patient must support a claim of uninformed consent with expert testimony. Hook v. Rothstein, 281 S.C. 541 (316 SE2d 690) (1984).
40. South Dakota: Physician must disclose risks that would be material to a reasonable person in the patient’s position. Although expert testimony is not required to establish the scope of the physician’s duty to disclose information to the patient, expert testimony may be necessary to prove other matters such as risks of treatment and alternative treatments. Wheeldon v. Madison, 374 NW2d 367 (1985).
41. Tennessee: Physician must disclose risks that a reasonable medical practitioner under similar circumstances would disclose. Under this reasonable physician approach, a patient must support a claim of uninformed consent with expert testimony. Shadrick v. Coker, 963 SW2d 726 (Tenn. 1998); Housh v. Morris, 818 SW2d 39, 41 (Tenn. App. 1991).
43. Utah: Utah Code Ann. § 78-14-5 (1987); Ramon v. Farr, 101 Utah Adv. Rep. 48 (770 P2d 131) (1989).
44. Vermont: Physician must disclose risks that would be material to a reasonable person in the patient’s position. Expert testimony is not needed to establish the patient’s informational needs, but may be required to prove such technical matters as risks. Small v. Gifford Mem. Hosp., 133 Vt. 552 (349 A2d 703) (1975).
45. Virginia: Physician must disclose risks that a reasonable medical practitioner under similar circumstances would disclose. A patient must introduce expert testimony to prove what information should be disclosed by a physician. Hunter v. Burroughs, 123 Va. 113-114; (96 SE 360, 366-367) (1918); Bly v. Rhoads, 216 Va. 645 (222 SE2d 783) (1976).
46. Washington: Elements patient must prove for an uninformed consent claim are that physician failed to inform of material facts regarding treatment, patient consented to treatment without being fully informed of such material facts, reasonably prudent patient would not have consented to the treatment if informed of such material facts, and treatment proximately caused injury. Expert testimony must be used to establish nature of proposed treatment, anticipated results of proposed treatment, recognized alternative treatment, and recognized serious risks of proposed treatment. Harbeson v. Parke-Davis, Inc., 98 Wn.2d 460 (656 P2d 483) (1983). Backlund v. Univ. of Washington, 137 Wn.2d 651 (975 P2d 950) (1999).
47. West Virginia: Physician must disclose risks that would be material to a reasonable person in the patient’s position. Although expert testimony is not required to prove patient’s informational needs, expert testimony ordinarily is needed to prove such things as the risks of the proposed treatment and alternative treatments. Cross v. Trapp, 170 W. Va. 459 (294 SE2d 446) (1982).
48. Wisconsin: Physician must disclose facts necessary to enable a reasonable person under circumstances similar to those facing the patient to intelligently exercise his right to consent to or reject the proposed treatment. Scaria v. St. Paul Fire &c. Ins. Co., 68 Wis.2d 1 (227 NW2d 647) (1975).
49. Wyoming: Physicians and dentists must disclose risks that a reasonable medical practitioner in similar circumstances would disclose. Under this reasonable physician approach, a patient must support a claim of uninformed consent with expert testimony. Roybal v. Bell,
The attached Appendix provides a summary of the law on the issue of informed consent in each of the other 49 states and confirms that Georgia stands alone on this issue.
136 Ga. App. 737 (222 SE2d 113) (1975).
Id. at 738-739 (1).
Schloendorff v. Society of New York Hosp., 211 N.Y. 125 (105 NE 92, 93) (App. 1914), overruled, Bing v. Thunig, 2 N.Y.2d 656 (143 NE2d 3) (App. 1957).
497 U. S. 261, 269 (110 SC 2841, 111 LE2d 224) (1990).
See Roscoe Pound, Spurious Interpretation, 7 Colum. L. Rev. 379, 380-384 (1907).
Ga. L. 1971, pp. 438-441.
See Early v. Early, 269 Ga. 415, 416 (499 SE2d 329) (1998); Hollowell v. Jove, 247 Ga. 678, 681 (279 SE2d 430) (1981).
Code §§ 88-2901; 88-2902; 88-2903; 88-2904; especially § 88-2905.
Richard Hodge, Consent to Elective Surgery Valid Even If Doctor Didn’t Warn of Known Risk, 28 Mercer L. Rev. 377 (1976).
Id. at p. 381.
Gary Smith, Georgia’s Medical Consent Law, 21 Ga. St. Bar J., No. 4, pp. 138-139 (1985).
OCGA § 31-9-6 (a).
Butler v. Brown, 162 Ga. App. 376, 378 (290 SE2d 293) (1982).
Albany Urology Clinic v. Cleveland, 272 Ga. 296, 299 (1) (528 SE2d 777) (2000).
Smith, 21 Ga. St. Bar J. at p. 140.
248 Ga. 832 (286 SE2d 715) (1982).
259 Ga. 579 (385 SE2d 651) (1989).
Cruzan, supra.
