ALLEN v. HARRISON
374 P.3d 812, 2016 Okla. LEXIS 45, 2016 OK 44 (2016)
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Rule of Law:
The doctrine of informed consent requires a physician to disclose all medically reasonable treatment alternatives, including non-invasive options, and those outside the physician's scope of practice, to enable the patient to make an intelligent choice.
Facts:
- On June 1, 2009, Teresa Lynn Allen swallowed a small nail.
- Allen went to the emergency room at Duncan Regional Hospital where she was examined by Dr. John J. Harrison.
- An X-ray confirmed the nail was in Allen's stomach, just below the diaphragm.
- Dr. Harrison prescribed a high-fiber diet and instructed Allen to let the nail pass through her digestive system.
- Dr. Harrison did not inform Allen about alternative treatment options, such as endoscopic or surgical removal of the nail.
- The following day, Allen experienced severe vomiting and went to a different hospital.
- Emergency surgery was performed to remove the nail, which was found to have perforated and infected her bowel.
- Allen subsequently required two additional surgeries to treat complications from the initial emergency surgery.
Procedural Posture:
- Teresa Lynn Allen sued Dr. John J. Harrison in an Oklahoma trial court for medical negligence and failure to obtain informed consent.
- Dr. Harrison filed a Motion for Partial Summary Judgment on the informed consent claim.
- The trial court granted Dr. Harrison's motion, ruling the doctrine of informed consent applies only when an affirmative treatment, not a failure to treat, causes injury.
- Allen's separate medical negligence claim proceeded to a jury trial, which resulted in a verdict for Dr. Harrison.
- Allen, as appellant, appealed the summary judgment ruling to the Oklahoma Court of Civil Appeals.
- The Court of Civil Appeals, as appellee's court, affirmed the trial court, concluding the doctrine is triggered only by injurious surgical treatment.
- Allen then petitioned the Oklahoma Supreme Court for a writ of certiorari, which the court granted.
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Issue:
Does the doctrine of informed consent require a physician to disclose medically reasonable alternatives to a recommended course of treatment, even when the recommended treatment is non-surgical or non-invasive?
Opinions:
Majority - Colbert, J.
Yes. The doctrine of informed consent requires a physician to disclose medically reasonable alternatives regardless of whether the recommended treatment is non-surgical or non-invasive. The court's reasoning is that a patient's right of self-determination is paramount, and this right can only be exercised effectively if the patient has enough information to make an informed choice. The decisive factor is not the invasiveness of a procedure but the patient's need for information. The court rejected the argument that informed consent only applies to affirmative surgical procedures, holding that prescribing a high-fiber diet is a form of treatment. Therefore, a physician's duty is not limited to disclosing only the treatments they recommend or can perform; they must inform the patient of all medically reasonable options and their attendant risks so the patient, not the physician, can make the ultimate decision.
Analysis:
This decision significantly clarifies and expands the scope of the informed consent doctrine in Oklahoma. It explicitly rejects any limitation of the doctrine to only surgical or invasive procedures, extending it to non-invasive treatment plans. This ruling places a greater affirmative duty on all physicians, including emergency room doctors, to disclose all medically reasonable alternatives, even those outside their expertise. By reaffirming the patient-centered 'full-disclosure' standard over the 'professional' standard, the case strengthens patient autonomy and potentially increases physician liability for failure to inform, even in cases involving conservative or 'wait-and-see' approaches.
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