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Smart Summary

Factual and Procedural Background

In February 1989, Cloma Duttry was diagnosed with esophageal cancer and consulted Dr. Lewis T. Patterson regarding the necessity of surgery. Duttry questioned Patterson about his experience performing the recommended operation, to which Patterson allegedly responded that he performed the procedure about once a month. Duttry consented to the surgery, which was performed on June 5, 1989. Postoperatively, a leak at the surgical site worsened into a rupture, necessitating emergency surgery. Duttry and her husband filed suit against Patterson, Patterson Surgical Associates, and Polyclinic Medical Center alleging medical malpractice and lack of informed consent, claiming Duttry suffered permanent lung damage and inability to work.

At trial, the plaintiffs sought to introduce evidence that Patterson had performed the surgery only nine times in the preceding five years, contradicting his statement to Duttry. The trial court ruled this evidence inadmissible, reasoning that only risks related to the procedure itself are relevant to informed consent, not the physician’s personal experience. The jury ruled in favor of the defendants. On appeal, the Superior Court vacated the judgment and remanded for a new trial, holding that Patterson’s experience and alleged misrepresentations were relevant to informed consent. The defendants petitioned for allowance of appeal, which the Supreme Court of Pennsylvania granted.

Legal Issues Presented

  1. Whether information concerning a surgeon's personal qualifications and experience is relevant to an informed consent claim.
  2. Whether the Superior Court erred in expanding the doctrine of informed consent to require disclosure of a physician’s experience when specifically asked by the patient.

Arguments of the Parties

Appellees' Arguments

  • Evidence of Patterson’s limited experience performing the surgery was relevant to the informed consent claim because it contradicted his representation to Duttry.
  • This misrepresentation was material and affected Duttry’s decision to consent to surgery.

Appellants' Arguments

  • The only information relevant to informed consent is material information about the procedure itself, including risks and alternatives.
  • Information regarding a physician’s personal experience or qualifications is irrelevant to informed consent.
  • The Superior Court improperly expanded the doctrine beyond its traditional limits.

Table of Precedents Cited

Precedent Rule or Principle Cited For Application by the Court
Phillips v. A-BEST Products Co., 665 A.2d 1157 (Pa. 1995) Standard of plenary review for questions of law. The Court applied plenary review to the legal question of informed consent scope.
Sinclair by Sinclair v. Block, 633 A.2d 1137, 1140 (Pa. 1993) Definition of material information required for informed consent. The Court reaffirmed that material information relates to the nature, risks, and alternatives of the procedure.
Gray v. Grunnagle, 223 A.2d 663, 674 (Pa. 1966) Scope of information a physician must provide to obtain informed consent. The Court emphasized that information must concern the operation itself, not the physician’s personal attributes.
Gouse v. Cassel, 615 A.2d 331, 334 (Pa. 1992) Objective standard for what a reasonable patient would consider significant in informed consent. The Court applied an objective test rather than subjective patient inquiry in determining materiality.
Morgan v. MacPhail, 704 A.2d 617 (Pa. 1997) Informed consent claims sound in battery; limits on expansion of doctrine. The Court cited this case to reject expansion of informed consent beyond traditional boundaries.
Kaskie v. Wright, 589 A.2d 213 (Pa.Super.Ct. 1991) Evidence of surgeon’s personal characteristics irrelevant to informed consent. The Court held this precedent supports limiting informed consent to procedural information, rejecting Superior Court’s expansion.
Collins v. Hand, 246 A.2d 398 (Pa. 1968) Physician’s lack of experience may support negligence claims. The Court noted that other causes of action, like negligence, address physician incompetence.
Bortz v. Noon, 729 A.2d 555 (Pa. 1999) Misrepresentation by physician may give rise to separate cause of action. The Court recognized misrepresentation claims as appropriate outside the informed consent doctrine.