McAfee, supra; Prevatte, supra.
See McAfee, supra; Prevatte, supra.
Cruzan, supra.
Id. at 269-278.
Id. at 269.
Hodge, 28 Mercer L. Rev. at p. 381.
Wilborn v. Blake, 242 Ga. App. 653, 655 (1) (a) (530 SE2d 778) (2000); Hailey v. Blalock, 209 Ga. App. 345, 346 (2) (433 SE2d 337) (1993).
Harrell v. Lusk, 263 Ga. 895, 899 (439 SE2d 896) (1994) (Carley, J., concurring specially); Kapsch v. Stowers, 209 Ga. App. 767 (434 SE2d 539) (1993).
(Emphasis supplied.)
See Culbertson v. Mernitz, 602 NE2d 98 (Ind. 1992).
Id. at 103.
169 Ga. App. 132 (1) (312 SE2d 124) (1983).
172 Ga. App. 335 (323 SE2d 166) (1984).
See 61 AmJur2d, Physicians, Surgeons & Other Healers, §§ 188-189 (1981); see also Woolley v. Henderson, 418 A2d 1123, 1128-1129 (Me. 1980).
See, e.g., Hook v. Rothstein, 281 S.C. 541 (316 SE2d 690) (App. 1984); Woolley, supra; Bly v. Rhoads, 216 Va. 645 (222 SE2d 783, 787) (1976), superseded by statute as stated in Black v. Bladergroen, 258 Va. 438 (521 SE2d 168) (1999).
See, e.g., Miller v. Kennedy, 11 Wn. App. 272 (522 P2d 852, 863) (1974); Wilkinson v. Vesey, 110 R.I. 606 (295 A2d 676, 688) (1972).
Supra.
See 88 ALR3d 1008, 1012, 1034 (1978).
OCGA § 31-9-6.1 (a) (3).
271 Ga. 352 (519 SE2d 210) (1999).
(Citation and punctuation omitted.) Id. at 360.
(Citation and punctuation omitted.) Thomas Dufour, The Proper Application of Judicial Decisions Overruling Established Tort Doctrines, 65 B.U. L. Rev. 315, 320, n. 36 (1985).
See id.; Kocourek & Koven, Renovation of the Common Law Through Stare Decisis, 29 Ill. L. Rev. 971, 972 (1935).
Renfroe v. Arrington, 238 Ga. App. 470, 473, n. 1 (519 SE2d 3) (1999); Kelly v. Reid, 186 Ga. App. 89, 90 (2) (366 SE2d 315) (1988); Young v. Yarn, supra.
251 Ga. 496, 497 (306 SE2d 404) (1983).
Supra at 298.
Id.
Compare Spikes v. Heath, 175 Ga. App. 187, 188-190 (2) (332 SE2d 889) (1985).
See generally Lowe v. State, 267 Ga. 754, n. 1 (482 SE2d 344) (1997).
See Hightower v. Kendall Co., 225 Ga. App. 71, 72 (3) (483 SE2d 294) (1997); English v. Liberty Mtg. Corp., 205 Ga. App. 141, 142-143 (1) (421 SE2d 286) (1992).
Concurring Opinion
concurring specially.
I concur in the judgment rendered by the majority affirming the trial court’s grant of summary judgment in favor of Dr. Howard on Ketchup’s claim that Dr. Howard committed malpractice by failing to inform him of the risks of the root canal procedure. The judgment in favor of Dr. Howard was mandated because the Georgia informed consent law set forth in OCGA § 31-9-6.1 did not require the disclosure of those risks.
I write separately to state that the majority opinion’s attempt by judicial fiat to prospectively expand the limitations of the Georgia informed consent law adopted by the General Assembly in OCGA § 31-9-6.1 usurps the exercise of legislative power to define the doctrine of informed consent in Georgia and is a matter beyond the authority of this Court. The majority does not contend that the informed consent law set forth in OCGA § 31-9-6.1 required Dr. Howard to inform Ketchup of the risks involved with the root canal procedure. To the contrary, the statute clearly does not apply the doctrine of informed consent to this procedure. Instead, the majority proclaims for prospective application only that: “Henceforth [,] the law of this state, like that of the other 49 states, will recognize the common law doctrine of informed consent.” Whether Georgia should recognize the doctrine of informed consent in a form similar to that adopted by other states is not the issue. The issue is whether the authority to do so rests with the courts or the General Assembly.
