Case Title: Mole v. Jutton

Citation: 381 Md. 27

Docket Number: 126/02

State: maryland

Court: Maryland Supreme Court

Date: 2004-04-13T00:00:00Z

Document:
Tasha Molé v. Jerrilyn Jutton, et al.
No. 126, September Term, 2002
HEADNOTES:  TIMELINESS OF PLEADINGS; MD RULE 1-322; ACTUAL
DELIVERY; BATTERY; NEGLIGENCE; JURY INSTRUCTIONS; TORT;
LACK OF INFORMED CONSENT.
Pleadings or papers that are mailed to a post office box designated by the Clerk of
the Court, are deemed to have been received when the Postal Service delivers them to that
specified address.  
In the case where a surgeon has exceeded the consent he or she was given, it is
proper for court to deny a party’s request for a jury instruction on battery, when, as read
as a whole, the court’s instructions to the jury clearly set forth the applicable law that the
cause of action for lack of informed consent is one in tort for negligence, as opposed to
battery or assault. 
Circuit Court for Anne A rundel Co unty
Case No.: C-2000-65962.OT
IN THE COURT OF APPEALS OF
MARYLAND
No. 126
   
 September Term, 2002
                                                                            
TASHA MOLÉ
v.
JERRILYN JUTTON, et al.
                                                                            
Bell, C.J.
         *Eldridge
Raker
Wilner
Cathell
Harrell
Battaglia,
               JJ.
                                                                            
Opinion by Bell, C.J.
                                                                            
Filed:   April 13, 2004
*Eldridge, J. now retired, participated in the
hearing and conference of this case while an
active member of this Court; after being recalled
pursuant to the Constitution, Article IV, Section
3A, he also participated in the decision and
adoption of this opinion. 
1  A mural nodule is a small lump on the cyst wall.
The issue we decide in this case is what is the proper cause of action when, in the
course of performing a surgical procedure, a surgeon exceeds the consent he or she was
given.   Maintaining that the tort of battery is the proper cause of action, the appellant, Tasha
Mole3, in addition to a negligence claim, included a count for battery in the  complaint she
filed in the Circuit Court for Anne Arundel County  against the appellees, Dr. Jerrilyn Jutton,
(“Dr. Jutton”), Dr. George E. Linhardt, and Dr. Jutton’s employer, Linhardt Surgical
Associates, P.A. and, at the conclusion of the trial,  requested  the trial court to instruct the
jury as to that count.  The trial court declined to do so.  The appellant challenges that ruling
on this appeal.    We shall affirm the judgment of the Circuit Court.
I.
 Tasha Molé, the appellant, consulted a doctor, after experiencing pain in her left
breast, in which she also discovered a lump.   She was referred for a sonogram of her breast,
the results of which  revealed that the appellant had two tender masses in her left breast, one
of which was determined to be a “simple cyst,” i.e. a fluid filled sac, and the other a
“complex cyst containing a mural nodule.” 1  As to the latter, a biopsy was “suggested,” due
to the possibility of malignancy.   
On her doctor’s advice, the appellant consulted a surgeon, the appellee, Dr. Jutton,
who was employed by Linhardt Surgical Associates, P.A., with respect to how best to
2In medical terms, to aspirate means to remove something, usually liquids or
gasses, by means of a suction device.  While attempting to aspirate the cyst, Dr. Jutton
was able to obtain a “milky fluid” and indicated on her notes that the fluid may suggest
the “presence of an underlying infection.” 
2
proceed with regard to the cysts.   Having initially attempted to aspirate2 the cysts to
determine if they were cancerous, but finding that “she was too tender for me to
aspirate,”with a needle, Dr. Jutton determined that “the best way to proceed would be a
surgical procedure to remove the solid nodule.”  
In preparation for the surgery, Dr. Jutton informed the appellant of the risks involved,
including post-operative infection.  The appellant consented to the expected procedure,
“excision breast mass left.”   She also agreed:
“I have been advised that during the course of this admission, conditions
unknown prior to the treatment may be revealed which necessitate or make
advisable an extension of the original procedure or a different procedure than
that referred to in Paragraph 1.   I, therefore, authorize and request that the
above named doctor, his assistants and associates perform such procedures or
render such treatment as is necessary or advisable in the exercise of
professional judgment.”
Thus, the appellant consented to any necessary extension of the surgery or to any different
procedure that Dr. Jutton, in the “exercise of professional judgment,” deemed “necessary or
advisable.”
During the surgical procedure, tissue surrounding the two cysts was removed and
some of the appellant’s milk ducts were cut, according to Dr. Jutton, “in the process of
removing the mass.”  Dr. Jutton also subsequently testified, “[t]he breast is composed of milk
3The appellant waived arbitration in accordance with Maryland Code (1973, 2000
Repl. Vol.) § 3-2A-06B (b) (1) of the Courts and Judicial Proceedings Article.   That
section provides:
“(b)(1) Subject to the time limitation under subsection (d) of this section,
any claimant may waive arbitration at any time after filing the certificate of
qualified expert required by §§ 3-2A-04(b) of this subtitle by filing with the
Director a written election to waive arbitration signed by the claimant or the
claimant's attorney of record in the arbitration proceeding.
