Schwartz v. Johnson
206 Md. App. 458, 2012 WL 2408435, 49 A.3d 359 (2012)
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Rule of Law:
Evidence of a patient's informed consent to the known risks of a medical procedure is irrelevant and unduly prejudicial in a medical malpractice action based solely on a theory of negligence. A patient's consent to a procedure does not constitute an assumption of the risk of the physician's negligence in performing that procedure.
Facts:
- Arvia Johnson underwent an elective outpatient colonoscopy performed by H. Jeffrey Schwartz, M.D.
- Prior to the procedure, Dr. Schwartz informed Johnson of the potential risks and complications, including the risk of bowel perforation.
- During the colonoscopy, Johnson's colon was perforated.
- As a result of the perforation, Johnson suffered severe pain, required multiple corrective surgeries, and developed permanent Short Bowel Syndrome.
- Johnson's theory of the case was that Dr. Schwartz's negligent technique with the colonoscope's tip caused the injury.
- Dr. Schwartz's defense theory was that the perforation was a non-negligent complication known as 'bowing,' which is an accepted risk of the procedure.
Procedural Posture:
- Arvia Johnson sued Dr. H. Jeffrey Schwartz and H. Jeffrey Schwartz, M.D., P.A. in the Circuit Court for Baltimore City for medical negligence.
- Prior to trial, Johnson filed a motion in limine to bar the introduction of any evidence related to informed consent.
- The trial court granted Johnson's motion.
- Following a five-day trial, the jury found that Dr. Schwartz was negligent and that his negligence caused Johnson's injuries.
- The jury awarded Johnson $23,791.19 in past medical expenses and $650,000.00 in non-economic damages.
- Dr. Schwartz (appellant) filed a motion for a new trial, which the trial court denied.
- Dr. Schwartz then appealed the judgment to the Court of Special Appeals of Maryland, with Johnson as the appellee.
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Issue:
Did the trial court err by excluding evidence that a physician advised a patient of a procedure's risks and complications when that evidence was offered to support an assumption of the risk defense in a medical malpractice case where the patient only alleged negligence, not lack of informed consent?
Opinions:
Majority - Woodward, J.
No, the trial court did not err. Evidence of informed consent is inadmissible in a pure medical negligence case because the doctrines of negligence and informed consent are separate and distinct theories of liability. Allowing such evidence would confuse the jury into believing that a patient's consent to a known risk of a procedure is equivalent to consenting to the physician's negligence, which is legally incorrect. The court reasoned that medical malpractice claims are predicated on a physician's failure to exercise the requisite skill (a breach of the standard of care), whereas informed consent claims relate to the physician's duty to disclose information before treatment. Admitting consent evidence in a negligence case could lead a jury to wrongly conclude the patient waived their right to complain about a negligently inflicted injury. Furthermore, the affirmative defense of assumption of the risk is inapplicable in this context because a patient, possessing inferior medical knowledge, does not voluntarily assume the risk of a physician's negligence; they only consent to the known, non-negligent risks. The defense is reserved for rare situations, such as a patient refusing recommended treatment or pursuing unconventional care, neither of which occurred here.
Analysis:
This decision reinforces a critical distinction in medical malpractice law between claims based on negligent performance and claims based on a lack of informed consent. It significantly narrows the availability of the assumption of the risk defense for healthcare providers in Maryland, effectively shielding patients from arguments that they 'accepted the risk' of a doctor's carelessness simply by consenting to a procedure. The ruling protects plaintiffs by preventing juries from being confused or prejudiced by consent forms in cases where the core issue is the quality of care, not the adequacy of pre-procedure warnings. This precedent clarifies that a consent form is not a liability shield for negligent conduct.
