Quick Summary
Janine Harnish (plaintiff) sued Children’s Hospital Medical Center and associated physicians (defendants) for medical malpractice, alleging failure to inform her of surgical risks resulting in loss of tongue function. The key issue was whether this failure breached the duty of informed consent.
The Massachusetts Supreme Judicial Court held that two physicians could be liable for not disclosing risks, but there was insufficient evidence against the hospital and another doctor. The court emphasized a physician’s duty to inform patients about significant risks associated with medical procedures.
Facts of the Case
Janine Harnish (plaintiff) underwent a surgical procedure at Children’s Hospital Medical Center (defendant) to remove a tumor from her neck. During the surgery, a nerve was severed, leading to a significant loss of tongue function for Harnish.
Harnish subsequently filed a medical malpractice lawsuit against Children’s Hospital and her physicians, alleging that they failed to inform her of the risks associated with the surgery, including the specific risk of injury to her tongue.
The defendants in this case include Dr. Anthony Holmes, Dr. Robert Gilman, and Dr. John B. Mulliken (defendants), all of whom were involved in Harnish’s medical care. The complaint suggests that the operation was elective and for cosmetic purposes, and had Harnish been aware of the potential risk of losing tongue function, she would not have consented to the surgery.
Procedural Posture and History
- Harnish filed a medical malpractice action against Children’s Hospital and her physicians.
- A medical malpractice tribunal convened as per G. L. c. 231, Section 60B, found Harnish’s proof inadequate.
- The case was dismissed after Harnish failed to post a bond as required by G. L. c. 231, Section 60B.
- Harnish appealed the dismissal to the Massachusetts Supreme Judicial Court.
I.R.A.C. Format
Issue
Whether the defendants’ failure to inform Harnish of the potential risk of losing tongue function during surgery constituted a breach of their duty to obtain informed consent from the patient.
Rule of Law
A physician has a duty to disclose all significant medical information that they possess or reasonably should possess that is material to a patient’s decision to give or withhold consent to a medical or surgical procedure. Failure to make such disclosure may constitute professional misconduct within the ambit of G. L. c. 231, Section 60B.
Reasoning and Analysis
The court reasoned that a patient’s right to make informed decisions about their medical care is paramount. This right necessitates that physicians provide sufficient information about the risks associated with any proposed medical or surgical procedure.
The court recognized the complexity of medical information but emphasized that patients should be made aware of material risks that could influence their decision-making.
The court also determined that whether an undisclosed risk materialized is a question for the medical malpractice tribunal, but whether a patient would have chosen not to undergo the procedure had they been informed is not related to medical expertise and therefore not within the tribunal’s purview.
The plaintiff’s offer of proof regarding Drs. Holmes and Mulliken raised an appropriate question for judicial inquiry, but there was insufficient evidence against Dr. Gilman and Children’s Hospital Medical Center.
Conclusion
The judgment dismissing the case against Drs. Mulliken and Holmes was reversed, allowing the case to proceed against them. However, the dismissal against Dr. Gilman and Children’s Hospital Medical Center was affirmed due to insufficient evidence of their direct involvement in the failure to inform.
Key Takeaways
- Physicians must disclose significant medical information material to a patient’s decision on whether to consent to a procedure.
- The standard for disclosure is based on what an average qualified physician should know and consider material for an informed decision by the patient.
- The determination of materiality is within the purview of laypersons and does not require expert testimony.
Relevant FAQs of this case
What constitutes informed consent in a medical context?
Informed consent in a medical context requires that a physician disclose all significant risks, benefits, and alternatives to the proposed medical procedure. The disclosure must be understandable to the patient, allowing them to make an educated decision regarding their treatment.
- For example: A doctor advising a patient on chemotherapy must explain the potential side effects, such as nausea and hair loss, as well as alternative treatments and the risk of non-treatment.
How is materiality of risk determined in informed consent cases?
Materiality of risk in informed consent cases is judged by a ‘reasonable patient’ standard: whether a reasonable person in the patient’s position would have attached significance to the risk when deciding whether to proceed with the procedure.
- For example: In deciding whether to undergo LASIK eye surgery, a reasonable patient would likely find potential risks such as long-term dryness or night glare important to their decision.
Does the actual occurrence of an undisclosed risk affect a claim for lack of informed consent?
The occurrence of an undisclosed risk may support a claim for lack of informed consent if it is deemed material and if disclosure could have altered the patient’s decision. However, liability is not automatically established merely because an undisclosed risk occurs; the failure to inform must be proven causative to the patient’s damages.
- For example: If a patient suffers an allergic reaction from a medication and was never advised of this possible side effect, they could have grounds for a claim if they would have refused the medication knowing the risk.
References
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