“(2) The claimant shall serve the written election on all other parties to the
claim in accordance with the Maryland Rules.
“(3) If the claimant waives arbitration under this subsection, all defendants
shall comply with the requirements of §§ 3-2A-04(b) of this subtitle by
filing their certificates at the Health Claims Arbitration Office or, after the
election, in the appropriate circuit court or United States District Court.”
3
ducts, milk ducts get cut when you do incision.”
The appellant filed an action against the appellees in the Circuit Court for Anne
Arundel County.3    The complaint contained two counts, one for medical negligence and the
other for battery.   The battery count was premised on Dr. Jutton’s having cut the milk ducts
leading to her left nipple during the surgery to remove the two cysts, without the appellant’s
authorization, that Dr. Jutton exceeded the scope of the consent she was given.   At the
conclusion of the trial, the appellant requested that the jury be given an instruction on battery,
as follows:
“15:2: BATTERY - Liability
           
4
           “a.   Generally
           “A battery is an intentional and unlawful touching which is harmful or
offensive.
           “b.   Touching
          “Touching includes the intentional putting into motion of anything
which touches another person, or which touches something that is connected
with, or in contact with, another person.
            “c.   Harmful
             “A touching is harmful if it causes physical pain, injury or illness to
the plaintiff.
            “d.   Offensive
            “A touching is offensive if it offends a plaintiff’s reasonable sense of
personal dignity.”
The trial court denied the appellant’s request.    Instead, it gave the jury the following
instruction:
“A physician has the duty to obtain the consent of a patient after disclosing to
the patient the nature of the condition to be treated, the nature of the treatment
being proposed, the probability of success of that treatment, the alternatives,
if any to the treatment, and every material risk of negative consequences of the
treatment being proposed.
“A material risk is a risk which the physician knows or ought to know would
be significant to a reasonable person who is being asked to decide whether to
consent to a particular medical treatment or procedure.  The purpose of the
require [sic] explanation is to enable the patient to make an intelligent and
informed choice about whether to undergo the treatment [being] proposed.  A
physician is negligent if the physician fails to disclose to the patient all
material information and risks.
“On the other hand, a physician is not negligent if the physician does disclose
4  Maryland Rule 8-202(a) provides: 
“Generally.  Except as otherwise provided in this Rule or by law, the notice
of appeal shall be filed within 30 days after entry of the judgement or order
from which the appeal is taken.  In this Rule, ‘judgment’ includes a verdict
or decision of a circuit court to which issues have been sent from an
Orphan’s Court.”
5
all material information and risk and the patient thereafter consents to the
treatment.
“In order to impose liability upon the physician, the Plaintiff must prove that
a reasonable person would not have consented if properly informed.  The
question is not whether this particular Plaintiff would have consented if given
proper information but whether a reasonable person in the same circumstances
would have consented or not.”
The jury returned a verdict in favor of the appellant, awarding her $22,500.00 in
damages.  Judgment was entered on the verdict against the appellees.  Despite the appellant’s
success with respect to the negligence count, she noted an appeal, in which she challenged
the trial court’s refusal to instruct the jury on battery.  Prior to any proceedings on the merits
in the intermediate appellate court, this Court, on its own initiative, issued the writ of
certiorari to address the important question that this case presents.  Mole3 v. Jutton, 373 Md.
406, 818 A.2d 1105 (2003).
                                                                        I.
The threshold issue that must be addressed is whether the appellant’s cause of action
should be dismissed as untimely.   The appellees responded to the appellant’s appeal by filing
a Motion to Dismiss the appeal.   Relying on Maryland Rule 8-202 (a), 4 they argued that the
6
appellant’s appeal was untimely. The Court of Special Appeals denied the appellees’ motion
to dismiss, indicating that they should seek that relief in their appellate brief.  The appellees
have included in their brief in this Court a motion to dismiss the appellant’s appeal.
 Maryland Rule 8-202 (a) requires that, “[e]xcept as otherwise provided in this Rule
or by law, the notice of appeal shall be filed within 30 days after entry of the judgment or
order from which the appeal is taken.”  An appeal filed more than thirty (30) days after entry
of judgment is untimely and, therefore, must be dismissed.   The jury returned its verdict in
this case on March 20, 2002 and judgment was entered the same day. (Respondent’s brief at
appendix 64-65).  The appellant had thirty (30) days from that date to file her notice of
appeal.   Accordingly, to be timely, the notice of appeal was required to be filed by April 19,
2002.
Maryland Rule 1-322 (a) provides:
“The filing of pleadings and other papers with the court as required by these
rules shall be made by filing them with the clerk of the court, except that a
judge of that court may accept the filing, in which event the judge shall note
on the papers the filing date and forthwith transmit them to the office of the
clerk.  No filing of a pleading or paper may be made by transmitting it directly
to the court by electronic transmission, except pursuant to an electronic filing
system approved under Rule 16-307 or 16-506.”
We considered the meaning and operation of Rule 1-322 (a) in Blundon v. Taylor, 364 Md.
