Howard v. University of Medicine & Dentistry
2002 N.J. LEXIS 752, 172 N.J. 537, 800 A.2d 73 (2002)
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Rule of Law:
A physician's serious misrepresentation of credentials or experience does not give rise to a separate cause of action for fraud, but may support a claim for lack of informed consent if the misrepresentation is material to the assessment of risks by a reasonably prudent patient.
Facts:
- Joseph Howard, who had a history of cervical spine disease, suffered a worsening of his condition after a 1997 car accident.
- Howard was referred to Dr. Robert Heary, a neurosurgeon, who recommended a surgical procedure known as a corpectomy.
- Dr. Heary conducted two pre-operative consultations with Howard and his wife.
- During the second consultation, the Howards allege they specifically asked about Dr. Heary's qualifications.
- The Howards claim Dr. Heary represented that he was Board Certified and had performed approximately sixty corpectomies per year for eleven years.
- Relying on these alleged representations of skill and experience, the Howards consented to the surgery.
- Dr. Heary performed the corpectomy on March 5, 1997.
- The surgery was unsuccessful, and Joseph Howard was rendered quadriplegic as a result.
Procedural Posture:
- Joseph Howard and his wife sued Dr. Robert Heary in a state trial court for medical malpractice based on negligence.
- During pretrial discovery, the Howards learned that Dr. Heary was not Board Certified at the time of the surgery and had performed far fewer corpectomies than allegedly represented.
- The Howards filed a motion in the trial court to amend their complaint to add a count for fraud.
- The trial court denied the Howards' motion to amend the complaint.
- The Howards were granted leave to appeal the interlocutory order to the Appellate Division, an intermediate appellate court.
- The Appellate Division reversed the trial court, ruling that the complaint could be amended to include a 'deceit based claim.'
- Dr. Heary (defendant-appellant) was granted leave to appeal the Appellate Division's decision to the Supreme Court of New Jersey, the state's highest court.
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Issue:
Does a physician's alleged misrepresentation of his professional experience and credentials to obtain a patient's consent for surgery support a distinct cause of action for fraud?
Opinions:
Majority - LaVecchia, J.
No. A physician's misrepresentation of credentials and experience to a patient does not support a distinct cause of action for fraud; rather, such allegations are properly addressed within a claim for lack of informed consent. The court reasoned that allowing a separate fraud claim would circumvent the specific causation and damages requirements of established medical torts and would improperly introduce the possibility of punitive damages. The court distinguished this situation from battery, such as in "ghost surgery," because the physician to whom consent was given did perform the procedure. The appropriate framework is lack of informed consent, where a physician's serious misrepresentation can be material if it is something a reasonably prudent patient would consider significant in assessing the risks of a procedure. To succeed on such a claim, a plaintiff must prove not only that they would have withheld consent, but also that the physician's actual, lesser experience substantially increased the risk of the harm that occurred, and that this increased risk was the cause of the injury.
Analysis:
This decision integrates claims of physician misrepresentation into the existing doctrine of informed consent rather than creating a new fraud-based tort in the medical context. By doing so, the court reinforces the negligence-based framework for consent-related claims and avoids the complexities of applying intentional tort principles, such as punitive damages. The ruling establishes a significant gatekeeper function for trial courts by creating a stringent, two-part causation test. This test requires plaintiffs to prove, via expert testimony, that the physician's actual experience level substantially increased the objective medical risk of the specific harm suffered, thus preventing claims based merely on a patient's subjective preferences or on misrepresentations that had no material impact on the procedure's risk profile.
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