Rizzo v. Schiller
445 S.E.2d 153, 10 Va. Law Rep. 1510, 248 Va. 155 (1994)
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Rule of Law:
A physician's duty to obtain a patient's informed consent is not satisfied by a general authorization form signed upon hospital admission. The duty requires a physician to make a reasonable disclosure of significant facts about a specific procedure, its risks, and alternatives, as a reasonable medical practitioner would under the same or similar circumstances.
Facts:
- Pamela Rizzo was admitted to Fairfax Hospital in active labor.
- Upon admission, Ms. Rizzo signed a general form titled 'Authorization for Medical and Surgical Procedures,' which did not specify any particular procedures or risks.
- After approximately 12 hours of labor and unsuccessful attempts by Ms. Rizzo to push the baby through the birth canal, her physician, Dr. Maurice Schiller, announced he was going to use forceps.
- Without providing any information about the risks or alternatives to using forceps, Dr. Schiller immediately used them to deliver the baby's head.
- The baby, Michael Sean Rizzo, Jr., was subsequently diagnosed with a subdural hematoma, a head trauma which expert testimony linked to the use of the forceps.
- Michael's injury resulted in cerebral palsy and permanent disability.
- A medical expert testified that in a non-emergent situation, the standard of care required Dr. Schiller to inform Ms. Rizzo about the use of forceps and allow her to participate in the decision.
- The same expert opined that Ms. Rizzo could have delivered the baby spontaneously without forceps if Dr. Schiller had waited.
Procedural Posture:
- Michael Sean Rizzo, Jr. and his parents (plaintiffs) filed a medical malpractice action against Dr. Maurice Schiller (defendant) in a state trial court.
- The complaint alleged two theories: negligent use of forceps and failure to obtain informed consent.
- The case proceeded to a jury trial.
- At the conclusion of the plaintiffs' case, the trial court granted Dr. Schiller's motion to strike the plaintiffs' evidence on the informed consent claim.
- The case went to the jury solely on the theory of negligent use of forceps, and the jury returned a verdict for Dr. Schiller.
- The Rizzos (appellants) appealed the trial court's decision to strike their informed consent claim to the Supreme Court of Virginia, with Dr. Schiller as the appellee.
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Issue:
Does a patient's signature on a general authorization form for medical and surgical procedures upon hospital admission satisfy a physician's duty to obtain informed consent for a specific, subsequent procedure like the use of obstetrical forceps?
Opinions:
Majority - Justice Hassell
No. A physician's duty to obtain a patient's informed consent for a specific medical procedure is not fulfilled by having the patient sign a generalized consent form upon admission. The law requires informed consent, not merely consent, which means a physician must make a reasonable disclosure of all significant facts concerning the procedure, including risks and alternatives, that a reasonable medical practitioner would provide under the circumstances. In this case, the authorization form signed by Ms. Rizzo was so general that it failed to inform her of any specific procedures or associated risks, thus it did not constitute informed consent for the use of forceps. The plaintiffs presented sufficient expert testimony that the standard of care required Dr. Schiller to inform Ms. Rizzo and involve her in the decision, and that his failure to do so was a breach of that duty. Furthermore, the evidence was sufficient for a jury to find that this breach was the proximate cause of the baby's injury.
Analysis:
This decision solidifies the legal distinction between general consent to treatment and specific, informed consent for a particular procedure. It clarifies that a patient's signature on a blanket authorization form at the time of admission does not absolve a physician of the ongoing duty to inform the patient about subsequent, significant interventions. The ruling emphasizes the importance of patient autonomy and shared decision-making in medical treatment. It reinforces that in medical malpractice cases based on lack of informed consent, expert testimony is crucial for establishing the standard of care regarding what information a reasonable physician should have disclosed.
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