### IN THE COURT OF APP EALS OF TENNESS EE AT JAC KSON Se pte m be r 23, 200 4 S es sio n MIC HAE L K. HOLT v. C . V . A LEX AN DER , JR ., M. D. , and

JAC KSON RA DIOLO GY AS SOC IATE S An Appeal f

romthe Circ uit Court for Madison Cou nty No. C99-410 D onald H. Allen, Jud ge

No. W2003-02541-C OA-R3-C V - F iled Janu ary 13, 2005

This is a medical battery

case . The plaintiff w ent to the hospital suf fering from a kidney

stone, and wa s a dmi tte d f

or ob se rv a tio n. Th e ne xt mornin g , the pl a int if f w a s to ld that hewa s sc he du le d to underg o a proc edure to remove the stone. Soon, the defe ndant phy sician came to see the plaintiff and told him that he would be performing an invasive pr ocedur e which r equire d signific ant re covery time. Accor ding to the plaintiff, the plaintiff then asked the defe ndant phy sician whether his treating urolog ist had approve d of t he proc edure . The de fendant phy sician re sponded that he ha d spoken with the urolog ist and that the urolog ist had approve d the proc edure . The plaintiff t h en s i gn ed a consent form, and the proc edure was pe rformed. The pla intiff later le arne d that the def endant phy sician had not spoken w i t h h is urologist, and that the urolog ist did notapprove the proc edure

. The plaintiff sue d the defe ndant phy sician and his medica l gr oup for medic al battery . The trial c ourt g ranted summary

judgme nt in favor of

the def endants. The plaintiff now appe als. We reve rse, finding that a g enuine issue of material f act exis ts a s to w hether

the plaintiff’s c onsent to surg ery was vitiated by

the def endant phy sician’s a lleg ed misrepr esentation of fac t.
Te nn. R . A pp. P . 3 App e al a s o f Rig ht ; J udgm e nt of t he Ci r c uit

Co ur t i s Reve rsed and Rem anded
H OL L Y M. K I RBY , J. , d e li v e r e d th e o p in io n o f th e Co u rt, inw h ic h W. F RAN K C RAW FORD , P.J ., W.S ., and A L AN E. H I G H ERS , J ., joined.
Ev e re tt B . G ibs on , M e mph is, Te nn e sse e , f or theapp e llant, Mic ha e l K . H olt

. Floy d S. Flippin and Paul B

. Conley , I I I , Humboldt, Te nnessee , for the a ppellees, C. V. Ale x ander , Jr., M. D. , a ndJac ks on Ra dio log y As so c iate s.K i d ne y s t o ne s are so l i d p i ec es o f m aterial t ha t fo rm i n the k i d ne y. T he y can “p ass” b y natural m ea ns, 1 wh i ch me an s t h ey c an t r av el on t h ei r ow n t owa r d t h e bl adde r a n d dow n t h e u r i n ar y t r ac t , or t h ey mu s t be t r ea t ed by p erfo rming o t her pro ced ures , one be i ng a s t o ne m ani p ul at i o n.

H o l t s t at ed t hat , i n t he p ast , t he H o spi t al wo ul d gi ve hi m m o rphine fo r t he p ai n. O n t hi s o ccasi o n, 2 ho wever, he was gi ven D i l aud i d , whi ch was l ess ef fect i ve at co nt roll i ng t he p ai n. -2- OP IN ION Plaintiff/Appellant Michae l K. Holt (“Holt”) , about 37 y ear s old at the time of the incident i n q u es t i o n , h ad a h i s t o ryo f r ec u rr i n g k i d n eys t o n es
. He s u ff er ed h i s fi rs tk i d n e y

s t o n e a tage 1 thirteen, a nd his parents broug ht him to a medical clinic for treatment. Holt was g iven medication for the pain, and a f

ew day s later, hepassed the stone without any further medical intervention. After he was 24 or 25 y ear s old, Holt had at least thre e additional bouts with kidney stones. Eac h time he had a kidne y stone “attac k,” he would g o to the hos pital and be give n intravenous ( “IV”) fluids and pain medication. Then he would be sent home and would pass the stones without further me dical interven t i o n
. He was not admit ted to the hospital on any of these prior occ asions, nor wa s he
su bje c te d to a ny

me dic a l pr oc e du re s to tr e a t th e kid ne y sto ne s. On Sunday , November