1, 11, 770 A.2d 658, 664 (2001) and concluded:
7
“that Rule 1-322 is so clear and unambiguous in this regard that it does not
require construction. Section (a) requires that, to be filed, pleadings and papers
must be actually delivered, either in person or by mail, to the clerk or a judge
of the court in which they are sought to be filed. That this is so is made clear
by the provision that the filing of pleadings or papers is accomplished by filing
them with the clerk or a judge of the court and the prohibition, excepting only
electronic filing systems pursuant to Rule 16- 307, against directly transmitting
such pleadings and papers by electronic transmission.”
See also Paul V. Niemeyer & Linda M. Shuett, MARYLAND RULES COMMENTARY (2d
ed.1984) at 35, in which, addressing Rule 1-322 (a), it is observed:
“A pleading or paper is filed by actual delivery to the clerk.   This may be
accomplished in person or by mail.   However, the date of filing is the date the
clerk receives the pleading, not the date when the pleading was mailed.   Filing
therefore differs from service of a pleading or paper by mail, which is, in fact,
complete upon mailing (see Md. Rule 1-321 (a)) . . . This rule permits a
pleading or paper to be filed with a judge, assuming the judge agrees to accept
the pleading or paper for filing.”
See also, Paul V. Niemeyer & Linda M. Shuett, MARYLAND RULES COMMENTARY (2d
ed.1992) at 41.  The issue presented in Blunden “involve[d] the validity of ‘faxing’--
transmitting by facsimile--a pleading or paper to the Maryland Health Claims Arbitration
Office.”    Id. at 3, 770 A.2d at 669.  It arose  because the copy of the petitioner’s Request
For Modification of Arbitration Award “faxed” to the Health Claims Arbitration Office was
received timely, and was so stamped by the HCAO, but the copy he mailed on the same day,
by regular mail,  was received in the Health Claims office  one day after the deadline for
filing the request for modification.  Id. at 6-7,  770 A. 2d at 661.   Concluding that Maryland
Rule 1-322 does not permit the filing of pleadings or papers via facsimile by direct electronic
5Maryland Rule 1-321 (a) provides:
“a) Generally. Except as otherwise provided in these rules or by order of
court, every pleading and other paper filed after the original pleading shall
be served upon each of the parties. If service is required or permitted to be
made upon a party represented by an attorney, service shall be made upon
the attorney unless service upon the party is ordered by the court. Service
upon the attorney or upon a party shall be made by delivery of a copy or by
mailing it to the address most recently stated in a pleading or paper filed by
the attorney or party, or if not stated, to the last known address. Delivery of
a copy within this Rule means: handing it to the attorney or to the party; or
leaving it at the office of the person to be served with an individual in
charge; or, if there is no one in charge, leaving it in a conspicuous place in
the office; or, if the office is closed or the person to be served has no office,
leaving it at the dwelling house or usual place of abode of that person with
some individual of suitable age and discretion who is residing there. Service
by mail is complete upon mailing.”
8
transmission, we held:
“It follows, therefore, that the ‘faxed’ copy of the petitioner’s request to
modify the panel award may not be considered in determining whether his
request was filed timely. And, because it is undisputed that the mailed copy of
the request was not received until April 30, 1997, one day after the deadline
set by §§ 3-222 for filing the application to modify or correct the award, it also
follows that the petitioner's application to modify or correct the award came
too late.”
Id. at 16-17, 770 A.2d at 667.
Thus, unlike service by mail, which is complete upon mailing, filing is not complete
until the clerk of the court or a judge receives the document.  See Maryland  Rule 1-321 (a);5
see MARYLAND RULES COMMENTARY (2d ed.1984) supra at 35.   See also  MARYLAND
RULES COMMENTARY (2d ed.1992) supra at 41. On the other hand, the date stamped on a
9
pleading or paper is not necessarily dispositive of the date on which the pleading or paper
was filed.    
In  In re Vy N., 131 Md. App. 479,  482, 749 A.2d 247, 249 (2000), the Court of
Special Appeals  reviewed de novo a trial court’s determination that the delinquency petitions
at issue in that case were “filed” timely.   The petitions, which had been delivered to the
Clerk’s Office for filing after 4:30 pm, when the trial court closed,  the trial court found, a
finding that the intermediate appellate court did not disturb, were accepted by someone in the
clerk’s office, rather than a judge, but stamped as received the first thing the next morning.
 Characterizing Rule 1-322 (a) as one that “allows attorneys to meet filing deadlines,”
quoting Melvin J. Sykes, Esq., November 12, 1983 meeting of the Rules Committee, the
Court of Special Appeals endorsed the view of the  Rules Committee, that the rule “(1)
‘effectually makes the court always open for the filing of papers,’ and (2) provides that ‘the
filing date’ is ‘the day the judge accepts the paper.’  Id. at 483, 749 A. 2d at 250 (footnote
omitted).   The court explained:
“When a pleading or other paper must be filed within a particular number of
days, it can be filed anytime before midnight on the last day provided that--if
the Clerk's Office has closed--it is delivered to a judge or to an employee of
the Clerk's Office who is authorized to accept delivery of such a document
during the hours that the office is open to the public.  Nothing in the applicable
statute or in the Maryland  Rules of Procedure provides that anything delivered
to a clerk after 4:30 p.m. is deemed to have been filed on the next day that the
Clerk's Office is open.  As is pointed out in the Maryland Rules Commentary,
supra at 41, judges often receive date sensitive documents after the clerk's
office has closed for the day.   We take judicial notice that clerks do so as well.
