Case Title: Parris v. Limes

Citation: 

Docket Number: 107979

State: oklahoma

Court: Oklahoma Supreme Court

Date: 2012-03-06T00:00:00Z

Document:
PARRIS v. LIMES2012 OK 18Case Number: 107979Decided: 03/06/2012THE SUPREME COURT OF THE STATE OF OKLAHOMA
NOTICE: THIS OPINION HAS NOT BEEN RELEASED FOR PUBLICATION IN 
THE PERMANENT LAW REPORTS. UNTIL RELEASED, IT IS SUBJECT TO REVISION OR 
WITHDRAWAL. 

BOB O. PARRIS, Plaintiff/Appellant,v.BARNEY LIMES, M.D., 
SHELBY D. BARNES, M.D., UROLOGY ASSOCIATES, INC., and SAINT ANTHONY HOSPITAL, 
tradename for SSM HEALTHCARE OF OKLAHOMA, INC., 
Defendants/Appellees,andJAMES BRINKWORTH, M.D., Defendant.
CERTIORARI TO THE COURT OF CIVIL APPEALS, DIVISION 
III,APPEAL FROM THE DISTRICT COURT OFOKLAHOMA COUNTY, 
OKLAHOMAHONORABLE PATRICIA G. PARRISH, JUDGE
¶0 In proceedings on remand from an earlier appeal, the medical-provider 
defendants sought and obtained summary judgments on plaintiff's medical 
malpractice claims relating to the cancer diagnosis of his prostate, its 
surgical removal and post-surgical treatment. The Court of Civil Appeals 
affirmed. This Court has previously granted certiorari. Upon review, we affirm 
summary judgment disposition of all the claims except plaintiff's claim against 
defendant Shelby D. Barnes, M.D., the surgeon who continued post-surgical 
treatment of plaintiff without disclosing the removed prostate showed no signs 
of cancer. We reverse this summary judgment and remand this claim for 
trial.
CERTIORARI PREVIOUSLY GRANTED;THE OPINION OF THE COURT OF 
CIVIL APPEALS IS VACATED;THE TRIAL COURT'S SUMMARY JUDGMENTS AFFIRMED IN 
TOTOEXCEPT AS TO PLAINTIFF'S CLAIM AGAINST DEFENDANT SHELBY D.BARNES, 
M.D. FOR TREATMENT WITHOUT DISCLOSURE.
Bob O. Parris, Oklahoma City, Oklahoma, Pro se Stephen Peterson, 
Beverly Pearson, J. Mark McAlester, FENTON, FENTON, SMITH, RENEAU & MOON, 
Oklahoma City, Oklahoma for Defendant/Appellee Barney Limes, M.D.Russell L. 
Hendrickson, PIERCE COUCH HENDRICKSON BAYSINGER & GREEN, L.L.P., Oklahoma 
City, Oklahoma, for Defendants/Appellees Shelby D. Barnes, M.D. and Urology 
Associates, Inc.,Alexander C. Vosler, James M. Webster, JOHNSON, HANAN AND 
VOSLER, Oklahoma City, Oklahoma, for Defendant/Appellee Saint Anthony Hospital, 
tradename for SSM Healthcare of Oklahoma, Inc.
REIF, J.,
¶1 This certiorari proceeding concerns medical malpractice claims that 
plaintiff asserted against the medical providers who were involved in the cancer 
diagnosis of his prostate, the surgery to remove it and his subsequent 
treatment. The trial court has twice rendered judgments in favor of the 
defendants. The first round of judgments were reversed by Division IV of the 
Court of Civil Appeals in the published case of Parris v. Limes, 
2009 OK CIV APP 19, ___ P.3d____. (Parris 
I) On remand, plaintiff had a jury trial on his claim against the 
pathologist who identified cancerous cells in the needle biopsy specimen of 
plaintiff's prostate. The jury returned a defendant's verdict. The remaining 
defendants sought and obtained summary judgments based on uncontroverted expert 
testimony they acted in accord with medical standards. Plaintiff's appeal of the 
judgment on the jury verdict in favor of the pathologist was dismissed as 
untimely, while Division III of the Court of Civil Appeals affirmed the summary 
judgments (Parris II). Upon certiorari review, we find Parris II 
properly affirmed the summary judgments except on plaintiff's claim against 
the surgeon who continued post-surgical treatment of plaintiff without 
disclosing the removed prostate showed no signs of cancer.