29, 1998, Holt suffer ed anothe r kidney stone attack. His wife took him to J ackson Madison County Gene ral Hospital (“the Hospital”). Holt w as treated and r elea sed with the hope that he would ag ain pass the kidney stone without surg ical interve ntion. He sa id he 2 was told that the kidney

stone was ve ry

small, and that he wa s expected to pass it a s he had in the pa st. I ns te a d, thepa in c on tin ue d a nd inc re a se d, so Ho lt we nt ba c k to the Ho sp ita l th a t e ve nin g . H olt was admitted to the Hospital under the car e of his reg ular urolog ist, J ohn Henning Meriwe ther, M.D. (“ Dr . M e ri we the r” ). Al tho ug h D r. Mer iw e the r w a s th e a dmi tti ng ph y sic ia n, he didno t me e t w ith Holt at the Hospital at that time. Holt be lieved that he was being admitted solely for the pur

pose of thea dmi nis tr a tio n o f IV f

lui ds a ndpa in me dic ine

. No fu rthe r p ro c e du re s w e redis c us se d at th e tim e of his admission.
T h e n e xt m o r n ing, Holt

w a s ta k e n f r o m h is H o s p it a l r o o m t o th e x- r a y r o o m. H e w a s xray ed, then moved to a differ ent room. When Holt asked what he was doing the re, H olt was told, “[T] hey ’re g oing to do the proce dure on y ou.” He asked what proce dure, and he wa s told that the phy sician would explain. Shortlythere afte r, Defendant/Appellee C.V. Alexander, J r., M.D. (“D r. Alex ander ”), w hom Holt had neve r met , en t ere d the room. Dr. A lexander told Holt that the kidney stone had to be remove d imme d i atelyand that he ( Dr. Ale x ander ) would have to go in and perf orm a proc edure called a percu t an o u s n ephrostolithotomy , or a stone manipulation. This is an invasive sur g ical pr oc e du rein w hic h th e su rg e on ins e rt s a nee dle in the patie nt’ s bac k an d, thr ou g h the ne e dle , in se rt s a devic e to manipul at e t h e s t one and phy sically remove the stone fr om the patient’s body . The proce dure r equire s the administration of an anesthe tic and four to five day s in the hospital following the surg ery
. Acc ording to Holt, Dr. Alexander briefly explained the proce dure, and he did not have an opportunity

to ask him any questions. Holt said he tol d Dr. Alex ander that he would only

do whatD r. A le x a n d e r d e n ie s tha t he m a d e this sta te m e n t t o H o lt. 3

It do es not ap p ear t hat Jackson R ad i o l o gy joi ned i n t he m o t i o n. H o wever, t he argume nt s and po si t i o ns 4
ta k e n o n b e h a lf o f D r. A le x a n d e r a p p ly with e q u a l f o rc e to J a c k so n R a d io lo g y. -3- Dr. Meriwether

told him t o do, and Dr . Alexander re plied that “h e h ad t al k ed to hi m [ Dr. Meriwe ther], and he okay ed this proc edure .” I n any event, Holt signe d the conse nt form pre sented 3 by Dr. Ale x ander

. Dr. Ale x ander

then perf ormed the stone manipulation on Holt. After the sur g ery , Holt was in considera

ble pain and remaine d in the Hospi tal for about a week. He had a tube coming out of his back draining down his leg . When the tube was r emoved a stent was plac ed in his urinary trac t that cause d him discomfort and pain. The pain had subsided by the first part of J anuary

1999.
It was later discovere d that Dr. Meriwether did not, in fact, orde r the stone manipulation for Ho lt. Ea rl y on themornin g of No ve mbe r 30, 19 98 , a ho sp ita l se c re tary

ma de a n e rr on e ou s e ntry

int o the hos pital’s computer sy stem indicating that Dr. Meriwether had orde red D r. Alexander to pe rform a s t o n e m an i p u l at i o n o n Ho l t