Prior to the 1988 enactment of the informed consent law in OCGA § 31-9-6.1, both this Court and the Supreme Court of Georgia held that the Georgia Medical Consent Law at OCGA § 31-9-6 established that there was no duty in Georgia to disclose the risks of medical treatment. Simpson v. Dickson, 167 Ga. App. 344, 347-348 (306 SE2d 404) (1983); Robinson v. Parrish, 251 Ga. 496, 497 (306 SE2d 922) (1983). Accordingly, under pre-1988 common law precedent, a failure to disclose such risks would not support a claim for professional negligence. Albany Urology Clinic v. Cleveland, 272 Ga. 296, 298 (528 SE2d 777) (2000), citing Young v. Yarn, 136 Ga. App. 737 (222 SE2d 113) (1975); Hyles v. Cockrill, 169 Ga. App. 132, 133 (312 SE2d 124) (1983); Padgett v. Ferrier, 172 Ga. App. 335 (323 SE2d 166) (1984). Both this Court and the Supreme Court of Georgia have also concluded that, since this common law rule is based on longstanding judicial interpretations of the Medical Consent Law which have become an integral part of that statute, any subsequent change in this rule could be accomplished only by an act of the General Assembly. Simpson, 167 Ga. App. at 347-348; Spikes v. Heath, 175 Ga. App.
Addressing this statutory change in Albany Urology, the Supreme Court held that:
Section 31-9-6.1 sets forth six specified categories of information that must be disclosed by medical care providers to their patients before they undergo certain specified surgical or diagnostic procedures. The Georgia informed consent statute does not impose a general requirement of disclosure upon physicians; rather, it requires physicians to disclose only those factors listed in OCGA § 31-9-6.1 (a). . . . Because OCGA § 31-9-6.1 is in derogation of the common law rule against requiring physicians to disclose medical risks to their patients, it must be strictly construed and cannot be extended beyond its plain and explicit terms. Thus, in situations not covered by the statute’s language, the common law rule must still govern, as courts are without authority to impose disclosure requirements upon physicians in addition to those requirements already set forth by the General Assembly.
(Footnotes omitted; emphasis supplied.) Albany Urology, 272 Ga. at 298-299.
Since nothing in the Georgia informed consent statute at OCGA § 31-9-6.1 required Dr. Howard to inform Ketchup of the risks of the dental procedure at issue, the common law rule against requiring disclosure applies. Verre v. Allen, 175 Ga. App. 749 (334 SE2d 350) (1985) (common law rule applicable to dental procedure). Moreover, as noted above, both this Court and the Supreme Court of Georgia have held that it is beyond the power of this Court to expand the limited risk disclosure requirements imposed upon health care providers by OCGA § 31-9-6.1. It follows that the majority’s attempt to do so, however well intentioned, ignores contrary Supreme Court of Georgia authority and invades the province of the General Assembly.
I am authorized to state that Presiding Judge Blackburn, Judge Ruffin and Judge Miller join in this opinion.
Concurring Opinion
concurring specially.
I concur in the judgment for the reasons set forth in Presiding Judge Andrews’ special concurrence, with which I fully agree. I write separately only to address the majority’s attempt to distinguish the
As the majority notes, the narrow issue to be decided in Albany Urology Clinic was whether a physician could be sued for failing to disclose his cocaine use to his patient before performing a surgical procedure. In analyzing this issue, however, the Court extensively discussed the state of the law governing the doctrine of informed consent. The Court expressly stated that
[p]rior to 1988, Georgia physicians were not required to disclose to their patients any of the risks associated with a particular medical treatment or procedure. ... As established by pre-1988 precedent, under the common law, evidence of a failure to reveal the risks associated with medical treatment is not even admissible in support of a claim for professional negligence. As recognized by Georgia’s appellate courts, this common law rule could be changed only by legislative act.53
The Court then noted that the legislature modified the common law rule in 1998 by passing an informed consent statute, OCGA § 31-9-6.1. As the Court stated,
[t]he Georgia informed consent statute does not impose a general requirement of disclosure upon physicians', rather, it requires physicians to disclose only those factors listed in OCGA § 31-9-6.1 (a). . . . [I]n situations not covered by the statute’s language, the common law rule must still govern, as courts are without authority to impose disclosure requirements upon physicians in addition to those requirements already set forth by the General Assembly.54
It is abundantly clear that the majority’s holding in this case — i.e., that physicians have a common law duty to inform their patients of the material risks of a proposed treatment or procedure — is directly contrary to the Supreme Court’s statement in Albany Urology Clinic that there is no such common law duty. Indeed, the majority makes no attempt to reconcile its decision with the plain language of the Supreme Court’s decision. Instead, the majority simply ignores such language, apparently on the grounds that it is dicta.
In my opinion, when the Supreme Court has clearly and unambiguously spoken on an issue, this Court should be extremely reluc
Were I not constrained by Supreme Court precedent, I would be very sympathetic to the majority’s argument that the informed consent doctrine should apply in Georgia. However, “the Court of Appeals is bound by decisions of the Supreme Court.”
I am authorized to state that Presiding Judge Andrews, Presiding Judge Blackburn and Judge Miller join in this special concurrence.
272 Ga. 296 (528 SE2d 777) (2000).
(Footnote omitted; emphasis supplied.) Id. at 298 (1).
(Emphasis supplied.) Id. at 298-299 (1).
Id. at 299 (1).
Hogan v. State, 118 Ga. App. 398, 400 (163 SE2d 889) (1968).
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