¶2 Briefly, the uncontroverted evidentiary material showed that the biopsy of 
plaintiff's prostate was properly performed by Dr. Limes, and the biopsy 
specimen was properly labeled and handled by Dr. Limes and St. Anthony's 
Hospital. The jury verdict determined there was no negligence by Dr. Brinkworth, 
the pre-surgical pathologist, in diagnosing cancerous cells in the specimen. In 
addition, plaintiff did not controvert the evidence from defendants' expert that 
Dr. Barnes' decision to remove plaintiff's prostate was appropriate in light of 
the diagnosis, and was in accordance with accepted medical practices and 
standards. Furthermore, plaintiff did not controvert the opinion of defendants' 
expert that Dr. Barnes' post-surgical treatment was appropriate based on 
plaintiff's pre-surgical PSA results, the findings in the pre-surgical biopsy 
specimen and cases reported in the medical literature. The expert noted the 
existence of cases where pre-surgical biopsy specimens were positive for cancer, 
post-surgical pathology findings appeared to be negative for cancer and the 
patients experienced a reoccurrence of cancer. These considerations are 
certainly dispositive of any claims of negligence in the medical decisions 
concerning the treatment plaintiff needed and received.1
¶3 These consideration are not dispositive, however, of plaintiff's claim for 
Dr. Barnes' continued treatment of plaintiff without disclosing that the 
post-surgical pathology findings showed no cancer. It is well-settled that in 
determining the propriety of granting a summary judgment, the trial court is not 
only authorized but required to rule out all theories of liability fairly 
encompassed within the evidentiary material presented. Hadnot v. Shaw, 
1992 OK 21, ¶ 25, 826 P.2d 978, 987. One theory of liability not ruled 
out by the evidentiary material presented upon summary judgment was plaintiff's 
right to recover for the physician's failure to obtain "informed consent" prior 
to undertaking the post-surgical treatment.
¶4 While not artfully pleaded or raised in a conventional manner, plaintiff 
did sufficiently call this theory of liability to the trial court's attention in 
Exhibit 19 to his Motion for Summary Judgment and Supplemental Objection to 
Defendants Summary Judgment Motions filed October 13, 2009. This exhibit 
contains the text of Uniform Jury Instruction 14.14 boldly titled INFORMED 
CONSENT-PHYSICIAN'S DUTY. The text of the instruction is accompanied by a 
specific argument relating to Dr. Barnes' rendering of post-surgical treatment 
without disclosing the removed prostate did not have cancer.
¶5 In Oklahoma, "[c]onsent to medical treatment, to be effective, should stem 
from an understanding decision based on adequate information about treatment, 
the available alternatives, and the collateral risks." Scott v. Bradford, 
1979 OK 165, ¶ 10, 606 P.2d 554, 556-7. This requirement is as essential 
as a physician's care and skill in the performance of therapy. Id. at ¶ 
10, 606 P.2d  at 557. Simply put, a physician has an affirmative duty to inform a 
patient of his options and their attendant risks. Id.
¶6 If a physician breaches this duty, a patient's consent is defective, and 
the physician is responsible for the consequences. Id. If the physician 
obtains a patient's consent but has breached this duty to inform, "the patient 
has a cause of action sounding in negligence for failure to inform the patient 
of his options, regardless of due care exercised at treatment, assuming there is 
injury." Id. at ¶ 11, 606 P.2d  at 557. 
¶7 In recognizing this cause of action, the Scott opinion cited 
approvingly the view of the California Court of Appeals that a physician 
violates a duty to his patient and subjects himself to liability if he withholds 
any facts which are necessary to form an intelligent consent by the patient to 
the proposed treatment. Id. at ¶ 13, 606 P.2d  at 557 (citing Salgo v. 
Leland Stanford, Jr., Univ. Bd. of Trustees, 154 Cal. App. 2d 560, 317 P.2d 170 (1957). In the discharge of this duty, a physician is obligated not only to 
disclose what he intends to do, but to supply information which addresses the 
question of whether he should do it. Id.
