Title: Younts v. St. Francis Hospital & School of Nursing

State: kansas

Issuer: Kansas Supreme Court

Document:

205 Kan. 292 (1970)
469 P.2d 330
NANCY D. YOUNTS, a Minor, by and Through Her Mother, Natural Guardian and Next of Kin, ETHEL M. JOHNSON, Appellant,
v.
ST. FRANCIS HOSPITAL AND SCHOOL OF NURSING, INC., Appellee.
No. 45,630

Supreme Court of Kansas.
Opinion filed May 9, 1970.
Richard H. Rumsey, of Wichita, argued the cause and was on the brief for appellant.
Lawrence McDonough, of Jochems, Sargent & Blaes, of Wichita, argued the cause and was on the brief for appellee.
The opinion of the court was delivered by
FROMME, J.:
This claim was filed by Ethel M. Johnson, mother, on behalf of Nancy D. Younts, her seventeen year old daughter, against the St. Francis Hospital and School of Nursing, Inc. (the hospital) for injury and damage to the tip of the daughter's right ring finger. The claim was tried to the court. Judgment was rendered in favor of the defendant based upon the court's findings. The plaintiff has appealed.
The claim was presented to the court on two theories. First, on the theory that one of the nurses employed by the hospital negligently caused the injury by closing a door on the daughter's finger, and second, on the theory that a resident surgeon employed by the hospital performed an unauthorized surgical procedure on the daughter to repair the finger without obtaining the consent of the daughter and her mother.
We will treat the contentions with respect to each separate theory in the order listed above.
The facts as to the accident are in dispute. In view of the court's findings in favor of the hospital the evidence favorable to the hospital will be summarized.
The mother had undergone major surgery on the day of the daughter's injury. The daughter was in the hospital and was concerned about her mother's condition. The mother was brought to her room on a surgical cart while the daughter waited outside her mother's room. The daughter followed the nurses into her mother's room. The nurses were preparing to transfer the mother from the surgical cart to the bed. The daughter was asked to step into the hall. When the daughter was in the hall one of the nurses (Wanda) closed the door to the room. She heard the daughter scream with pain. In a partial closing of the door the nurses's view of the daughter had been obscured by the door. The nurse could not anticipate and did not see the daughter's move toward the door. It may be inferred the daughter stepped forward after the door was *294 partially closed and unconsciously placed her finger in the scissor-like action of the door hinge. A piece of flesh from the daughter's finger was found on the floor below the hinges of the door. The door was opened immediately for the nurse had not yet released the door handle. The daughter was suffering and her finger was bleeding. One of the nurses (Joyce) asked the daughter if she would like to go see about getting her finger fixed. The daughter said she would. The nurse obtained permission at the nurses' station to take the daughter to the emergency room of the hospital. The resident surgeon in the hospital treated and repaired her finger.
The court made the following findings with regard to negligence of the hospital employees:
The judgment of the court denied plaintiff relief.
Upon appellate review this court accepts as true the evidence and all inferences to be drawn therefrom which tend to support the findings of the trial court. The appellate court disregards any conflicting evidence and inferences which do not tend to support the findings. When findings are attacked for insufficiency of evidence or as being contrary to the evidence the appellate court's power begins and ends with determining whether there is evidence to support such findings. It is of no consequence that contrary evidence was adduced which, if believed, would have supported different findings. In short, the findings of a trial court as to negligence or the lack of it which are supported by substantial relevant evidence will not be overturned on appellate review (Morris v. Hoesch, 204 Kan. 735, 466 P.2d 272; In re Estate of Bernatzki, 204 Kan. 131, 460 P.2d 527.)
Plaintiff's claim based on the theory that one of the nurses employed by the hospital negligently caused the injury by closing a door on the daughter's finger is disposed of by the findings of the trial court. The findings are supported by substantial competent evidence and will not be overturned on appeal.
