Valles v. Albert Einstein Medical Center
758 A.2d 1238, 2000 Pa. Super. 243, 2000 Pa. Super. LEXIS 2116 (2000)
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Rule of Law:
A hospital cannot be held vicariously liable for a physician's failure to obtain a patient's informed consent, even if the physician is a hospital employee. The doctrine of informed consent requires a physician to inform a patient of all medically recognized and viable alternative methods of performing a surgical procedure, not merely alternative procedures.
Facts:
- In November 1992, Lope Valles was admitted to Albert Einstein Medical Center (AEMC) with a suspected aortic aneurysm.
- An aortogram was performed by Dr. Steven Allen, a radiologist employed by AEMC, after Dr. Muriel Gordon, a resident, obtained Valles's consent.
- Valles experienced a reaction to the contrast material used in the aortogram, which caused renal failure and necessitated dialysis.
- To facilitate dialysis, a more permanent catheter was required, and the surgery was to be performed by Dr. Jay Morros.
- Dr. Wladis, a medical resident, informed Valles of the general risks of the catheter implantation but did not discuss specific, alternative placement sites for the catheter.
- During the procedure, Dr. Morros chose to place the catheter in Valles's right subclavian vein.
- While attempting to insert the catheter, Dr. Morros's guidewire penetrated the vein and entered Valles's chest, causing a hemopneumothorax (collapsed lung) and cardiac arrest.
- Valles lapsed into a coma due to oxygen deprivation and died on January 16, 1993, without regaining consciousness.
Procedural Posture:
- Esmelinda Valles, as administratrix of Lope Valles's estate, filed a wrongful death and survival action in a state trial court against Albert Einstein Medical Center (AEMC), Dr. Morros, and others.
- During discovery, Valles (Plaintiff) narrowed her claims to focus on AEMC's vicarious liability for its employee Dr. Allen's alleged failure to obtain informed consent, and Dr. Morros's failure to obtain informed consent regarding catheter placement sites.
- AEMC (Defendant) filed a motion for summary judgment, which the trial court granted.
- Dr. Morros (Defendant) filed a motion in limine, which the trial court treated as a motion for a compulsory nonsuit and granted before the trial began.
- Valles (Appellant) appealed both the summary judgment order in favor of AEMC and the nonsuit order in favor of Dr. Morros to the Superior Court of Pennsylvania, the state's intermediate appellate court.
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Issue:
Is a hospital vicariously liable for its employee-physician's failure to obtain a patient's informed consent, and does the informed consent doctrine require a surgeon to advise a patient of alternative, medically viable sites for the surgical implantation of a medical device?
Opinions:
Majority - Joyce, J.
No, a hospital is not vicariously liable for its physician's failure to obtain informed consent, but yes, the informed consent doctrine does require discussion of alternative viable surgical methods. A hospital cannot be held vicariously liable because it does not control the manner in which a highly specialized physician performs their work; imposing such liability would improperly inject the hospital into the physician-patient relationship. The duty to obtain informed consent is personal to the physician performing the procedure. Regarding the scope of consent, the doctrine extends to the method or manner of surgery, requiring a physician to inform a patient of medically recognized and viable alternative methods. However, in this case, summary judgment for Dr. Morros was proper because the undisputed evidence showed that, in Dr. Morros's medical judgment, no other catheter placement sites were medically viable for Valles given his specific health history and condition.
Dissenting - Del Sole, J.
Yes, a hospital should be vicariously liable for its employee-physician's failure to obtain informed consent, and the issue of whether alternative sites were viable should have been decided by a jury. Under standard principles of agency law, an employer (the hospital) is liable for the torts of its employee (Dr. Allen) committed within the scope of employment. Regarding Dr. Morros, summary judgment was improper because the plaintiff's expert, Dr. Leitman, explicitly testified that the right femoral vein was a viable alternative site for the catheter. This testimony created a genuine issue of material fact as to whether Dr. Morros breached his duty of informed consent, which is a question for a jury, not a judge, to decide.
Concurring-in-part-and-dissenting-in-part - Musmanno, J.
No, the hospital is not vicariously liable, but the claim against Dr. Morros should have proceeded to a jury. I agree with the majority that a hospital has no duty under the informed consent doctrine, so summary judgment for AEMC was proper. However, I agree with the dissent that a genuine issue of material fact existed regarding whether there were viable alternative sites for the catheter, and therefore summary judgment should not have been granted in favor of Dr. Morros.
Analysis:
This decision reinforces a significant limitation on hospital liability in Pennsylvania, holding that the duty of informed consent is non-delegable and rests solely with the physician. By rejecting vicarious liability even for employee-physicians, the court insulates hospitals from a major category of medical malpractice claims, emphasizing the physician's independent professional judgment. The decision also expands the scope of the informed consent doctrine itself, clarifying that a physician's disclosure duty includes not just different treatments but also different methods of performing the same treatment. Future litigation will likely focus on what constitutes a 'medically viable' alternative that triggers this expanded duty to disclose.
