Sard v. Hardy
379 A.2d 1014, 281 Md. 432 (1977)
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Rule of Law:
A physician has a duty to disclose all information that a reasonable person in the patient's position would find material to their decision-making process regarding a proposed medical treatment. The scope of this duty is measured by the patient's need for information, not by the professional custom of other physicians.
Facts:
- After a life-threatening first pregnancy involving eclampsia and two subsequent Caesarean sections, Katie Sue Sard discussed permanent sterilization with her physician, Dr. Erving D. Hardy.
- Dr. Hardy recommended a tubal ligation, which he performed during Mrs. Sard's third C-section, stating that future pregnancies would endanger her life.
- He used the 'Madlener technique,' which had a 2% failure rate when performed during a C-section, but did not inform the Sards of this specific risk.
- Dr. Hardy did not disclose that alternative sterilization techniques, such as the Uchida or Irving methods, had significantly lower failure rates (less than 0.1%).
- He also failed to inform Mrs. Sard that the procedure's success rate would be dramatically higher if performed at a time other than during the C-section.
- Mrs. Sard testified that Dr. Hardy affirmatively assured her before the operation that she would not have any more children.
- The Sards were not informed about vasectomy as an alternative, and Mr. Sard, who was functionally illiterate, signed a consent form without reading it, as did his wife just before surgery.
- Following the procedure, Mrs. Sard became pregnant for a fourth time and delivered a healthy child via C-section.
Procedural Posture:
- Katie Sue Sard and David Penn Sard, Jr. sued Dr. Erving D. Hardy in the Circuit Court for Talbot County, a trial court.
- The complaint included counts for negligence, lack of informed consent, and breach of express warranty.
- At the close of the Sards' case at trial, the judge granted a directed verdict in favor of Dr. Hardy.
- The Sards, as appellants, appealed the judgment to the Court of Special Appeals of Maryland, an intermediate appellate court.
- A divided Court of Special Appeals affirmed the trial court's judgment, finding the 2% risk of failure was not material as a matter of law.
- The Sards, as appellants, 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:
Is evidence that a physician failed to disclose the specific risk of failure of a sterilization procedure, the existence of more effective alternative procedures, and the option to perform the procedure at a later time with a higher success rate legally sufficient to allow a jury to decide a claim for lack of informed consent?
Opinions:
Majority - Levine, J.
Yes. A physician's duty to disclose information is measured by its materiality to the patient’s decision, and the evidence presented was sufficient for a jury to determine whether the withheld information was material. The court formally adopted the 'materiality' or 'prudent patient' standard for informed consent, rejecting the 'professional' standard that bases the duty on what other physicians customarily disclose. A risk is material if a physician knows or should know it would be significant to a reasonable person in the patient's position. The court found that the 2% failure rate, the existence of more effective alternatives, and the option to perform the procedure at a more opportune time were all facts a jury could find material to a reasonable patient's decision. Causation should be judged by an objective standard: whether a reasonable person in the patient's position would have withheld consent if fully informed. Given Mrs. Sard's desire to avoid the health and financial risks of another pregnancy, a jury could conclude that a reasonable person with full information would have chosen a different course.
Analysis:
This landmark decision establishes the modern, patient-centered standard for informed consent in Maryland, shifting the legal focus from medical custom to the patient's right to self-determination. By adopting the 'materiality' standard, the court makes it easier for plaintiffs to bring informed consent claims, as they no longer need expert testimony to establish the scope of the physician's duty to disclose. The adoption of an objective test for causation balances this patient-centric approach by preventing recovery based solely on the patient's self-serving hindsight, thereby protecting physicians from frivolous claims. This case sets a crucial precedent for how patient-physician communication is evaluated in medical malpractice litigation.
