Valles v. Albert Einstein Medical Center
805 A.2d 1232 (2002)
Premium Feature
Subscribe to Lexplug to listen to the Case Podcast.
Rule of Law:
A medical facility cannot be held vicariously liable for a physician's failure to obtain a patient's informed consent, as this duty is personal to the physician and outside the hospital's scope of control. Furthermore, the doctrine of informed consent requires disclosure of alternative treatments, not alternative methods or techniques for performing a single, agreed-upon surgical procedure.
Facts:
- Lope Valles, a diabetic, was admitted to Albert Einstein Medical Center (AEMC) for a suspected abdominal aortic aneurysm.
- An aortogram was scheduled, and Dr. Allen performed the procedure after a radiology resident obtained Valles' written consent. Following the procedure, Valles' kidney function worsened.
- Valles was later readmitted to AEMC with renal failure and, after his aneurysm was repaired, required extended dialysis.
- To facilitate dialysis, doctors recommended the surgical placement of a Permacath catheter, to be performed by Dr. Morros.
- A surgical resident obtained Valles' written consent for the Permacath insertion, advising of general risks such as bleeding and death, but did not discuss the specific anatomical site where the catheter would be placed.
- Dr. Morros attempted to insert the Permacath into Valles' right subclavian (chest) vein.
- During the insertion procedure, Valles suffered a hemopneumothorax (air and blood in the chest cavity) and cardiac arrest.
- Valles subsequently fell into a coma and died nine days later on January 16, 1993.
Procedural Posture:
- Esmelinda Valles, as administrator of Lope Valles's estate, filed a complaint in the trial court against Albert Einstein Medical Center (AEMC), Dr. Jay Morros, and others.
- AEMC filed a motion for summary judgment.
- The trial court granted AEMC's motion for summary judgment, dismissing it from the case.
- Dr. Morros filed a pre-trial motion to preclude informed consent claims, which the trial court granted, dismissing the claim against him.
- Valles (Appellant) appealed the dismissals of both AEMC and Dr. Morros (Appellees) to the Superior Court of Pennsylvania.
- A divided en banc panel of the Superior Court affirmed the trial court's orders.
- The Supreme Court of Pennsylvania granted allocatur to hear the appeal from Valles and a cross-appeal from Morros.
Premium Content
Subscribe to Lexplug to view the complete brief
You're viewing a preview with Rule of Law, Facts, and Procedural Posture
Issue:
1. Can a hospital be held vicariously liable under the doctrine of respondeat superior for its employee-physician's failure to obtain a patient's informed consent? 2. Does the doctrine of informed consent require a physician to disclose alternative methods or sites for performing a proposed surgical procedure, in addition to discussing alternatives to the procedure itself?
Opinions:
Majority - Justice Cappy
1. No. A hospital cannot be held vicariously liable for a physician's failure to obtain informed consent. The duty to obtain informed consent is a non-delegable duty that belongs solely to the physician and is based on the highly individualized physician-patient relationship. A medical facility lacks the necessary control over this aspect of care to justify vicarious liability, meaning a battery resulting from lack of informed consent does not occur within the scope of employment for purposes of respondeat superior. 2. No. The doctrine of informed consent does not require a physician to discuss alternative methods or techniques for performing a proposed surgical procedure. The doctrine is limited to disclosing material risks, complications, and alternatives to the proposed procedure. The choice of an insertion site for a catheter is a matter of surgical technique and professional judgment, and a claim challenging that choice sounds in negligence, not in battery for lack of informed consent.
Dissenting - Justice Nigro
1. Yes. A hospital can be held vicariously liable for its employee-physician's failure to obtain informed consent. Obtaining consent is an integral part of performing a surgical procedure, which is precisely the kind of work the physician is employed by the hospital to perform. Therefore, the failure to obtain consent falls within the scope of employment, and a jury should determine the hospital's liability. 2. Yes. A patient should be advised of viable alternative locations for a surgical procedure, as these constitute alternative types of treatment. The choice between different surgical sites, each with its own set of risks, is a material fact that a reasonable person would consider significant. Therefore, the failure to discuss alternative viable sites for the Permacath is a proper basis for an informed consent claim.
Concurring-in-part-and-dissenting-in-part - Justice Saylor
Joins the majority in holding that the doctrine of informed consent does not encompass a choice among alternative sites for performing a surgical procedure. However, dissents from the majority's holding regarding vicarious liability and joins Justice Nigro's dissenting opinion on that issue, concluding that a hospital can be held vicariously liable for its employee-physician's failure to obtain informed consent.
Analysis:
This decision significantly shields hospitals from liability by creating a legal exception for informed consent claims, establishing that the duty to inform is exclusively the physician's, regardless of employment status. It reinforces the non-delegable nature of this duty, preventing plaintiffs from using the 'deep pockets' of a hospital to recover for a physician's communication failure. The ruling also narrows the scope of the informed consent doctrine by distinguishing between alternative treatments (which must be disclosed) and alternative techniques for a single procedure (which need not be). This distinction forces plaintiffs to challenge a physician's choice of technique under a negligence standard, which requires expert testimony to establish a breach of the standard of care, rather than the intentional tort of battery for lack of consent.
