Court: Court of Appeals for the Seventh Circuit; January 25, 1988; Federal Appellate Court
Sheila Mele, the plaintiff, filed a medical malpractice lawsuit against Sherman Hospital after undergoing a tubal ligation performed by Dr. Jae Han, an independent physician with staff privileges at the hospital. The district court granted the hospital's motion for a directed verdict, leading to Mele's appeal, which was ultimately affirmed by the Seventh Circuit Court of Appeals.
Mele entered the hospital for a laparoscopic tubal ligation, a procedure that involves a small incision and use of gas to locate and cut the fallopian tubes. The hospital’s bylaws require patient consent for surgical operations, except in emergencies. Upon admission, Mele signed a consent form prepared by the hospital, which outlined authorized treatments and risks associated with surgery. The form, filled out by a nurse, specified a "laparoscopic tubal coagulation" but did not mention a laparotomy.
During the surgery, Dr. Han inadvertently nicked a membrane in Mele's abdomen, leading him to perform a laparotomy to investigate bleeding. He noticed the bleeding had stopped and completed the procedure without further remedial action, resulting in a scar on Mele's abdomen. Mele claimed that Dr. Han did not inform her of the surgical risks, while Dr. Han stated he communicated some risks but deemed the chance of complications minimal.
Mele initially sued Dr. Han in 1983 for negligent performance and failure to obtain informed consent, but a jury ruled in favor of Dr. Han.
Mele filed a lawsuit against the Hospital, claiming negligent failure to obtain her informed consent following a prior verdict. The Hospital's motion for summary judgment based on the preclusion of the suit by Mele's earlier lawsuit was denied, but the district court later granted the Hospital a directed verdict after Mele's case-in-chief was presented. Jurisdiction was established under 28 U.S.C. § 1332 for diversity of citizenship and 28 U.S.C. § 1291 for appeal.
The court applies the state standard of review in diversity cases, specifically the Pedrick standard from Illinois, which dictates that directed verdicts should only be granted when the evidence overwhelmingly favors the moving party. In medical malpractice cases, the plaintiff must demonstrate the standard of care required by the hospital, show a deviation from that standard, and link that deviation to the harm suffered.
Mele did not prove that the standard of care required the Hospital to warn her of potential surgical risks from an independent physician. The court noted that the Hospital's duty involves reasonable conduct, which can be established through various forms of evidence, including expert testimony and hospital bylaws. The Hospital's bylaw requiring informed consent does not impose a duty on the Hospital to ensure that patients are informed of risks; it directs independent physicians to obtain consent but does not create liability for the Hospital itself. The district court concluded that it was unlikely a reasonable jury could find that the bylaw imposed such a duty on the Hospital.
The court upheld the district court's ruling, agreeing that the consent form provided by the Hospital does not obligate the Hospital to ensure that a physician fully informs the patient. Expert testimony from Dr. Hassan indicated that the consent form signed by Mele was "incomplete" as it did not mention the possibility of a laparotomy, but he clarified that it is the doctor's duty to inform patients of surgical risks, not the Hospital's. During cross-examination, Dr. Hassan confirmed he did not believe the Hospital should have included information not provided by the physician on the consent form.
The evidence presented only suggested that the Hospital's responsibility was to create a system facilitating informed consent, which it did through its bylaws and consent form. Patients received a pamphlet before surgery, emphasizing that the physician is responsible for explaining the procedure and encouraging questions. The court found that Mele was adequately informed about potential risks, including blood loss, and had consented to additional procedures for unforeseen complications.
Informed consent requires patients to be aware of foreseeable risks and alternatives. However, Dr. Hassan's testimony did not imply that failing to mention a laparotomy constituted a lack of discretion in disclosing necessary information. The court concluded that Mele did not establish the Hospital's standard of care or a breach of that standard, thus affirming the verdict in favor of the Hospital. The concurring opinion by Circuit Judge Ripple reiterated that the Hospital was not required to guarantee informed consent.
The hospital was not responsible for obtaining consent, concluding the case without further commentary on the adequacy of the advice provided. The principles established in Erie R.R. Co. v. Tompkins highlight that states possess the exclusive authority to legislate in areas not reserved for the federal government. Consequently, federal courts should limit their involvement in state law matters, particularly regarding informed consent, which Illinois has defined. The development of these principles should occur on a case-by-case basis, free from federal judicial interference, especially in contexts involving novel surgical techniques. The adequacy of disclosure in such situations warrants careful consideration from state lawmakers and judges. While Illinois courts may disregard federal opinions on state law, any federal rulings can influence reliance until state courts have the opportunity to address the issue. Therefore, the author refrains from endorsing the portion of the opinion that discusses this topic.