 The correct procedure in such a situation calls for the judge (or other
6The address that appears on the Judiciary website for the Circuit Court for Anne
Arundel County is the same as the address to which the appellant forwarded the notice of
appeal, 7 Church Circle, Annapolis, Maryland 21401.  It is interesting to note that the zip
code is different from the zip code for the Post Office Box, 21401 as opposed to 21404.  
The Circuit Court also uses a Post Office Box, the zip code for which is, like that for the
Post Office Box for the Clerk’s Office, 21404.  
10
authorized person) to (1) note (or stamp) the minute, hour and day that the
document is received;  and (2), as soon as is practicable thereafter, present it
to the employee(s) of the Clerk's Office assigned to process such documents.
 In these situations, the document is deemed ‘received for filing’ on the day
that it is delivered to the judge or other authorized person.”
Id. at 483-84, 749 A. 2d at 250.
Rather than deliver the notice to the Clerk in person, the appellant chose to mail it.
She did so on April 17, 2002, addressing it to “Clerk, Circuit Court Anne Arundel, Appeals
Division, 7 Church Circle, Annapolis, Maryland 21401.”  On its letterhead, the address of
the Anne Arundel County Circuit Clerk’s office is listed as P.O. Box 71, Church Circle,
Annapolis, Maryland 21404-0000.6  The notice of appeal was delivered by the Postal Service
to Post Office Box 71 at 7:45 a.m. on April 19, 2002.   The docket entries reflect that the
notice was filed on April 22, 2002, at 9:55 a.m.
 The appellees maintain the appellant did not timely file the notice of appeal with the
Clerk.   They argue that “filing” requires the actual receipt of the pleading or paper by the
Clerk.    The “delivery of the Notice of Appeal to the post office box of the Clerk of the
Court does not  qualify as actual filing of the pleading,” they submit.   (respondent’s brief at
32.)  That is so, the appellees assert, because “a filing must be made with the clerk of the
11
court, directly.” (respondent’s brief at 33).
Not surprisingly, the appellant does not agree.  She argues, on the contrary,  that the
notice of appeal was filed on April 19, 2002, rather than April 22, 2002, because that is the
date the notice of appeal was delivered to the post office box that the Clerk gave as its
mailing address and, therefore, was actually received by the Clerk.   We agree with the
appellant.
 
The
appellees acknowledge that a pleading or paper may be filed by mail.   That would occur
when the pleading or paper was delivered to, and, therefore, received in, the Clerk’s Office.
The situation is simple and straight forward when the mail is delivered by the postal service
directly to, and, thus, is accepted directly in the Clerk’s office.   What complicates this case
and makes it unique is that the Clerk’s mailing address is to a post office box.  Therefore,
mail, including pleadings and papers for filing, rather than being delivered directly to the
Clerk’s office, is delivered to the Clerk’s post office box.   Thus, to get the pleading or paper
to the Clerk’s Office requires another step, someone must pick up the mail from the post
office box and deliver it to the Clerk’s Office.   We believe that, whether delivered by the
Postal Service directly to the Clerk’s Office or to a post office box,  the mail is received, and
therefore pleadings or papers filed, when the mail is delivered to the address designated by
the Clerk.   That the Clerk may have the mail delivered to a post office box, rather than to his
office directly, does not change the analysis or the result.  Delivery of pleadings or papers by
the Postal Service to the address designated by the addressee is receipt by the addressee of
7By statute, in Arizona, “[n]o medical malpractice action brought against a medical
provider shall be based upon assault and battery.”  A.R.S. § 12-562 (B).
12
those pleadings or papers.   A person aware of the filing deadline, who acts  reasonably to
file pleadings timely, should not be at the mercy of the procedure set up by the Clerk’s Office
for its convenience.   
To agree with the appellees, we would have to ignore altogether the delivery of the
mail by the Postal Service, in accordance with express instructions from the Clerk, to the
place designated and focus only on when it is actually taken or delivered, by whomever, to
the Clerk’s Office.    There would be no certainty; where the delivery is to a post office box,
a day, or more,  could elapse, as it did here, between delivery to the post office box and
actual delivery to the Clerk’s Office.  Moreover, the appellees’ position completely
eliminates the option of mailing pleadings or papers later in the period, at least where the
Clerk has implemented a system of mail collection off-premises.  
We hold that delivery of the appellant’s notice of appeal by the Postal Service to the
Post Office Box designated by the Clerk as his mailing address constitutes actual delivery
of that notice to the Clerk under Md. Rule 8-202.    Accordingly, the notice was timely filed.
II.
To be sure, in Maryland, consistent with the general rule, see, e.g. McGrady v. Wright,
729 P. 2d 338, 341 (Ariz. 1986);7 Cobbs v. Grant, 502 P. 2d 1, 7-8 (Cal. 1972); Kennis v.
Mercy Hospital Medical Center, 491 N. W. 2d 161, 164 (Iowa 1992); Paul v. Lee, 568 N. W.
