Payne v. Marion General Hospital
1990 WL 10179, 549 N.E.2d 1043, 1990 Ind. App. LEXIS 144 (1990)
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Rule of Law:
A physician has a duty to obtain a patient's informed consent before issuing a 'no code' (do not resuscitate) order. A breach of this duty does not require expert medical testimony if there is evidence the patient was competent and the physician made no effort whatsoever to obtain consent, as this failure falls within a layperson's comprehension.
Facts:
- Cloyd Payne, a 65-year-old man with numerous serious health conditions, was admitted to Marion General Hospital under the care of Dr. Miles W. Donaldson on June 6, 1983.
- By the evening of June 11, Payne's condition had worsened, with a rising temperature and labored breathing.
- Deposition testimony from several nurses indicated that Payne was conscious, alert, and capable of communicating verbally or through eye contact on June 11, remaining so until moments before his death.
- Payne’s sister visited him and, after observing his condition, informed a nurse that she did not want him to be resuscitated.
- The nurse relayed this request to Dr. Donaldson by telephone. Dr. Donaldson had not seen Payne for several hours.
- Without attempting to assess Payne's competency or obtain his consent, Dr. Donaldson authorized a 'no code' order for Payne's chart after speaking with the nurse and Payne's sister.
- Payne died shortly after midnight on June 12, 1983, and, due to the 'no code' order, no cardiopulmonary resuscitation was attempted.
- A year prior, in March 1982, Payne had been treated by Dr. Donaldson for the identical set of medical conditions and had survived.
Procedural Posture:
- Dr. Donaldson initiated a lawsuit against the Estate of Cloyd Payne for payment of medical services in an Indiana trial court.
- The Estate filed a counterclaim against Dr. Donaldson for medical malpractice, also naming his employer, Marion Family Practice, Inc., as a party.
- The Estate's counterclaim also asserted a negligence claim against Marion General Hospital for failing to have adequate safeguards for 'no code' orders.
- Pursuant to Indiana's medical malpractice law, a medical review panel reviewed the claim and issued an opinion that the defendants were not negligent.
- All defendants (Dr. Donaldson, the Practice, and the Hospital) subsequently moved for summary judgment in the trial court.
- The trial court granted summary judgment in favor of all defendants, dismissing the Estate's counterclaim.
- The Estate, as the appellant, appealed the trial court's grant of summary judgment to the Court of Appeals of Indiana.
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Issue:
In a medical malpractice action, is a physician entitled to summary judgment after issuing a 'no code' order without the patient's consent when lay testimony creates a genuine issue of material fact as to the patient's competence at the time the order was given?
Opinions:
Majority - Buchanan, Judge.
No. A physician is not entitled to summary judgment when genuine issues of material fact exist regarding the patient's competence and the physician's failure to obtain informed consent for a 'no code' order. A patient's right of self-determination is the foundation of the physician's duty to obtain informed consent. Here, whether Payne was competent is a question of fact, and the nurses' testimony provided sufficient evidence to create a genuine dispute, precluding summary judgment. Similarly, the fact that Payne had previously survived the same conditions creates a question of fact as to whether he was terminally ill. Because a jury could conclude Payne was competent, it could also find that Dr. Donaldson breached his duty by making no effort to secure Payne's consent. This total failure of disclosure is not a complex medical issue requiring expert testimony; it is within the realm of a layperson's comprehension to determine if such conduct was negligent. Therefore, summary judgment for Dr. Donaldson and his Practice was improper. However, summary judgment was appropriate for the Hospital because the Estate failed to produce any expert testimony to establish the standard of care for hospital policies regarding 'no code' orders or to prove the Hospital's conduct fell below that standard.
Analysis:
This case is significant as a matter of first impression regarding a physician's civil liability for issuing a 'no code' order without patient consent. It strongly affirms the doctrine of informed consent, holding that a physician cannot delegate a competent patient's right of self-determination to a family member. The decision's most impactful aspect is its creation of an exception to the general rule requiring expert testimony in medical malpractice cases. By ruling that a complete failure to seek consent from a seemingly competent patient is understandable by a lay jury, the court lowered the evidentiary burden for plaintiffs in similar informed consent cases, making it easier to survive summary judgment.