. W h en Dr

. Al ex an d er arri v ed att h e H o s p i t al fo r w o rkt h atm o rn i n g, h e r e c e i v e d t h e e rr o n e o u s o r d e r f o r H o l t ’ s s t o n e m a n i p u l a t i o n
. D r
. A l e x a n d e r r e v i e w e d H o l t ’ s x
- r a ys and dete rmined that the reque sted proce dure was justified. He then met with H olt, informed him of the risks, bene fits, and steps of the pr ocedur e, and obtai n ed Ho l t ’s consent to perform the stone manipulation.
It is undisputed that Dr . Alexander did not speak w ith Dr. Meriwe ther prior to performing the stone manipulation on Holt, and that Dr. M eriwether wa s unawa re of it until he ar

rived at the ho sp ita l late r that mor nin g a nd sa w Dr Al e xan de r pe rf ormin g thesto ne ma nip ulatio n o n H olt . H olt would subseque n tly

say that Dr. Meriwether

later told him that he neve r would have order ed the proce dure, and that it “never should have be en done.”
On Novembe r 29, 1999, Holt filed this l aw s uit ag ainst Dr. Alexander , his medical g roup, De fe nd a nt/Ap pe lle e Jac ks on Ra dio log y As so c iate s (“ Jac ks on Ra dio log y ” ), a ndtheHo sp ita l. H olt alleg ed that the defe ndants committed me dical malprac tice by obtaining his c onsent to the stone manipulation proce dure without g iving him ade quate information and by perf orming the proc edure
o n h i mu n d e r

t h o s e c i r c u m s t a n c e s
. 4 T h e c o m p l a i n td i d n o ti n c l u d e a c l a i mf o r m e d i c a l b a t t e r y.
On Fe bruary

24, 2000, Dr. Ale x ander and Jackson R ad iology

filed a motion for summary judgme nt on the alleg ations in the complaint. On May 10, 2 0 0 1 , t h e t ri al court entere d an orde r g ranting the motion for summary judgme nt on all claims of medica l malprac tice other than the issue of in formed consent. L ater , Holt settled his claims ag ainst the Hospital, and the c omplaint was dismiss ed as to the H ospital on November 4, 2002. On April 1, 2003, Dr. A lexander filed a rene wed motion for summary judgme nt on Holt’s lack of informed c onsent claim. I n that motion, counsel for Dr. Alex ander informed the trial court 4A copy of t hat l et t er , dat ed M ar ch 24 , 200 3, was i ncl uded i n t he r ecor d on appeal

. T he part i es ag r ee t hat 5 H o lt the re a fter a b a n d o n e d his la c k o f i n fo rm e d c o n se n t cla im a n d p ro c e e d e d o n ly o n his c la im o f m e d ic a l b a tter y.

D r
. Al exa nder does not make t hi s as s er t i on on appeal

. I n D r
. M er i wet her ’ s depo s i t i on, he i s as ked wh et her 6
t her e wa s an y t hi ng wr ong w i t h D r
. Al exa nder , af t er s eei ng t he hos pi t al document s howi ng t hat D r
. M er i wet her ha d order ed a s t one mani pul at i on for H ol t , per formi ng t he procedur e wi t hout t al ki ng t o D r
. M er i wet her

. D r
. M er i wet her
r epl i ed, “ A bsol ut el y not hi ng wr ong w i t h t hat

. ” T he fol l owi ng ex cha ng e t hen t ake s pl ace :

Q

. W el l , I want y o u t o t ake i nt o acco unt every t hi ng t hat y o u knew o n M o nd ay m o rni ng plus every t hi ng t hat y o u have l earned s i nce M o nd ay m o rni ng ab o ut t hi s p art i cul ar case. D o y o u have any cri t i ci sm at al l of D r. A l exand er f o r perfo rming t hi s st o ne m ani p ul at i o n pro ced ure on M r. H o lt?

A

. D r. A l exand er was d o i ng exact l y what he wo ul d have no rma l l y do ne und er t he no rma l every d a y ro u tine . N o thin g w o u ld ha v e b e e n o u tsid e o f t h e o rd ina ry fro m D r. A le x a n d e r’s sta n d p o int in t hi s ca s e. Q

. You h a v e n o c r i t i c i s ms a t a l l of h i m?

A . N o c riticism s a t all.

