Gomez v. Sauerwein
180 Wash. 2d 610 (2014)
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Rule of Law:
A health care provider is not liable for failing to obtain informed consent regarding treatment options for a condition that the provider has diagnostically ruled out, even if that diagnosis is ultimately incorrect. In such cases, the appropriate cause of action is for medical negligence based on a misdiagnosis that breaches the standard of care.
Facts:
- Christina Palma Anaya (Mrs. Anaya), who suffered from uncontrolled diabetes, sought treatment at a hospital for urinary tract infection symptoms on August 20, 2006, where blood samples were taken.
- On August 24, a lab informed Mrs. Anaya's clinic of a preliminary positive result for yeast in one of her blood cultures.
- Dr. Sauerwein, the covering physician, was notified of the result and conferred with another of Mrs. Anaya's physicians.
- A nurse from the clinic called Mrs. Anaya, who reported that she had been feeling much better since her last hospital visit.
- Based on Mrs. Anaya's reported improvement and the common occurrence of false positives, Dr. Sauerwein concluded the lab result was a false positive due to contamination.
- Dr. Sauerwein did not inform Mrs. Anaya about the preliminary positive test result for yeast.
- On August 26, the lab confirmed the yeast as candida glabrata, a serious infection, but did not notify Dr. Sauerwein or the clinic.
- Mrs. Anaya's condition worsened, and she was hospitalized on August 29; she ultimately died from the infection on November 17, 2006.
Procedural Posture:
- Mr. Anaya, as personal representative of Mrs. Anaya’s estate, filed a medical malpractice action against Dr. Sauerwein and his clinic in Yakima County Superior Court (trial court).
- Shortly before trial, the estate moved to add a claim for failure to obtain informed consent.
- At the close of the plaintiff's case, the trial judge granted the defense's motion for judgment as a matter of law, dismissing the informed consent claim.
- The negligence claim proceeded to the jury, which returned a verdict in favor of Dr. Sauerwein, finding no breach of the standard of care.
- Mr. Anaya (appellant) appealed the dismissal of the informed consent claim to the Court of Appeals, Division Three, with Dr. Sauerwein and the Clinic as respondents.
- The Court of Appeals affirmed the trial court's dismissal.
- The Washington Supreme Court granted discretionary review.
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Issue:
Does a health care provider's duty to obtain informed consent apply to treatment options for a condition that the provider has diagnostically ruled out based on the patient's overall clinical picture?
Opinions:
Majority - J.M. Johnson, J.
No. When a health care provider rules out a particular diagnosis based on the patient’s clinical condition, the provider is not liable for informed consent claims arising from that ruled-out diagnosis. The court reasoned that informed consent and medical negligence are distinct theories of recovery. Citing its precedent in Backlund v. University of Washington, the court affirmed that a provider who misdiagnoses a condition and is therefore unaware of appropriate treatments cannot be held liable for failure to secure informed consent for those unknown treatments; the proper claim is for negligence. Here, Dr. Sauerwein used the complete clinical picture—including Mrs. Anaya's report of feeling better—to conclude the test was a false positive. Because he did not believe she had a yeast infection, he had no duty to inform her of possible treatments for it. The court distinguished this case from Gates v. Jensen, where ongoing, objective test results indicated a clear risk, presenting a diagnosable choice for the patient. As a separate and sufficient ground for dismissal, the court also found no evidence of proximate cause, as testimony indicated treatment would have been ineffective even if initiated on August 24.
Concurring - González, J.
Yes, a provider can be liable for both negligence and informed consent on the same facts, but the claim here fails for lack of proximate cause. The concurrence disagrees with the majority's reasoning that negligence and informed consent are mutually exclusive in misdiagnosis cases. It argues that the majority misinterprets the Backlund rule, which established the two as alternative, not mutually exclusive, methods of imposing liability. A provider must secure informed consent regardless of whether the initial diagnosis was negligent. However, the concurrence agrees with the ultimate result of dismissing the informed consent claim because the plaintiff failed to present sufficient evidence that Dr. Sauerwein's failure to inform proximately caused Mrs. Anaya's death; evidence showed the standard treatment would have been ineffective and she would have died regardless.
Analysis:
This decision solidifies the distinction between medical negligence and informed consent claims in Washington, particularly in the context of misdiagnosis. It reinforces the Backlund rule, holding that a provider's diagnostic conclusion, even if incorrect, dictates the scope of the informed consent duty. By narrowly construing the precedent in Gates, the court limits the application of informed consent principles to the diagnostic phase, making such claims viable only when a known risk presents a clear, actionable choice for the patient regarding further testing or treatment. This ruling protects providers from liability for failing to discuss treatments for every theoretical or ruled-out condition, thereby centering the informed consent doctrine on patient choices among available options for a diagnosed condition.