¶8 A cause of action based on a lack of informed consent has three elements: 
(1) breach of the duty to inform (non-disclosure), (2) causation, and (3) 
injury. Id. at ¶ 18, 606 P.2d  at 558; see also Smith v. Reisig, 
1984 OK 56, ¶ 10, 686 P.2d 285, 288 This cause of action exists to 
protect the prerogative of every patient to chart his own course and to 
determine what action he will take. Scott, 1979 OK 165 at ¶ 14, 606 P.2d  at 557.
¶9 As concerns the duty to inform, the Scott opinion expressly 
considered and declined to adopt a standard of disclosure based on the 
professional standard of custom or usage in a local medical community. 
Id. at ¶ 15, 606 P.2d  at 557-58. The opinion cited approvingly the view 
of the Court of Appeals for the District of Columbia that the standard for 
measuring performance of the duty of disclosure is conduct which is reasonable 
under the circumstances. Id. (citing Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972)). "[T]he scope of a physician's communications must be 
measured by his patient's need to know enough [information] to enable him to 
make an intelligent choice." Id. at ¶ 15, 606 P.2d  at 558.
¶10 The causation element turns on whether plaintiff would have consented to 
the proposed treatment had he been adequately informed. Id. at ¶ 22, 606 P.2d  at 559; Smith, 1984 OK 56 at ¶ 12, 686 P.2d  at 288. If the plaintiff 
testifies he would not have consented to the treatment, then the causation 
problem must be resolved by examining the credibility of the plaintiff's 
testimony. Id. at ¶ 22, 606 P.2d  at 559; Smith, 1984 OK 56 at ¶ 13, 686 P.2d  at 288. The physician 
can protect himself from being at the mercy of a patient's hindsight by insuring 
that he has adequately informed each patient he treats. Scott, 
1979 OK 
165 at ¶ 23, 606 P.2d  at 559.
¶11 In regard to the injury element, the Scott case said that the 
occurrence of an undisclosed risk is important to the determination of injury 
and absent such occurrence, a physician's failure to reveal the risk is possibly 
not actionable. Id. at ¶ 24, 606 P.2d  at 559. While such focus on risk is 
entirely appropriate in cases where the treatment has produced adverse 
consequences, it is not relevant to recovery by a patient who contends he would 
have foregone the treatment altogether, if he had been fully informed of all 
material facts. Again, a physician is obligated not only to disclose what he 
intends to do, but to supply information which addresses the question of whether 
he should do it. Id. at ¶ 13, 606 P.2d  at 557. Furthermore, the physician 
is "responsible for the consequences" of providing treatment without having 
obtained informed consent and one of the elements of damage is any injury and 
expense caused by the treatment. Smith, 1984 OK 56 at ¶ 15, 686 P.2d  at 288-89. (quoting 
Scott, 1979 OK 
165 at ¶ 10, 606 P.2d at 557). 
¶12 In applying the foregoing law to the summary judgment record in the case 
at hand, we first observe that all facts and inferences presented in the summary 
judgment record must be viewed in a light most favorable to the non-movant. 
Manley v. Brown, 1999 OK 79, ¶ 22, 989 P.2d 448, 455. Also, appellate courts must bear 
equally an affirmative duty to test all evidentiary material tendered in the 
summary process for its legal sufficiency to support the relief sought by the 
movant. Id. at ¶ 22, 989 P.2d  at 455-56. Summary relief issues stand for 
de novo examination. Id. at ¶ 22, 989 P.2d  at 455.
¶13 Upon de novo review of the summary judgment record in a light most 
favorable to the plaintiff, we conclude that the trial court erred in treating 
plaintiff's "concealment" claim as a claim predicated solely on fraud. While we 
find the trial court properly ruled Dr. Barnes was entitled to summary judgment 
on this claim under a fraud based theory of recovery, he was not entitled to 
complete dismissal of the claim. Under the summary judgment record, this claim 
remained viable insofar as it concerned plaintiff's right to recover under the 
theory of breach of a physician's duty to obtain informed consent. 
¶14 In reaching this conclusion, we first observe that the summary judgment 
materials of both parties include a copy of plaintiff's amended petition. This 
pleading alleged; (1) the post-surgery pathology examination showed no evidence 
of cancer in the removed prostate; (2) Dr. Barnes never told plaintiff of this 
finding, and (3) plaintiff did not discover the truth about the post-surgery 
pathology until September 2004. Plaintiff's Motion for Summary Judgment filed 
April 19, 2009, similarly stated that Dr. Barnes intentionally concealed the 
information that plaintiff's prostate was cancer free. The motion added that Dr. 