8Like Arizona, the cause of action for lack of informed consent is, in North
Carolina, statutory.  See N.C. G. S. 90-21.13.
9The action for lack of informed consent is also statutory in Utah.   See Utah Code
Ann. § 78-14-5 (1).
13
2d 510, 514 ( Mich. 1997), rev’d on other grounds, Smith v. Globe Life Ins., 597 N. W. 2d
228 (Mich. 1999); Kohoutek v. Hafner, 383 N. W. 2d 295, 298-300 (Minn. 1986); Baltzell
v. Van Buskirk, 752 S. W. 2d 902, 906 (Mo. Ct. App. 1988); Howard v. University of
Medicine and Denistry of New Jersey, 800 A. 2d 73, 78-79 (N. J. 2002); Dries v. Gregor, 424
N. Y. S. 2d 561, 564 (N. Y. A.D. 1980); McPherson v. Ellis, 287 S. E. 2d 892, 895 (N. C.
1982);8 Ashe v. Stroup, 9 S. W. 3d 119, 121 (Tenn. 2000); Lounsbury v. Capel, 836 P. 2d
188, 193-94 (Utah 1992);9  Martin v. Richards, 531 N. W. 2d 70, 76-77 (Wis. 1995), a claim
under the informed consent doctrine must be pled as a tort action for negligence, rather than
as one for battery or assault.   This pronouncement was made first in Sard v. Hardy, 281 Md.
432, 434, 379 A. 2d 1014, 1017 (1977), in which this Court “address[ed] for the first time
the so-called doctrine of informed consent.”  After stating the doctrine and defining its
contours, id. at 438-440, 379 A. 2d at 1019-29, we 
“note[d] in passing our approval of the prevailing view that a cause of action
under the informed consent doctrine is properly cast as a tort action for
negligence, as opposed to battery or assault. See, e. g., Cobbs v. Grant, 8
Cal.3d 229, 104 Cal.Rptr. 505, 502 P.2d 1, 8 (1972); Perin v. Hayne, 210
N.W.2d 609, 618 (Iowa 1973); Downer v. Veilleux, 322 A.2d 82, 89-90
(Me.1974); Trogun v. Fruchtman, 58 Wis.2d 569, 207 N.W.2d 297, 311-13
(1973).”
Id. at 440 n. 4, 379 A. 2d at 1020 n. 4.   That approval has been confirmed in subsequent
14
opinions of this Court,  Faya v. Almaraz, 329 Md. 435, 450 n. 6, 620 A.2d 327, 334 n. 6
(1993) (“The cause of action for lack of informed consent is one in tort for negligence, as
opposed to battery or assault.”); Wright v. Johns Hopkins Health Sysytem Corporation, 353
Md. 568, 596 n. 16, 728 A. 2d 166, 179 n. 16 (1999) (“Wright's parents' cause of action for
lack of informed consent is properly a cause of action for negligence.”); Dingle v. Belin, 358
Md. 354, 368, 749 A. 2d 157, 164-65 (2000) (“In [Sard, supra.], we recognized, as a separate
negligence-based (rather than battery-based) cause of action, the performance of a medical
procedure by a physician without the informed consent of the patient.”), and followed by the
Court of Special Appeals, Zeller v. Greater Baltimore Med. Center, 67 Md. App. 75, 81-82,
506 A. 2d 649, 651 (1986)(pronouncing that “the rendering of medical services absent
informed consent, if pled properly, constitutes a separate and new count of negligence.”);
Miller v. Shafer, 80 Md. App. 60, 72 n. 5, 559 A. 2d 813, 819 n. 5 (1991) (quoting Sard);
Yonce v. Smithkline Beecham Clinical Laboratories, Inc., et al, 111 Md. App. 124, 154-155
680 A.2d 569, 583-584 (1996) (reasoning that “[t]he doctrine of informed consent, adopted
in Sard, supra, is based on principles of negligence and imposes upon a physician a duty to
disclose material risks and available alternatives so that a patient can make an informed
decision.”), and federal courts applying Maryland law, Lipscomb v. Memorial Hospital, 733
F. 2d 332, 335 (4 th Cir. 1984) (noting that, under Maryland law, the case presented a claim
grounded upon lack of informed consent, rather than lack of consent, which properly is cast
as a tort action for negligence as opposed to battery); Robinson v. Cutchin,140 F. Supp. 2d
10The appellees challenge “much of this purported authority” as having been
overruled by statute or reversed on appeal or being otherwise distinguishable factually.  
Without directly responding to the challenge on the merits, the appellant persists in her
arguments, suggesting that some of the cases the appellees rely on, in fact recognize that a
battery claim lies for exceeding the scope of a consent and that an examination of the
appellees’s arguments confirm the validity of her position.  
15
488, 492-93 (D. Md. 2001).