Court's Reasoning and Analysis

The Court analyzed whether the Superior Court erred by expanding the informed consent doctrine to include a physician’s personal qualifications and experience. It reaffirmed that informed consent requires disclosure of material information related to the procedure itself—its nature, risks, and alternatives—not personal attributes of the physician. The Court emphasized established precedent limiting the doctrine to procedural information, citing Gray and Gouse, and rejected the Superior Court’s rationale that a patient’s specific inquiry about experience obligates disclosure under informed consent.

The Court found the Superior Court’s approach problematic because it deviates from the objective standard of materiality, which does not depend on the particular patient’s questions or curiosity. The Court clarified that this holding does not immunize physicians who mislead patients; rather, other legal remedies such as negligence or misrepresentation claims remain available. The Court acknowledged that some sister states have broadened informed consent doctrines to include physician attributes but declined to follow that path, preferring to maintain the traditional, narrower scope.

Accordingly, the Court reversed the Superior Court’s order vacating the judgment and remanded for consideration of the remaining claims raised by the plaintiffs.

Holding and Implications

The Supreme Court of Pennsylvania held that information concerning a surgeon's personal qualifications and experience is irrelevant to the doctrine of informed consent, regardless of whether the patient specifically requests such information.

This decision reverses the Superior Court’s expansion of the informed consent doctrine. The direct effect is that informed consent claims in Pennsylvania are limited to disclosure of material information about the procedure itself, not about the physician’s personal experience or skills. The Court emphasized that other causes of action, such as negligence or misrepresentation, remain available to address physician misconduct or misstatements. No new precedent expanding informed consent was established; rather, the Court reaffirmed the doctrine’s traditional boundaries.

CLOMA E. DUTTRY AND ALVIN DUTTRY, Appellees v. LEWIS T. PATTERSON, M.D., PATTERSON SURGICAL ASSOCIATES AND POLYCLINIC MEDICAL CENTER, Appellants.

OPINION

Justice CAPPY.

We granted allocatur in this matter to determine whether the Superior Court below impermissibly extended the scope of the doctrine of informed consent. We conclude that it did, and therefore reverse.

In February of 1989, Cloma Duttry ("Duttry") was diagnosed with esophageal cancer. She consulted with Lewis T. Patterson, M.D. ("Patterson") regarding whether she needed surgery to treat her cancer. During this consultation, Duttry claims that she questioned Patterson about his experience in performing the type of operation he recommended. Patterson allegedly told Duttry that he had performed this particular procedure approximately once every month. Duttry ultimately consented to have the surgery performed by Patterson.

On June 5, 1989, Patterson performed the surgery; the surgery involved resection of portions of Duttry's esophagus and stomach. Three days after surgery, a leak developed at the site of the surgery. The leak eventually worsened and became a rupture. Because of the rupture, Duttry underwent emergency surgery.

Duttry and her husband (collectively, Appellees) filed suit against Patterson, Patterson Associates, and the Polyclinic Medical Center (collectively, Appellants), raising claims of medical malpractice and lack of informed consent. Appellees contended that Duttry now has adult respiratory disease syndrome and permanent damage to her lungs as a result of complications arising out of the rupture. Furthermore, they claimed that because of these physical problems, Duttry is unable to work.

At trial, Appellees sought to introduce evidence establishing that Patterson had performed the type of surgery which he had performed on Duttry only nine times in the preceding five years, a frequency far below the once a month figure he allegedly gave Duttry. Appellees contended that such evidence was relevant to the informed consent claim.

The trial court ruled that this evidence was inadmissible because it was not relevant to the issue of informed consent. It reasoned that the only information that a physician must impart to a patient to obtain informed consent is information relative to the risks of the procedure itself. The trial court therefore concluded that as information regarding the personal skills and abilities of the physician is not relevant to understanding the risks of the procedure itself, then such information need not be conveyed in order to deem the patient's consent as being informed.