A t no p o i nt , how ever, i s D r. M eri wether asked i n hi s d ep o si t i o n whet her he would have ap p roved t he st o ne m ani p ul at i o n fo r H o l t had he be en asked. Since D r. A l exand er do es not po i nt t o a place i n t he reco rd where D r. M e riw e the r m a k e s su c h a sta te m e n t, w e d o no t co n sid e r it i n his a p p e a l. -4- that he had rec eived a letter from counsel for Holt indicating that Holt intended to rely entirely on a claim for medica l battery , not lack of informed consent. On the same day , Dr. Ale x ander filed a 5
rene wed moti on for summ ary judgme nt on Holt’s anticipated medical battery claim, ar g uing that the fac ts were undisputed and that he w as entitled to a judg ment as a matter of law

. On J uly 17, 2003 , Ho l t filed a motion for le ave to f ile an ame nded complaint to include a
cause of ac tion for medica l battery

. On J uly 18, 2003, the t rial court hear d oral a rg ument reg arding Dr. Ale x ander ’s motion for summary judgme nt and Holt’s motion to amend his c omplaint. At that he ari ng , c ou ns e l f

or Dr . A le xander tol d th e tria l c ou rt that D r. Me ri we the r h a d te sti fi e d inhis deposition that he would have approve d the procedure for Holt in any event “ beca

use of the size of thesto ne a ndtheloc a tio n. ” He ari ng that, the tria l c ou rt re a so ne d, “ if

that’ s th e c a se , th e n o bv iou sly 6 there ’s no dispute bec ause Mr

. Ho l t said, ‘Well, I would have g one throug h this procedur e had I known Dr. Me riwethe r had approved it, y ou know.’ ” Consequently , the trial court determined that “I think – I can listen to all the proof , I would probably

g rant – I fee l co n fi d en t t h at I would g rant judgme nt on be half of Dr. Ale x ander in this case. . . . [I ]tjust doesn’t appea r that there ’s re ally

any dis pu te a s to a ny

mate ri a l f

a c ts in this c a se .” Onthat ba sis , th e tria l c ou rt g rante d H olt ’s mot ionto amend, but conte mporane ously g rante d summary judgme nt in favor of Dr. Alexander a nd J ackson Radiology

on Holt’s claim of medic al b at t er y
. On September 10, 2003, the trial court entere d an
or de r c on sis te nt w ithits or a l ruli ng . Fro m th a t or de r, Ho lt n ow app e a ls. On appe al, Holt arg ues that the trial c ourt err ed in gr anting summary judgme nt in favor of Dr. Ale x ander an d J ac k s o n Radiology on his claim of medica l battery , beca use g enuine issues of-5-

mate ri a l f a c t e xist re g ard ing that c la im. He arg ue s that, vie wi ng thefa c ts i n a lig ht m os t f

a vo ra ble to him, a jury

could conc lude that h i s signature on the c onsent form wa s based on a materia l misrepre sentation of fac t and, there fore , was a nullity . I n response , Dr. Ale x ander arg ues that there is no evidenc e of circ umstances that would nullify Holt’s consent to the procedure

. Dr. Ale x ander maintains that, in any event, Holt’s claim is a ctually a case based on la ck of informed conse nt. Since Holt had no expert testimony to support his claim of lack of informed c onsent, summary judgme nt in favor of

Dr. Ale x ander

and Jackson Radiology

was a ppropriate

. We r e vie w the tria l c ou rt ’s g rant o f s umm ary jud g me nt de novo with no presumption of
corr ectne ss. Wa rre n v . Esta te of Kir k , 9 54 S.W. 2d72 2, 72 3 ( Te nn . 1 99 7) . Su mma ry jud g me nt i s appropriate whe re “ the pleading s, depositions, answers to interr og atories, and admissions on file, toge ther with the affidavits, if any , show that there is no ge nuine issue as to any materia l fac t and that the mov ing pa

rty is e nti tle d to a jud g me nt a s a matte r of la w. ” Te nn
. R. Civ

. P. 56 .0 4. We m us t view the e vidence in a light most favor able to the nonmoving party , g iving that party the bene fit of all rea sonable infe renc es. Warren , 9 5 4 S

. W

. 2 d at7 2 3 (q u o t i n g Bain v . W e lls , 936 S.W .2d 618, 622 (Tenn. 1997)). Once the m oving party demonstrates that no ge nuine issues of material fac t exi st, the non-moving party

must demonstrate, by

aff idavits or otherwise, that a disputed issue of material fac t exis ts for trial. By rd

v . Ha ll , 847 S.W .2d 208, 211 (Tenn. 1993)

