Gates v. Jensen
92 Wash. 2d 246, 1979 Wash. LEXIS 1329, 595 P. 2d 919 (1979)
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Rule of Law:
The doctrine of informed consent requires a physician to disclose a patient's abnormal conditions, associated risks, and the existence of alternative diagnostic procedures. Furthermore, under the 'reasonable prudence' standard, a physician may be found negligent for failing to perform a simple, risk-free diagnostic test if circumstances indicate it is necessary, even if this standard is higher than the custom of the profession.
Facts:
- In May 1972, Elisabeth Gates, who had severe myopia which increased her risk for glaucoma, consulted ophthalmologist Dr. James Hargiss for vision problems.
- Dr. Hargiss measured Gates's eye pressure and found it was in the 'borderline area for glaucoma,' but told her everything was 'all right.'
- Dr. Hargiss examined Gates's optic nerves with a direct ophthalmoscope but did not dilate her pupils for a better view.
- Dr. Hargiss did not inform Gates of her high eye pressure readings, her increased risk for glaucoma, or the availability of simple, risk-free alternative diagnostic tests such as pupil dilation or a visual field examination.
- Over the next two years, Gates revisited the clinic 12 times with worsening symptoms including blurring, fog, and gaps in her vision.
- The clinic's doctors did not administer any additional glaucoma tests during this two-year period.
- In April 1974, Gates was diagnosed with advanced open angle glaucoma, which had rendered her functionally blind.
Procedural Posture:
- Elisabeth Gates sued Dr. James Hargiss and the Eye Clinic of Seattle for medical malpractice in a Washington state trial court.
- At trial, the court refused to give the jury Gates's requested instructions on the doctrine of informed consent and the 'reasonable prudence' standard of care.
- The jury returned a verdict in favor of the defendants, Dr. Hargiss and the clinic.
- Gates, as appellant, appealed the judgment to the Washington Court of Appeals.
- The Court of Appeals affirmed the trial court's judgment in favor of the appellees, Dr. Hargiss and the clinic.
- Gates, as petitioner, was granted review by the Supreme Court of Washington.
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Issue:
Does a physician commit malpractice by failing to inform a patient of an abnormal condition and alternative diagnostic tests, and can a physician be found negligent under a 'reasonable prudence' standard for not administering such tests even if professional custom does not require it?
Opinions:
Majority - Horowitz, J.
Yes. A physician's duty of informed consent requires disclosing material facts about a patient's condition, including abnormalities and alternative diagnostic procedures, and the reasonable prudence standard may require a physician to perform simple, risk-free tests even if not standard practice in the profession. The patient's right to know is not confined to treatment choices but extends to decisions about diagnosis, requiring the physician to disclose abnormalities, risks, and alternative diagnostic procedures so the patient can make an informed choice. Citing Helling v. Carey, the court found the reasonable prudence standard applies because the patient presented with high-risk factors for a serious disease (glaucoma), and simple, risk-free diagnostic tests were available. The court held that statute RCW 4.24.290, which requires proof that a defendant failed to exercise the skill 'possessed' by the profession, did not abrogate the Helling rule because all ophthalmologists possess the skill to perform these simple tests, even if they don't always practice it.
Concurring-in-part-and-dissenting-in-part - Dolliver, J.
Partially No. While the physician has a duty of informed consent, the legislature's enactment of RCW 4.24.290 explicitly abrogated the Helling v. Carey 'reasonable prudence' standard, returning the standard of care in medical malpractice cases exclusively to that of the profession. The dissent agrees with the majority on the informed consent issue. However, it argues the legislative history of RCW 4.24.290 demonstrates a clear intent to overrule Helling and re-establish the professional standard of care. The majority's focus on the word 'possessed' versus 'practiced' is a semantic distinction that frustrates the legislature's mandate. Therefore, the trial court was correct to refuse the jury instruction on reasonable prudence, which would have allowed the jury to find negligence even if the defendants complied with the professional standard.
Analysis:
This decision expands the doctrine of informed consent beyond treatment to the diagnostic phase of medicine, establishing a patient's right to be informed of physical abnormalities and alternative diagnostic tests. It also preserves the controversial 'reasonable prudence' standard from Helling v. Carey by narrowly interpreting a statute intended to abrogate it. This ensures that courts can hold physicians to a standard of care higher than that of their profession when a simple, risk-free precaution could prevent a devastating injury, thus maintaining a significant, patient-protective exception to the traditional professional standard of care.
