Woolley v. Henderson
418 A.2d 1123, 1980 Me. LEXIS 645 (1980)
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Rule of Law:
A physician's duty to disclose information to a patient for informed consent purposes is measured by the professional standard of care, which is what a reasonable medical practitioner would disclose under similar circumstances. Causation in an informed consent claim is judged by an objective standard, requiring the plaintiff to show that a reasonable person in the patient's position would have declined treatment if adequately informed of the risks.
Facts:
- Linda Woolley had a history of back problems and a prior surgery in 1965 for a ruptured disc at the L4, L5 vertebrae.
- In January 1976, experiencing renewed pain, Woolley consulted Dr. Lester K. Henderson, an orthopedic surgeon.
- Dr. Henderson diagnosed a ruptured disc at the L4, L5 level and, after conservative treatments failed, recommended surgery.
- In February 1976, Dr. Henderson performed a laminectomy on Woolley.
- Due to a congenital abnormality in Woolley's spine that made it difficult to count the vertebrae, Dr. Henderson operated at the L3, L4 interspace instead of the intended L4, L5 level.
- During the procedure, Dr. Henderson inadvertently tore the dura, the protective tissue around the spinal cord, causing a spinal fluid leak. Medical experts for both sides agreed this was a normal risk of such surgery.
- Post-surgery, Woolley's pain intensified, and she developed chronic adhesive arachnoiditis, a condition causing severe, intractable back pain.
- Another physician later performed a successful surgery on Woolley at the correct L4, L5 interspace, which alleviated some, but not all, of her pain.
Procedural Posture:
- Linda and Brandon Woolley filed a four-count complaint against Dr. Lester K. Henderson in the Superior Court, Somerset County.
- Prior to trial, the presiding justice struck the plaintiffs' implied contract count sua sponte, ruling it was redundant to the negligence claim.
- At the close of evidence, the court denied the plaintiffs' motion to amend their complaint to add a battery claim.
- The case was tried before a jury, which returned a verdict in favor of the defendant, Dr. Henderson.
- The Superior Court entered a final judgment for the defendant on April 13, 1979.
- The plaintiffs, Linda and Brandon Woolley, appealed from that judgment to the Supreme Judicial Court of Maine.
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Issue:
Is a physician's duty to disclose risks of a proposed surgery measured by the 'professional standard' of what a reasonable medical practitioner would disclose, as established by expert testimony, rather than the 'material-risk' standard of what a reasonable patient would want to know?
Opinions:
Majority - Justice Glassman
Yes. A physician’s obligation to disclose risks is measured by the professional standard of care, not a patient-centric standard of materiality. To establish a breach of this duty, a plaintiff must ordinarily use expert medical testimony to show that the physician deviated from the standard of care of a reasonable practitioner in the same field. The court rejected the 'material-risk' standard, which is based on a patient's need for information, fearing it would allow lay juries to judge complex medical decisions with the benefit of hindsight, place good medical practice in jeopardy, and force physicians to practice defensively. Furthermore, the court held that causation must be determined by an objective test: whether a reasonable person in the patient's position would have refused the treatment if properly informed, not whether the specific plaintiff subjectively would have refused. The court also clarified that a good-faith surgical error, such as operating on the wrong level, sounds in negligence, not battery, and that malpractice claims are tort actions, not actions for breach of an implied contract.
Concurring - Justice Roberts
Justice Roberts concurs with the judgment to vacate and remand for a new trial but writes separately to emphasize the error in the voir dire process. He argues that the presiding justice committed a clear abuse of discretion by not promptly removing jurors who had been excused for cause. The danger of prejudice from their continued participation was eminently foreseeable, and allowing them to answer further questions created an unfair impression that could have impaired the remaining jurors' ability to be impartial.
Analysis:
This decision establishes Maine's adoption of the traditional, physician-centric 'professional standard' for informed consent, rejecting the growing trend of the patient-centric 'material-risk' standard. By requiring expert testimony to define the scope of disclosure and applying an objective test for causation, the court significantly raises the evidentiary burden for plaintiffs in medical malpractice cases based on lack of informed consent. This ruling protects physicians from liability based on a patient's hindsight and a jury's lay judgment, thereby solidifying a more conservative, pro-defendant approach in this area of tort law. The opinion also streamlines malpractice litigation by confining claims for good-faith medical errors to negligence, rather than allowing separate claims for battery or breach of implied contract.