. Whil e Holt has e lected to pur sue only his claim for medic al battery , Dr. Ale x ander insists that Holt’s cause of ac tion is actually based on me dical malpra ctice and lack of informed c onsent, which require s expert testimony reg arding the applicable s tandar d of ca re. Se e Bla nc har

d v . Ke llum , 975 S.W .2d 522, 524 (Ten n
. 1 9 9 8 ). I n Bla nc har d , the Tenne ssee Supre me Court set out a cle ar dis tin c tio n b e tw e e n a

c la im o f me dic a l batte ry a nd a me dic a l ma lpr a c tic e inf orme d c on se nt c la im. The Court said:

We believe that ther e is a dist i n ct ion betwee n: (1) ca ses in which a doc tor pe rf orms an u nauth orize d p ro c e du re ; a nd(2 ) c a se s inwh ich the pr oc e du reis authorized but the patient cla ims that the doctor fa il ed t o i n form the patient of any or all the risks inher ent in the proc edure

. Performance of an unauthorized proce dure constitutes a m edica l battery

. A s imple inquiry can be us ed to determine whether a case co n s t i tutes a medica l battery : (1) wa s the patient aw are that the doctor w as g oing to pe rform the proce dure ( i.e., di d the patient know that the dentist was g oing to pe rform a root cana l on a specifie d tooth or that the doctor was g oing to pe rform surg ery on the spec ified knee?); and, if so (2) did the patient authorize perf ormanc e of the proc edure ? A plaintiff’s c ause of action may be classified as a medical battery only when answers to either of the above questions are in the neg ative. I f, howe ver, answe rs to the above questions are aff irmative and if the plaintiff is a lleg ing that the doctor failed to inform of any or all risks or aspe cts associated with a proc edure , the p a t i e n t ’ s c au s e o f

a c t i o n r e s t s o n a n i n f

o r m e d c o n s e n tt h e o r y. Id. Thus, under the “simple inquiry ” test, the court must a sk whether the plaintiff was awa re t hat t h e s p e c i f i c p r o c e d u r e w a s g o i n g t o b e d o n e a n d w h e t h e r t h e p l a i n t i f

f au t h o r i z e d t h e p r o c e d u r e
. If-6-

either que stion is answe red in the neg ative, then the claim is one for medical battery

. The Bla nc har d Court expl ained that, in an inf ormed consent case , expert testimony is nece ssary , beca use “a court mus t c on sid e r the natur e of theme dic a l tr e a tme nt, e xten t of th e ri sk s in vo lve d a ndtheapp lic able standard of

car e” in de termining whether the information provide d to the patient was adequate

. Id. Howeve r, expert testimony is not mandated in a medic al battery case beca

use “t h e primary consideration is whether the patient knew of and authorized a proce dure. This determination does not require the testimony

of an e x pert witness.” Id.
I n the instant case , Dr. Alex ander arg ues t hat Holt actua lly asserts lack of informed c onsent beca use (1) Holt knew that Dr. Alexander wa s g oing to pe rform the stone manipulation proce dure on him, and (2) Holt cle arly authorized the procedure by signing the conse nt form. Ther efor e, Dr

. Alexander a

rgu es , b ec ause both que stions of the “simple inquiry ” test ar e answ ere d in the aff irmative, this is not a

medical battery

case
. See id. I n response , Holt conce des that he kne w that Dr. Ale x ander

was g oing to pe rform the stone manipulation proce dure on him, but arg ues that the signe d consent form is a nullit y beca use he w as induce d into signing it under fa lse prete nses. He claims that, to induce him into signing the conse nt form, Dr. A lexander told him that he had spoken wi th D r. Me ri we the r and

that D r. Me ri we the r a

pp ro ve d o f the pr oc e du re
. In his de po sit ion , H olt sa id that when Dr . Alexander tol d him that it was necessa ry for him to do a stone manipulation, he a sked if Dr. Me riwethe r had or dere d the proc edure : [Holt ]: I said [to Dr. Alex ander ], “I haven’ t seen my