Noting that “Maryland tort law ... recognizes and protects an individual’s right to
determine what shall be done with his or her body,” and asserting that “no other case in
Maryland addresses [or has addressed] the question presented by this case,” the appellant
submits that the pronouncement in Sard with respect to the informed consent doctrine, and
the subsequent confirmations thereof, “[do] not rise to the level of stare decisis.”    Relying
on out-of-state authority, which she characterizes as holding that “physician’s operations in
excess of the scope of informed consent may be pled as a battery,”10 the appellant argues:
“A physician who exceeds the scope of consent is committing the tort of
battery, by performing an unauthorized touching, offensive to the victim, and
is denying the victim the right to determine what shall be done with her own
body.   Maryland should recognize that a physician may be held liable in
battery for exceeding the scope of consent.”
We reject the appellant’s argument that the Sard pronouncement, recognizing the
separate negligence-based (rather than battery-based) cause of action of lack of informed
consent, does not rise to the level of stare decisis.  As we have seen, this court has stated that
recognition clearly and reiterated it on several occasions, in contexts indicating that it was
a holding, rather than dicta.  See Faya, supra, 329 Md. at 450, 620 A. 2d at 334; Dingle,
16
supra, 358 Md. at 368, 749 A. 2d at 164-165.
On the other hand, the appellant’s observation that no opinion of this Court or of the
Court of Special Appeals has addressed the precise issue this case presents is accurate.   In
Sard, Mrs. Sard, who was then pregnant for the third time, selected sterilization from among
the options  her gynecologist gave her, consistent with her wish not to become pregnant
again.   Id. at 436, 379 A. 2d at 1018.   While delivering Mrs. Sard’s third child by caesarian
section and pursuant to a consent form executed by Mrs. Sard and her husband, the doctor
performed a bilateral tubal ligation.   Id. When  M s. Sard became pregnant for the fourth
time, she and her husband sued the doctor, alleging negligent performance of the bilateral
tubal ligation and, “specifically ... that [the doctor] negligently failed to advise them that the
surgical procedure employed by him was not absolutely certain to succeed and that [the
doctor] failed to apprise the Sards of the potential results of the operation and alternative
methods of sterilization, thereby precluding [them] from giving their informed consent.”  Id.
at 435, 379 A. 2d at 1017.  The Sards did not allege that the doctor committed a battery. 
Consequently, the Court did not mention at all medical battery; although the Court discussed
informed consent, its nature and doctrinal basis, it did not discuss, as many courts  have done,
see e.g. Howard, 800 A. 2d at 77-78 (analyzing the distinction between lack of informed
consent and  battery and noting that “[t]he doctrine of informed consent was tied initially to
the tort of battery, but its evolution has firmly established it as a negligence concept.”);
Lounsbury v. Capel, 836 P. 2d at 194 (indicating, quoting Baltzell v. Van Burkirk, 752 S. W.
11Both patients alleged negligence, negligent failure to obtain the patient’s
informed consent, fraud and intentional infliction of emotional distress.  One of them
alleged, in addition, negligent misrepresentation and breach of contract, while the other
added loss of consortium, breach of fiduciary duty and battery.  Faya v. Almaraz, 329 Md.
435, 441, 620 A. 2d 327, 330 (1993).
17
2d at 906,  that “the informed consent doctrine apparently began as an offshoot of battery”);
Martin v. Richards, 531 N. W. 2d at 76 (“Traditionally, informed consent was based upon
the tort of battery.”).  See  Cobbs v. Grant, 502 P. 2d at 7-8; Kohoutek v. Hafner, 383 N. W.
2d at 298-99,  the relationship of the informed consent doctrine to medical battery. 
Faya v. Almaraz involved  two patients of a surgeon, who was infected with the
AIDS virus and who operated on each of them, but without first informing them of the fact
of that infection.  329 Md. at 438, 620 A. 2d at 328.   The patients, in separate actions against
the doctor and the hospital at which he had operative privileges, alleged “various wrongful
acts,”11 one of which,  pled by one of the patients, was a battery count.  Id. at 441, 620 A. 2d
at 330.  The trial court dismissed all of the counts, holding that the patients failed to allege
a legally compensable injury.   Id. at 442-43, 620 A. d at 330.  This Court, concluding that
the gist of the complaints was the surgeon’s wrongful conduct in operating on the patients
without first telling them that he was HIV-positive, and later ill from AIDS,  and of the risk
of contracting HIV as a result of the surgery, id., determined that  at their core was the
surgeon’s negligence,  the failure to disclose his HIV-positive status, and, therefore,
addressed only the negligence counts.   As to them, we concluded:
“In evaluating the well-pleaded allegations of the complaints with respect to
18
the duty component of the tort of negligence, we cannot conclude that they are
legally insufficient to survive the appellees’ motions to dismiss; in other
words, we cannot say as a matter of law that no duty was imposed upon Dr.
Almaraz to warn the appellants of his infected condition or refrain from
operating on them.”
It was in this context that the Court confirmed the Sard pronouncement, “[t]he cause
of action for lack of informed consent is one in tort for negligence, as opposed to battery or
assault.” 281 Md. at 440, 379 A. 2d at 1017.    Accordingly, the Court ruled that the trial
court erred in dismissing the negligence counts based on the failure of the surgeon to disclose
his infected condition.  Id. at 459, 620 A. 2d at 339.   But rather than ordering reinstatement
of only the negligence counts addressed, the Court opined:
“In view of our disposition of the basic negligence counts grounded on Dr.
