Hoofnel v. Segal
2006 Ky. LEXIS 167, 2006 WL 1650616, 199 S.W.3d 147 (2006)
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Rule of Law:
A patient's signature on a clear and unambiguous medical consent form that authorizes 'possible' procedures or any 'additional procedures as are deemed necessary' creates a strong presumption of valid consent. This written consent can supersede the patient's prior verbal statements expressing a contrary desire.
Facts:
- Eva Hoofnel met with Dr. Susan Galandiuk to discuss surgical removal of a lesion in her lower colon.
- During the consultation, Dr. Galandiuk recommended removing Hoofnel's ovaries (oophorectomy) and uterus (hysterectomy) in addition to the colon surgery and appendectomy.
- Hoofnel stated at this meeting that she did not want her uterus or ovaries removed.
- Three days later, Hoofnel signed a 'Consent to Operation' form at the hospital for her scheduled surgery.
- The form listed the procedures as 'anterior resection colon with appendectomy and possible bilateral oophorectomy.'
- The form also included a clause authorizing the physician to perform 'such additional procedures as are deemed necessary in their professional judgment' if unforeseen conditions arose during the operation.
- During surgery, Dr. Galandiuk discovered that Hoofnel's abnormally large uterus was physically impairing her ability to resect the colon lesion.
- Dr. Galandiuk consulted with gynecologist Dr. James Segal, and they proceeded to perform a hysterectomy and oophorectomy, believing them to be medically necessary to complete the primary surgery.
Procedural Posture:
- Eva Hoofnel sued Drs. James Segal and Susan Galandiuk for medical battery in the Jefferson Circuit Court, a state trial court.
- The defendant doctors filed a motion for summary judgment.
- The trial court granted summary judgment in favor of the doctors, defeating Hoofnel's claim.
- Hoofnel, as appellant, appealed the summary judgment to the Kentucky Court of Appeals, an intermediate appellate court.
- The Court of Appeals affirmed the trial court's decision in favor of the doctors, appellees.
- The Supreme Court of Kentucky granted Hoofnel's petition for discretionary review.
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Issue:
Does a patient's signature on a consent form authorizing a 'possible' procedure and any 'additional procedures as are deemed necessary' constitute valid consent for those procedures sufficient to defeat a medical battery claim, even if the patient had previously told the doctor she did not want the procedures performed?
Opinions:
Majority - Graves, Justice
Yes, the patient's signature on the consent form constituted valid consent for the procedures. The signed consent form is clear evidence of consent that defeats the battery claim. The form specifically listed a 'possible bilateral oophorectomy' and contained a clause authorizing additional procedures 'as are deemed necessary' in the physician's judgment. This clause provided consent for the hysterectomy because the enlarged uterus was impeding the primary colon surgery, making its removal medically necessary. Although consent is a process, a signed consent form creates a presumption of validity, and Hoofnel's signature on this form superseded her previous verbal statement refusing the procedures.
Dissenting - Cooper, Justice
No, the consent form does not automatically constitute valid consent sufficient to warrant summary judgment because genuine issues of material fact exist regarding the consent process. The majority improperly resolved factual disputes in favor of the doctors, which is the role of a jury. There is substantial evidence that Hoofnel explicitly refused the removal of her 'female parts,' that she did not understand the medical term 'oophorectomy' used on the form, and that the form did not mention a hysterectomy at all. Citing precedent that 'consent is a process, not a document,' the dissent argues that the conflicting testimony and circumstances surrounding the signing of the form create a factual question about the validity of Hoofnel's consent that should have been decided at trial, not on summary judgment.
Analysis:
This decision significantly strengthens the legal authority of written consent forms in medical battery litigation within this jurisdiction. It establishes that a general authorization for 'necessary' procedures can validate a surgery not explicitly named on the form if an unforeseen medical necessity arises during the operation. By holding that a subsequent written consent form supersedes prior verbal refusals, the court shifts the legal focus from the entire 'consent process' back to the final, signed document. This precedent makes it more difficult for patients to succeed on battery claims when they have signed a broad consent form, thereby increasing the protection afforded to medical professionals who rely on such documents.