The jury returned a verdict in favor of Appellants. After denial of their post-trial motions, Appellees appealed. A divided panel of the Superior Court vacated and remanded for a new trial. Duttry v. Patterson, 741 A.2d 199 (Pa.Super.Ct. 1999). The majority found that evidence relating to Patterson's experience in performing this particular type of surgery, and his alleged misrepresentations to Duttry, was relevant to the issue of informed consent. The majority noted that because of its resolution of the informed consent issue, it need not resolve other issues Appellees presented in support of the informed consent claim.

President Judge Emeritus Cirillo dissented. Judge Cirillo expressed the belief that only information relative to the procedure itself need be imparted in order to obtain the patient's informed consent; he posited that information concerning a physician's personal experience is irrelevant to an informed consent claim.

Appellants then filed a Petition for Allowance of Appeal with this court and we granted allocatur. For the reasons that follow, we now reverse.

The question with which we are presented is whether the Superior Court erred as a matter of law when it determined that information concerning a surgeon's personal qualifications and experience is relevant to an informed consent claim. As with all questions of law, our review is plenary. Phillips v. A-BEST Products Co., 665 A.2d 1157 (Pa. 1995).

The informed consent doctrine requires physicians to provide patients with "material information necessary to determine whether to proceed with the surgical or operative procedure or to remain in the present condition." Sinclair by Sinclair v. Block, 633 A.2d 1137, 1140 (Pa. 1993). We have on several occasions defined the nature of this "material information". We have stated that the information provided by a physician must give the patient "a true understanding of the nature of the operation to be performed, the seriousness of it, the organs of the body involved, the disease or incapacity sought to be cured, and the possible results." Gray v. Grunnagle, 223 A.2d 663, 674 (Pa. 1966). Thus, a physician must "advise the patient of those material facts, risks, complications and alternatives to surgery that a reasonable person in the patient's situation would consider significant in deciding whether to have the operation." Gouse v. Cassel, 615 A.2d 331, 334 (Pa. 1992). A claim that a physician failed to obtain the patient's informed consent sounds in battery. Id.; see also Morgan v. MacPhail, 704 A.2d 617 (Pa. 1997).

As noted by Appellants and amicus curiae Pennsylvania Medical Society, the legislature recently codified the law of informed consent. See 40 P. S. § 1301. 811-A (effective January 25, 1997). That statute is inapplicable to the matter sub judice as it became effective long after Duttry's surgery was performed.

In addressing this issue, the Superior Court found it critical that Patterson's alleged misinformation was given in response to a specific question posed by Duttry. The majority held that where a patient requests information regarding the physician's experience, then the physician must answer that question accurately in order to obtain the patient's informed consent.

The majority sub silentio recognized that its own decision in Kaskie v. Wright, 589 A.2d 213 (Pa.Super.Ct. 1991) seemingly would militate a different result. In Kaskie, the Superior Court held that evidence regarding characteristics particular to the surgeon, rather than information concerning the procedure itself, was irrelevant to an informed consent claim. The Kaskie court reasoned that to "expand the informed consent doctrine to include matters not specifically germane to surgical or operative treatment[, to include] . . . facts personal to the treating physician, extends the doctrine into realms well beyond its original boundaries." Id. at 217. The Superior Court attempted to distinguish the matter sub judice from Kaskie by emphasizing that Duttry had specifically requested information regarding Patterson's experience; in Kaskie, however, the physician was not asked a question regarding his personal competency, but rather merely refrained from divulging this information. Thus, the majority of the panel below apparently viewed information concerning a physician's experience as being material to an informed consent claim only where the particular patient poses specific questions regarding that experience.

We are unpersuaded by the Superior Court's reasoning. The expansive approach taken by the Superior Court below is in opposition to this commonwealth's traditional view that the doctrine of informed consent is a limited one. We have historically demanded that a physician acquaint the patient only with "the nature of the operation to be performed, the seriousness of it, the organs of the body involved, the disease or incapacity sought to be cured, and the possible results." Gray, 223 A.2d at 674. The requirement of Gray is not a broad one; it clearly focuses on imparting information relative only to the surgery itself. In contrast, in neither Gray nor its progeny did we intimate that personal attributes or experience of the physician are relevant to an informed consent claim. Thus, we hold that evidence of a physician's personal characteristics and experience is irrelevant to an informed consent claim; such a holding is more in keeping with our case law than the approach taken by the Superior Court.

