McQuitty v. Spangler
2009 Md. LEXIS 563, 976 A.2d 1020, 410 Md. 1 (2009)
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Rule of Law:
A cause of action for lack of informed consent does not require an affirmative physical violation of the patient's integrity. A healthcare provider has a continuing duty to disclose material information that a reasonable person would find significant in deciding whether to continue with a previously consented-to course of treatment.
Facts:
- On March 30, 1995, Peggy McQuitty, who was 28 weeks pregnant, was admitted to a hospital under the care of Dr. Donald Spangler due to vaginal bleeding caused by a partial placental abruption.
- Dr. Spangler recommended, and McQuitty consented to, a plan of hospitalization and expectant management ('watchful waiting') to allow the fetus to mature before performing a planned Cesarean section.
- On April 12, an ultrasound revealed a new, significant placental abruption, but McQuitty testified she was not informed of this development.
- On April 28, another ultrasound showed the fetus was suffering from intrauterine growth restriction (IUGR), a serious condition. McQuitty testified Dr. Spangler's explanation was inadequate and left her with the impression the baby was merely small.
- On May 3, a test revealed oligohydramnios (dangerously low amniotic fluid). McQuitty pleaded with Dr. Spangler to deliver the baby, but he advised her to continue waiting.
- Dr. Spangler stipulated that he never offered McQuitty the alternative of an elective Cesarean section at any point after her initial consent to hospitalization and before the final emergency.
- On May 8, 1995, McQuitty suffered a complete placental abruption, which required an emergency C-section.
- As a result of the complete abruption, her son, Dylan McQuitty, was born with severe and permanent neurologic injuries, including cerebral palsy.
Procedural Posture:
- Peggy McQuitty sued Dr. Donald Spangler in the Circuit Court for Baltimore County (a trial court) for medical malpractice and lack of informed consent.
- At the first trial, a jury returned a verdict for Dr. Spangler on the malpractice claim but deadlocked on the informed consent claim.
- A second trial was held solely on the issue of informed consent, and the jury found for the McQuittys, awarding them $13,078,515.00 in damages.
- Dr. Spangler filed a motion for judgment notwithstanding the verdict (JNOV), which the trial judge granted, overturning the jury's verdict on the grounds that an informed consent claim requires an 'affirmative violation of the patient’s physical integrity.'
- The McQuittys, as appellants, appealed to the Court of Special Appeals (an intermediate appellate court).
- The Court of Special Appeals affirmed the trial court's judgment, agreeing that an affirmative physical violation was a necessary element of the claim.
- The McQuittys petitioned for a writ of certiorari to the Court of Appeals of Maryland (the state's highest court), which was granted.
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Issue:
Under Maryland law, does a cause of action for lack of informed consent require an affirmative violation of the patient's physical integrity?
Opinions:
Majority - Battaglia, J.
No, an informed consent claim may be asserted by a patient in the absence of an affirmative violation of the patient’s physical integrity. The doctrine of informed consent is grounded in negligence and focuses on the healthcare provider's duty to communicate all information material to a patient's decision-making. This duty requires a provider to inform a patient of material changes in their condition, along with the risks and alternatives, so the patient can make an intelligent choice about whether to continue with a course of treatment. The court explicitly rejected prior interpretations that limited informed consent claims to cases involving a physical battery, clarifying that the 'affirmative physical invasion' standard was based on a misapplication of out-of-state case law. The core purpose of the doctrine is to protect a patient's autonomy and their right to determine what shall be done with their own body, which includes the right to withdraw consent or choose an alternative treatment based on new, material information.
Analysis:
This decision significantly clarifies and expands the doctrine of informed consent in Maryland by explicitly rejecting the 'affirmative physical invasion' requirement. By grounding the claim firmly in negligence rather than battery, the court extends the physician's duty to disclose beyond just obtaining consent for a specific procedure. The ruling establishes that a physician's failure to update a patient on material changes and alternative treatments during an ongoing course of care can constitute a breach of informed consent. This precedent broadens potential liability for physicians in 'watchful waiting' scenarios and empowers patients to bring claims for harm resulting from a lack of information, even when no new invasive procedure was performed.