Almaraz’s asserted failure to warn the appellants of his infected condition, and
because the damages claimed on all counts are essentially the same, the trial
judge erred in dismissing the other counts as well.   As we see it, after viewing
the allegations of the complaints in support of these counts, dismissal was not
appropriate in the circumstances.”
Id. at 460-61, 620 a, 2d at 339.
Both a count for battery and a count for lack of informed consent were included in the
complaint in Wright against Hopkins for wrongfully prolonging the life of an AIDS patient
by resuscitating him from cardiac arrest.   As we have seen, we reiterated that the cause of
action under the informed consent doctrine is negligence-based.   353 Md. at 595 n. 16, 728
12Maryland Code (1982, 1994 Repl. Vol., 1998 Cum. Supp.) § 5-607  [of the
Health-General Article] reads: 
“A health care provider may treat a patient who is incapable of making an
informed decision, without consent, if: 
“(1) The treatment is of an emergency medical nature; 
“(2) A person who is authorized to give the consent is not
available immediately;  and 
“(3) The attending physician determines that: 
“(i) There is a substantial risk of death or
immediate and serious harm to the patient;  and 
“(ii) With a reasonable degree of medical
certainty, the life or health of the patient would
be affected adversely by delaying treatment to
obtain consent.”
19
A. 2d at 179 n. 16.  We dismissed that count, however, because “Section 5-607,[12] under
which the CPR was authorized, accords with the common law doctrine of informed consent,
which is suspended in an emergency situation.”   Id. at 595, 728 A. 2d at 179.    The battery
claim, although preserved by cross-petition for certiorari, was abandoned, as no argument as
to it was included in the brief of the proponent of that argument.   Id. at 596, 728 A. 2d at
179. 
In Dingle v. Belin, the complaint alleging negligent performance of gall bladder
surgery by a resident physician under supervision of a surgeon, who, it also was alleged,
contracted to perform the surgery himself, included, in addition, a count for lack of informed
consent and a count for battery.   358 Md. at 358, 749 A. 2d at 159.  The lack of informed
consent count, which we specifically mentioned was negligence-based, was submitted to the
jury, which found in favor of the surgeon.  Id. at 359, 749 A. 2d at 159.  The battery count
13“A battery is the intentional touching of a person without that person's consent.  
Touching includes the intentional putting into motion of anything which touches another
person, or which touches something that is connected with, or in contact with, another
person. In order to be a battery, the touching must be harmful or offensive. A touching is
harmful if it causes physical pain, injury or illness. A touching is offensive if it offends
the other person's reasonable sense of personal dignity.”
20
was dismissed at the end of the surgeon’s case and not pursued on appeal.  Id.
The issue that this case presents was addressed by the United States District Court for
the District of Maryland in Robinson v. Cutchin.   There, a patient, whose child was
delivered by an emergency caesarean section, and her husband sued her doctor and the
hospital for damages they allegedly suffered as a result of the doctor’s performance of a
bilateral tubal ligation, for which no informed consent was given, and which prevented her
having any additional children.   140 F. Supp. at 490.   In addition to the count alleging lack
of informed consent, the complaint contained, inter alia, a count for battery, which, it was
alleged, was committed with malice.   Id.   The defendants moved in limine to preclude the
pursuit of the battery count.  Id. Treating that motion as one for summary judgment, the court
entered summary judgment in favor of the defendants.  Id. at 492.   After reviewing the
nature of assault and battery in Maryland, “the unpermitted application of trauma by one
person upon any part of the body of another,” citing Saba v. Darling, 72 Md. App. 487, 491,
531 A.2d 696 (1987), aff'd 320 Md. 45, 575 A.2d 1240 (1990) and  MPJI 15:2,13 id., and
noting that a cause of action for lack of informed consent is one sounding in negligence,
rather than battery or assault, id., citing Sard and Faya v. Almaraz, the court concluded:
21
“This malpractice suit is an informed consent case in which Mrs. Robinson
claims, inter alia, that Dr. Cutchin committed a battery.   The intentional
touching sought to be proved is that of a physician occurring during an
operative procedure.   Plaintiffs do not here contend that Mrs. Robinson did
not consent to the emergency C-Section procedure.  Moreover, Mrs. Robinson
has not claimed that she suffered increased pain and discomfort because Dr.
Cutchin, during the course of the operation to which she had consented, ...
performed a tubal ligation in addition to the C-Section procedure.   Although
Mrs. Robinson consented to the initial touching by the doctor, the fact that the
touching was more extensive than agreed upon does not amount to a battery
in a case where the critical issue is whether or not there was informed
consent.”
Id. (footnote omitted).
The court further elaborated:
“[E]vidence of record does not support a claim of battery. ...  There is no proof
that Dr. Cutchin acted ‘intending to cause a harmful or offensive contact....’
Nelson v. Carroll, 355 Md. 593, 601, 735 A.2d 1096 (1999) (quoting
RESTATEMENT (SECOND) OF TORTS §  13 (1965)).   The touching by Dr.