Barnes continued to treat plaintiff for another five years after surgery and 
administered frequent PSA tests. 
¶15 Dr. Barnes' answer is not included in the summary judgment record, but 
his Motion for Summary Judgment filed April 29, 2009, admits he provided 
post-surgical treatment and proffers as an undisputed fact that plaintiff 
returned to see Dr. Barnes as a patient for multiple return visits through 
November 2003. While Dr. Barnes did not directly address the issue of 
disclosure, one of plaintiff's summary judgment filings referenced deposition 
testimony by Dr. Barnes in which Dr. Barnes stated he had advised Mr. Parris of 
the fact that there was no cancer. Clearly, the summary judgment record 
discloses a controversy over the first element of whether Dr. Barnes breached 
his duty to inform plaintiff as an essential condition of plaintiff's consent to 
the post-surgical treatment.
¶16 As concerns the causation element, plaintiff's Objection to Barnes 
Supplemental Motion as to Concealment filed October 13, 2009, again recounted 
Dr. Barnes continued treatment of plaintiff after surgery and frequent PSA 
tests. This filing also expressly stated: "Had [plaintiff] know [sic] of the 
deceit he would not have returned for Barnes kindly treatment..." In cases where 
a plaintiff testifies that he would not have consented to treatment if 
adequately informed, then the causation problem must be resolved by examining 
the credibility of the plaintiff's testimony. Smith, 1984 OK 56 at ¶ 13, 686 P.2d  at 288. However, it is 
not the province of the appellate court or trial court to pass upon the 
credibility of witnesses on this issue. Id. The jury must be instructed 
that it must find plaintiff would have refused treatment if he is to prevail. 

¶17 In regard to the injury element, plaintiff's amended petition generally 
alleged pain and suffering as detriment or damage he sustained from the alleged 
wrongs of the defendants. At the first hearing on remand from Parris I, 
the trial court correctly observed that this general allegation related to 
plaintiff's misrepresentation or concealment claim in addition to his 
malpractice claims. As noted, plaintiff's motion for summary judgment filed 
April 9, 2009, related that Dr. Barnes "administered frequent PSA tests." In his 
response to Dr. Barnes' Motion for Summary Judgment, plaintiff agreed with Dr. 
Barnes' proffered undisputed fact of continued treatment and multiple return 
visits, but added that Dr. Barnes gave plaintiff "lab tests every other visit." 
While the exact nature of these "PSA tests" and "lab tests" is not disclosed, 
counsel for Dr. Barnes referred to them as "additional blood testing." At one 
point in commenting on the issues of injury and damages, the trial court also 
observed that plaintiff "continued to incur expenses in doing whatever the 
post-operative treatment was." 
¶18 Upon trial, if a jury does believe plaintiff's testimony that Dr. Barnes 
did not tell plaintiff there was no cancer in the removed prostate and that he 
would not have consented to the post-surgical treatment if he had known this 
fact, then Dr. Barnes is "responsible for the consequences," including any 
injury and expense incurred in the treatment. Id. at, ¶ 15, 686 P.2d  at 
288-89. The injury for which a patient may recover need not be extensive or 
permanent, and can include the temporary discomfort of invasive blood testing. 
Recoverable expenses can include not only the cost of the treatment, but all 
necessary and reasonable expenses of travel to and from the treatment, and the 
value of a patient's time in attending the treatment as well as the time in 
traveling to and from the treatment.2
¶19 In conclusion, we hold the trial court properly granted summary judgment 
to the defendants on plaintiff's medical malpractice claims and to Dr. Barnes 
and Urological Associates, Inc. on plaintiff's claim for "concealment" as a 
fraud-based theory of recovery. We further hold that the trial court erred, 
however, in granting summary judgment to Dr. Barnes on plaintiff's claim for 
"concealment" insofar as it is grounded on a theory of "informed consent."3 Based on the summary 
judgment record, a jury must determine (1) whether Dr. Barnes informed plaintiff 
that there was no cancer found in plaintiff's removed prostate before 
undertaking post-surgical treatment of plaintiff, and, if not informed, (2) 
whether plaintiff is truthful in his assertion he would not have accepted this 
treatment from Dr. Barnes had Dr. Barnes informed him that no cancer was found 
in the removed prostate; and if plaintiff is found credible, (3) the damage or 
detriment plaintiff suffered as a consequence of the post-surgical treatment as 
well as the amount that would compensate him for such damage or detriment. In 
the trial of this matter, plaintiff is not required to present expert testimony 
concerning Dr. Barnes' duty to inform or disclose, or to establish a breach of 
this duty. The trial court is to instruct the jury on this issue in accordance 
with Uniform Jury Instruction 14.14 and generally in a manner consistent with 
the doctrine of informed consent as discussed in this opinion. The trial court 
is to instruct the jury that plaintiff's damages can include all necessary and 
reasonable expenses of travel to and from treatment, the value of his time in 
attending the treatment, including travel to and from the treatment, in addition 
to any injury and the expense caused by the treatment.