It should be noted at this point that a malpractice claim based upon negligence in the care and treatment of a patient is not concerned with consent of the patient. The consent of a patient or of *295 his parent is immaterial in such a case because a consent does not free the hospital or the doctor from the consequences of negligence. (See Tefft v. Wilcox, 6 Kan. 46; Hershey v. Peake, 115 Kan. 562, 223 Pac. 1113; Travis v. Bishoff, 143 Kan. 283, 54 P.2d 955; Riggs v. Gouldner, 150 Kan. 727, 96 P.2d 694; Zink v. Basham, 164 Kan. 456, 190 P.2d 203.)
See also Joy v. Brown, 173 Kan. 833, 252 P.2d 889, Richey v. Darling, 183 Kan. 642, 331 P.2d 281, and Kimberly v. Ledbetter, 183 Kan. 644, 331 P.2d 307, where recoveries were authorized despite consent when abortions were negligently performed.
The article by William A. Kelly, associate professor of law at the University of Kansas School of Law, entitled "The Physician, The Patient, And The Consent" points out that consent, or the lack of it, is immaterial in malpractice claims based upon negligence. (8 Kan. L. Rev. 405 at pp. 426, 427)
An examination of plaintiff's claim and of the evidence introduced during the trial indicates no attempt was made to establish that Dr. Winsky, the treating physician, was negligent in his care or treatment of this injury.
We turn now to plaintiff's second theory, that Dr. Winsky performed an unauthorized surgical procedure on the daughter without obtaining the consent of the daughter and her mother. In addition the plaintiff contends the consent of the daughter cannot be sufficient because the docter failed to adequately inform the daughter as to the consequences of this surgical procedure.
It will be helpful to examine some additional facts bearing upon the question. The injury occurred in the hospital at a time when the mother was semi-conscious by reason of a general anaesthetic. She was being returned to her room after major surgery. The injured daughter's parents were divorced. The father was living two hundred miles away. His address was unknown and not immediately available. The daughter was seventeen years old, intelligent and capable for her age. The injury resulted in loss of the fleshy tip of her right ring finger. The fingernail was left intact and the end of the bone was slightly fractured. The surgical repair, accomplished in the emergency room of the hospital, was of a minor nature. The plaintiff remained conscious throughout the treatment and was fully aware of what was being done. She raised no objection to the surgical procedure. The testimony of both the family doctor and the treating physician indicates the medical procedure utilized in the repair was necessary and customary for *296 that particular injury. The functional and cosmetic results attained were good. The family doctor, who was consulted before the repair was undertaken, gave his consent. He indicated to the treating physician that the surgical procedure suggested was proper, necessary and should be undertaken.
The family physician, Dr. Thompson, testified in part as follows:
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Dr. Winsky, the treating physician, testified as follows:
*298 Mrs. Johnson, the mother, testified on cross-examination as follows:
The trial court's findings, which relate to plaintiff's theory that the medical procedure performed on plaintiff was unauthorized and without the consent of the daughter and her mother, were as follows:
Plaintiff contends these findings are erroneous as a matter of law and do not support a judgment in favor of defendant.
It is the settled general rule that in the absence of an emergency or unanticipated conditions arising during surgery a physician or surgeon before treating or operating must obtain the consent of the patient, or if the patient is incompetent the consent must be obtained from someone legally authorized to give it for him. A surgical operation on the body of a person is a technical battery or trespass, regardless of its result, unlesss the person or some authorized person consents to it. Generally the surgeon is liable for damages if the operation is unauthorized. (41 Am. Jur., Physicians and Surgeons, § 108, p. 220; 70 C.J.S. Physician and Surgeons, § 48 g, p. 967.)
See annotations on the subject of consent to surgical operations appearing in 76 A.L.R. 562 and in 139 A.L.R. 1370.
The consent of a patient to be sufficient for the purpose of authorizing a particular surgical procedure must be an informed *299 consent. The patient must have reasonable knowledge of the nature of the surgery and some understanding of the risks involved and the possible results to be anticipated.
In Natanson v. Kline, 186 Kan. 393, 350 P.2d 1093, this court said:
The medical treatment in that case was a technical cobalt radiation treatment of a serious and dangerous nature where the risks and hazards of the treatment endanger life and must be weighed against the need of the particular patient.
It was also stated in Natanson:
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In the opinion denying a rehearing in Natanson v. Kline, supra, reported at 187 Kan. 186, 354 P.2d 670, it is pointed out that what is a reasonable disclosure upon which an informed consent may rest must depend upon the facts and circumstances of each case.
See also Williams v. Menehan, 191 Kan. 6, 379 P.2d 292, where it was held the physician made a reasonable disclosure as to a cardiac catheterization procedure which resulted in the death of the patient.
In Yeates v. Harms, 193 Kan. 320, 393 P.2d 982, which involved the loss of an eye after a cataract operation, this court said:
In the present case we are confronted with an additional question of whether a seventeen year old girl can give her consent to a minor surgical procedure without the knowledge or consent of her parents. We find no Kansas cases on the subject.
In Lacey v. Laird, 166 Ohio St. 12, 139 N.E.2d 25, where plastic surgery was performed on the nose of an eighteen year old girl without her parents' consent, it was pointed out:
It is stated in the concurring opinion in Lacey v. Laird, supra, that although an infant may avoid liability on contracts solely because of his age, the general rule as to torts does not allow an infant to escape the consequences of his informed consent if he has the degree of maturity of mind which permits him to understand the intricacies of the matter.
A majority of the cases collected in 76 A.L.R. 562 and 139 A.L.R. 1370 recognizes that the consent of a parent may not be necessary or required under circumstances where the child has knowingly consented. In such cases the sufficiency of a minor's consent depends upon his ability to understand and comprehend the nature of the surgical procedure, the risks involved and the probability of attaining the desired results in the light of the circumstances which attend.
In Bonner v. Moran, 126 F.2d 121, 139 A.L.R. 1366, a fifteen year old boy consented and became the donor in an extensive skin graft procedure for the benefit of another person who was seriously burned. The procedure required the boy to remain in the hospital for two months. The case holds generally the consent of a parent to a surgical operation on a child is necessary. Certain *301 exceptions are recognized in the opinion and those exceptions generally recognized by the courts are, (1) when an emergency exists, (2) when the child has been emancipated, (3) when the parents are so remote as to make it impracticable to obtain consent in time to accomplish proper results and (4) when the child is close to maturity and knowingly gives an informed consent. The opinion stresses that one of the basic considerations to be taken into account is whether the proposed operation is for the benefit of the child and performed with a purpose of saving his life or limb.
In our opinion the proper rules of law were set forth and applied in Bonner.
Applying those rules of law to the facts and circumstances of the present case it appears that the father's consent was not available or necessary. The mother's consent was not obtained but her physical condition at the time would have necessitated delaying necessary treatment of a painful injury. The mother's testimony at the trial indicates that if she had been asked for her consent she would have relied largely upon the judgment of her family doctor. This doctor was consulted by the treating physician in advance and he approved the surgical procedure adopted, including the "pinch graft" taken from the girl's forearm. The plaintiff was conscious throughout the treatment and indicated her consent both verbally and by submitting herself to the treatment. She was of sufficient age and maturity to know and understand the nature and consequences of the "pinch graft" utilized in the repair of her finger. It is uncontradicted that the method of repair utilized was the approved surgical treatment and in the best interests of the patient. The desired results were accomplished and permanent damage resulting from the injury after the treatment was minimal from both a functional and a cosmetic standpoint.
We hold that the facts and circumstances attending the injury and repair of the plaintiff's finger bring this case within an exception to the general rule requiring the consent of the parent to a surgical operation on a child. The exception applicable is that under the circumstances the daughter was mature enough to understand the nature and consequences and to knowingly consent to the beneficial surgical procedure made necessary by the accident.
The findings of the trial court in this regard are supported by *302 substantial competent evidence and include a finding that the plaintiff suffers no disability or damage to her finger as a result of the treatment.
The judgment is affirmed.