Cutchin was not harmful because it did not cause any additional physical pain,
injury or illness other than that occasioned by the C-Section procedure. ...  See
MPJI 15:2.   Indeed, Mrs. Robinson claims that she was not even aware that
the tubal ligation procedure had occurred until June of 1999, more than 21
months after the delivery of  her baby. ...  Moreover, what occurred here did
not offend Mrs. Robinson's reasonable sense of personal dignity.  Id.  She may,
as claimed, have sustained emotional injury, and that claim will be presented
to the jury in this case by way of her own testimony. However, the fact that she
was not able to have a seventh child after previously giving birth to six
children is hardly something which would offend her reasonable sense of
personal dignity.”
Id. at 493 (footnotes omitted).
The appellant accurately observes that this Court is not bound by the decision in
Robinson v. Cutchin.   We, however, find that case to be persuasive and, consequently, adopt
14There is contrary authority.  See, e.g. Valles v. Albert Einstein Medical Center,
805 A. 2d 1232, 1237 (Pa. 2002) (“A claim of a lack of informed consent sounds in the
intentional tort of battery because an operation performed without the patient’s consent is
deemed to be the equivalent to a technical assault”); Sood v.Smeigh, 578 S.E.2d 158, 162
(Ga. App. 2003) (indicating installation of prosthetic patella in a backward position
contrary to the instruction and design of the device would constitute an unconsented-to
battery “because such action was contrary to any informed consent granted to do a total
knee replacement”).   These simply are not persuasive.
22
its analysis and rationale, aligning ourselves, therefore, with the majority of the courts that
have addressed this issue.14   Thus, as explained by Cobbs v. Grant, supra, 502 P. 2d at 8, one
of the authorities that Sard cited with approval, albeit on another point, 
“The battery theory should be reserved for those circumstances when a doctor
performs an operation to which the patient has not consented.  When the
patient gives permission to perform one type of treatment and the doctor
performs another, the requisite element of deliberate intent to deviate from the
consent given is present.  However, when the patient consents to certain
treatment and the doctor performs that treatment but an undisclosed inherent
complication with a low probability occurs, no intentional deviation from the
consent  given appears; rather, the doctor in obtaining consent may have failed
to meet his due care duty to disclose pertinent information.  In that situation
the action should be pleaded in negligence.”
See also Howard v. University of Medicine and Denistry of New Jersey, 800 A. 2d at 80
(noting that battery, an intentional tort, “is reserved for those instances where either the
patient consents to one type of operation but the physician performs a substantially different
one from that foe which authorization was obtained, or where no consent is obtained” and
an action for negligence for “where the surgery that was performed was authorized with
arguably inadequate information”); Lounsbury v. Caspel, 836 P. 2d at 195 (“A typical
23
medical battery case is that of a patient who consents to a particular procedure, but who
receives treatment different from that which was authorized.”); Martin v. Richards, 531 N.
W. 2d at 76 (stating that, traditionally, a battery cause of action existed where a patient did
not authorize treatment or consented to one form of treatment and the physician performed
a substantially different one);  Baltzell v. Van Buskirk, 752 S. W. 2d at 906 (“A claim in
battery ... may lie ... where an operation is performed without the patient’s consent or where
the operation is not the surgical procedure to which the patient have his consent.   By
contrast, where the consent to treatment was given but with insufficient or incomplete
disclosure of risks, the cause of action is in medical malpractice based on negligence of the
physician to meet a recognized standard of care.”). 
The appellant consented to the excision of the mass from her left breast, the procedure
for which she consulted Dr. Jutton, and to any necessary extension of that surgery or to a
different procedure should Dr. Jutton, in the “exercise of professional judgment,” deem it
“necessary or advisable.”   That procedure was the one that Dr. Jutton performed.  The
conduct about which she complains, the cutting of some of the appellant’s milk ducts,
occurred during the course of the performance of the excision of the left breast mass. 
Indeed, there was testimony, the appellant’s only rebuttal to which is that it is ambiguous,
that the cutting of the milk ducts was a necessary part of the expected procedure, that it did
not occur during an independent or unrelated procedure.   Consequently, as the appellees
argue, “Appellant’s only complaint can be that Dr. Jutton inadequately disclosed the potential
24
risks associated with [the contemplated] procedure: that an incision close to the nipple area
may result in the cutting of milk ducts, which could release/ correct Appellant’s chronic
nipple retraction.   Such is the evidence of lack of informed consent, not of battery.”
We hold that, under the circumstances sub judice, the trial court properly denied the
appellant’s request for a jury instruction on battery.  CSX Transportation, Inc. v. Continental
Insurance Co., 343 Md. 216, 240, 680 A. 2d 1082, 1094 (1996) (“[i]t is well settled that if,
when read as a whole, the court’s instruction to the jury clearly set forth the applicable law,
there is no reversible error.”), citing Nizer v. Phelps, 252 Md. 185, 202-03, 249 A. 2d 112,
122 (1969); Alston v. Forsythe, 226 Md. 121, 135, 172 A. 2d 474, 481 (1961).   See also
Wegad v. Howard Street Jewelers, 326 Md. 409, 414, 605 A.2d 123, 127 (1992).   
JUDGMENT AFFIRMED, WITH COSTS.
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