doctor.” An d [D r. Al e xan de r] s a id, “ We ll, I ’v e ta lke d to Dr . B ic kn e ll, a ndDr . B ic kn e ll order ed the pr ocedur e.” I said, “Dr . Bic knell is not mydoctor,” and my exact words I

reme mber ve ry c le arl y , b e c aus e I

wi ll n ot l e t D r. B ic kn e ll tre a t me. Th a t, “If I ha ve a ny say -s o inthi s matte r w hatso e ve r, I wi ll not do wh a t D r. B ic kn e ll s a y s. Dr . M e ri we the r i s my doctor, a nd I

will onlydo what Dr . Meriwe ther tells me to do.” So Dr. Alex ander then s aid, “Oh, oh, that’s right. I ’ve ta lked to him, and he okay ed this proce dure.” [Question] : “Talke d to him,” being Dr. Meriwether ? [Holt ]: I mply ing D r. Meriwether

. Thus, Holt arg ues, Dr. A lex an d er ’s allege d misrepre sentation that he ha d spoken with Dr. Meriwe ther a nd that Dr. Meriwether “okay ed” the proce dure w as the re ason he r eluctantly signe d the conse nt form. B eca us e Dr

. Al exander ha d in fac t not spoken to Dr. Meriwe ther a nd Dr. M e r i w e t h e r

h a d n o tap p r o v e d t h e p r o c e d u r e , H o l tar g u e s , h i s c o n s e n tw a s a n u l l i t y.
I n support of his position, Holtrelies on Chu rch v. Perale s , 39 S.W .3d 149 (Tenn. Ct. App. 2000). In Chu rch , the court cited Bla nc har d ’s explanation of the diffe renc e betwe en a c laim based on medical battery

and one based on lack of informed consent. Chu rch went further, howe ver, and stated that a sig ned conse nt form ra ises a pre sumption t hat the patient has consente d to the proce dure-7-

“in the absence of proof of m isrepre sentation, inadequate disclosure, f org ery , or lac k of ca

pacity .” Chu rch , 39 S.W .3d at 161. The c ourt observe d th at when “ no evidenc e compe tently undermines the validity

of t h at co n s en t , the surg ery is not a battery .” Id. a t 16 1- 62 (f oo tno te omi tte d) . H olt arg ues the ne g ative infe renc e fr om that statement, that wher e ther e is evidenc e to undermine the va lid ity of the plaint if

f’ s c on se nt, the n thec la im i s o ne fo r m e dic a l batte ry . In th is c a se , h e arg ue s, there was e vidence of a misre prese ntation s u ff icient to rebut the pr esumption of consent fr om the signe d consent form. I n fac t, he ar g ues, the e vidence is undisputed that Dr. Alexander did not speak to Dr. Meriwether

prior to the p ro ce d u re, and that Dr. Meriwether did not give an order

for the pr oc e du re . Wh e n th e e vid e nc e is v ie we d in a lig ht mos t fa vo ra ble to him , Ho lt arg ue s, a

jury c ou ld f i n d t h a th i s c o n s e n tw a s b a s e d o n a m i s r e p r e s e n t a t i o n a n d , t h e r e f o r e , w a s a n u l l i t y.
Dr. Ale x ander

corr ectly asserts that a signe d consent form shows that the plaintiff was a war e that the surg ery

was g o i n g to take plac e. See, e.g., Harris v. Buckspan , 984 S.W .2d 944, 949-50 (T e nn . Ct . A pp . 1 99 8) . T he sig ne d co ns e nt fo rm , how e ve r, raise s only a pr e su mpt ionof

c on se nt t o su rg e ry . A c la im f

or me dic a l batte ry c a n b e e sta bli sh e d if it i s sh ow n th a t th e ph y sic ia n in te nti on a lly
or re cklessly