CERTIORARI PREVIOUSLY GRANTED;THE OPINION OF THE COURT OF 
CIVIL APPEALS IS VACATED;THE TRIAL COURT'S SUMMARY JUDGMENTS AFFIRMED IN 
TOTOEXCEPT AS TO PLAINTIFF'S CLAIM AGAINST DEFENDANT SHELBY D.BARNES, 
M.D. FOR TREATMENT WITHOUT DISCLOSURE.
¶20 TAYLOR, C.J., WATT, WINCHESTER, EDMONDSON, REIF, and COMBS., JJ., 
concur.
¶21 GURICH, J., dissents.
¶22 COLBERT, V.C.J., and KAUGER, J., not participating.
FOOTNOTES
1 On remand following 
Parris I, Plaintiff has argued both in the trial court and on appeal that 
the trial court did not follow the Court of Civil Appeals opinion. More 
particularly, plaintiff complains that the trial court disregarded the portions 
of the opinion that (1) allowed him to rely on the doctrine of res ipsa 
loquitur, and (2) stated he did not need an expert to controvert expert evidence 
that defendants acted in accord with accepted medical practices and standards. 
Our review of the opinion leads us to conclude that plaintiff has misconstrued 
the discussion of res ipsa loquitur in Parris I. The application of res 
ipsa loquitur in Parris I was an issue only in regard to the summary 
judgment granted to Dr. Brinkworth. Parris I expressly states, "we 
conclude sufficient facts existed to establish a prima facie case of negligence, 
and to overcome Dr. Brinkworth's Motion for Summary Judgment." Dr. Brinkworth 
was the pathologist who diagnosed cancerous cells in the biopsy specimen taken 
by Dr. Limes. As concerns the dismissals of Dr. Limes, St. Anthony Hospital and 
Dr. Barnes, the Court of Civil Appeals observed that these dispositions were 
based upon motions to dismiss that were grounded on plaintiff's failure to 
identify an expert. The Court of Civil Appeals held that granting the motions to 
dismiss of these defendants was an abuse of discretion, because (1) plaintiff 
had sufficiently identified an expert, and (2) "the trial court had not yet had 
the opportunity to examine the evidence." Parris I, 2009 OK CIV APP 19, ¶ 13, ___P.3d at ___. 
The Court of Civil Appeals further stated: "the issue of whether expert 
testimony is necessary to raise a disputed fact concerning standard of care as 
to those Defendants is not directly before us." Id. at ¶ 17 n.6, ___P.3d 
at ___. 
2 In the physician-patient relationship, the physician is 
not the only party whose time is valuable; the patient's time has value as well. 
It is only fair and reasonable that a doctor should compensate a patient for 
wasting the patient's time in administering treatment for which the patient has 
not given informed consent due to concealment or non-disclosure of material 
facts by the doctor. 
3 The duty to inform is personal to the physician and, 
therefore, this claim is remanded for trial only as to Dr. Barnes' liability and 
not for determination of liability on the part of Urological Associates, Inc. 
The duty to make full and frank disclosure to the patient of all pertinent facts 
relative to his illness and the treatment prescribed or recommended flows from 
the fact that the relation between a physician and patient is one of confidence 
and trust. Woods v. Brumlop, 377 P.2d 520, 524 (N.M. 1962). 
Oklahoma has long recognized that the relationship between a physician and 
patient is a fiduciary and confidential relationship. Clinton v. Miller, 
1920 OK 5, 186 P. 931.