Furthermore, we note that this holding does not shift depending upon whether a patient inquires as to the physician's experience. We find the Superior Court's rationale that evidence of the physician's personal characteristics is relevant to an informed consent claim whenever the particular patient requests such information to be highly problematic. The Superior Court's reasoning on this point is divorced from the fundamental principle of the informed consent doctrine that information is material to the procedure at hand, and therefore must be divulged in order to obtain the patient's informed consent, if a reasonable person would wish to know it. Gouse, supra. This is an objective, rather than subjective, analysis; its calculus does not shift depending on how inquisitive or passive the particular patient is.

Based on the foregoing, we hold that information personal to the physician, whether solicited by the patient or not, is irrelevant to the doctrine of informed consent. Our holding should not, however, be read to stand for the proposition that a physician who misleads a patient is immune from suit. Rather, we are merely stating that the doctrine of informed consent is not the legal panacea for all damages arising out of any type of malfeasance by a physician. Nor do we see a need to expand this doctrine into a catchall theory of recovery since other causes of action provide avenues for redress to the injured patient. For example, it is conceivable that a physician's lack of experience in performing an operation would support a plaintiff's case in negligence. See Collins v. Hand, 246 A.2d 398 (Pa. 1968). Also, in situations such as the one presented sub judice, in which the physician allegedly provides inaccurate information regarding his experience in performing a procedure, the plaintiff may have a cause of action for misrepresentation. See Bortz v. Noon, 729 A.2d 555 (Pa. 1999).

We realize that some of our sister states have expanded the concepts of the doctrine of informed consent so that they require a physician to inform the patient not only of the risks of the procedure itself, but of personal attributes, interests and experience of the physician. See, e.g., Ufaya v. Almara, 793 P.2d 479 (Cal. 1990) (to obtain the patient's informed consent, the physician must reveal any potential conflicts of interest); Johnson v. Kokemoor, 545 N.W.2d 495 (Wisc. 1996) (physician must reveal physical impairment and lack of experience to obtain the patient's informed consent). While we acknowledge that the learned high courts of some of our sister states have broadened their concept of the informed consent doctrine, we see no compelling reason to follow a similar course. As discussed infra, plaintiffs such as Appellees have recourse against allegedly inexperienced and deceptive physicians via other causes of action. We see no need to alter this commonwealth's definition of informed consent in order to provide what will often be a redundant cause of action. Cf. MacPhail, supra (rejection of request to expand doctrine of informed consent beyond its traditional boundaries).

For the foregoing reasons, we reverse the order of the Superior Court and remand the matter for the Superior Court's consideration of the remaining claims raised by Appellees in their appeal to that court.

Justice NIGRO files a dissenting opinion.

Justice NIGRO, Dissenting.

I respectfully dissent from the majority opinion since I fail to see how a patient who specifically asks her physician how many times he has performed a surgical procedure can be said to have given her informed consent to surgery when the physician misleads the patient by grossly exaggerating his experience. As the majority notes, the informed consent doctrine requires a physician to "advise the patient of those material facts, risks, complications and alternatives to surgery that a reasonable person in the patient's situation would consider significant in deciding whether to have the operation." Gouse v. Cassel, 615 A.2d 331, 334 (Pa. 1992). In my view, evidence that Dr. Patterson misled Cloma Duttry by telling her that he had performed the surgery at issue once a month for five years, i.e., sixty times, when in reality he had performed it only nine times, is clearly a material fact that a reasonable person would consider significant in deciding whether to undergo surgery. Accordingly, I would affirm the Superior Court's order granting a new trial.

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DUTTRY v. PATTERSON
(May 22, 2001)