misrepre sented a

materia l f

act in or der to obtain the patient’s sig nature on the conse nt form, thus vitiating the patient’s consent. F o r ex am p l e, in Petzelt v. Te wes , 581 S.E.2d 345, 347 (Ga . Ct. App. 2003), the plaintiff conse nted to a “de nervation” procedure to a lleviate pain in her back, ba sed on the de fend ant phy sician’s re prese ntation that the patient’s orthope dic surg eon wa s “fully awa re” of eve rything the de fendant phy sician wa s doing. Id. at 346-347. I n re al i t y , the defe ndant phy sician had dic tated notes indicating a “c.c .” to the orthopedic surg eon, but had no idea whether the orthopedic surg eon had e ither re ceive d or re viewed the notes. It turned out t h at the orthopedic s u rge on was una war e of the defe ndant phy sician’s c ourse of treatment of the plaintiff. Id. at 347-348. The appellate court found that the jury could conclude from the evidenc e t h at the defe ndant phy sician had misrepre sented to the pl aintiff that the orthopedic surg eon had a cquiesc ed to her tre atment plan for

the plaintiff. Id. at 348. Under these circ umstances, the plaintiff’s conse nt to the medical pr ocedur e “may be vitiated.” Id. a t 34 7; see also Duncan v. Scottsdale Med. Im aging, Ltd. , 70 P.3d 435, 440 (Ariz. 2003) (en banc) ( holding that althoug h consent to injection was g iven, conse nt was obtained by misrepre sentation and, thus, was inva lid).
I n th e ins ta nt c a se , H olt su bmi tte d his ow n te sti mon y that D r. Al e xan de r r e pr e se nte d to him that he had spoke n to Dr. Meriwe ther befor e the surg ery and that Dr . Meriwe ther a pproved of

the proce dure. In fac t, Dr. Alexander a dmits he did not t alk with Dr. M er i we ther, a nd he later discovere d that Dr. Meriwether did not order the pr ocedur e. This claim is n o t o n e o f l ack of inf orme d c on se nt, wh e rethe ph y sic ia n “ faile d to inf orm [the patie nt] of

a ny or a ll risk s o r a sp e c ts associate d with a proc edure .” Bl an char d , 975 S.W .2d at 524. Acc ording to the Restatement of To rt s:
If t h e p e r s o n c o n s e n t i n g t o t h e c o n d u c to f a n o t h e r i s i n d u c e d t o c o n s e n tb y a substantial mist ake c oncerning the nature of the invasion of his intere sts or the extent of the ha rm to be expected f

rom it and the mistake is known t o the other or is induced-8-

by the ot h e r ’ s mi s r e p r e s e n tati o n , th e c o n s e n t i s n o t e f f e c ti v e f o r th e u n e xp e c te d inv a sio n o r h arm
. Restatement 2d Torts 892B (2) ( 1979), quoted in Duncan , 70 P.2d at 440. Under c omment h of the Restatement, a patient adver sely aff ecte d by the misrepre sentation may either bring an action for misrepre sentation or “tr ea t the consent a s invalid and maintain any tort action open to him in the absenc e of c onsent.” Where a signe d consent form raises the pr esumption of valid consent, a nd the p l a i n t i f f c l a i m s t h a t h i s c o n s e n t w a s v i t i a t e d b y “ m i s r e p r e s e n t a t i o n , i n a d e q u a t e d i s c l o s u r e , f o r g e r y, or la c k o f c apa c ity ,” a

c la im f or me dical bat ter y is state d a nde xpe rt te sti mon y

is n ot n e c e ssa

ry to prove suc h a claim. Chu rch , 39 S.W .3d at 161.
I n this case, Holt states a c laim for medica l battery , insofar a s his consent to the medica l proce dure w as base d on Dr. Alex ander ’s allege d misrepre sentation. As such, e x pert testimony was not require d to establish his claim. Holt’s testimonyreg arding Dr. Ale x ander ’s alleg ed mis re pr e se ntatio n w a s su ff ic ie nt t o c re a te a

g e nu ine iss ue of mate ri a l fa c t wi th re sp e c t to theva lid ity of his c on se nt. Th us , th e tria l c ou rt e rr e d in g ranti ng su mma

ry jud g me nt on Dr . A le xan de r’ s b e ha lf at this juncture.
T h e d ec i s i o n o f t h e t ri al co u rti s re v er s ed an d t h e ca u s e i s re m an d ed fo r f u rt h erp ro ce ed i n gs not inc onsistent with this Opinion. Costs on appe al ar e to be taxed to Appellee s C. V. Alexander, J r., M.D., and Jackson Radiolog y Associates, f

or which e x ecution may

issue, if nec essary
.

___________________________________ HOLL Y M. KI RBY, JUDGE