Opinion ID: 2832576
Heading Depth: 4
Heading Rank: 1

Heading: In any action for medical tort based on an

Text: incident that occurred after January 1, 1977, based on the rendering of professional service without informed consent, evidence may be introduced that the health care provider complied with standards established by the board of medical examiners governing the information required to be given by or at the direction of the health care provider to a patient, or the patient’s guardian in the case of a patient who is not competent to give informed consent. (b) The board of medical examiners shall, insofar as practicable, establish reasonable standards of medical practice, applicable to specific treatment and surgical procedures, for the substantive content of the information required to be given and the manner in which it is given and in which consent is received in order to constitute informed consent from a patient or a patient’s guardian. The standards shall include provisions which are designed to reasonably inform and to be understandable by a patient or a patient’s guardian of the probable risks and effects of the proposed treatment or surgical procedure, and of the probable risks of not receiving the proposed treatment or surgical procedure. The standards established by the board shall be prima facie evidence of the standards of care required but may be rebutted by either party. (c) Nothing in this section shall require informed consent from a patient or a patient’s guardian when emergency treatment or emergency surgical procedure is rendered by a health care provider and the obtaining of consent is not reasonably feasible under the circumstances without adversely affecting the condition of the patient’s health. 21  FOR PUBLICATION IN WEST’S HAWAII REPORTS AND PACIFIC REPORTER  that the board’s standards were “admissible as evidence of the required specific standards of care only if the board’s specific standards [we]re designed to reasonably inform the patient of, inter alia, the recognized serious possible risks and complications of each specific treatment or surgical procedure”). The board, however, did not fulfill the statutory mandate because there were too many medical and surgical procedures to provide such an itemization. 6 Haw. App. at 567, 732 P.2d at 1259. In Leyson, 5 Haw. App. 504, 705 P.2d 37, overruled by Bernard II, 79 Hawaiʻi 362, 903 P.2d 667, the ICA first recognized the emerging confusion in the informed consent doctrine. First, the ICA opined that that there appeared to be a conflict in Nishi regarding the scope of a physician’s duty. The ICA explained that “Nishi initially describe[d] the [informed consent] doctrine as a precise and definite duty[,]” 5 Haw. App. at 513, 705 P.2d at 44, on the part of the physician to disclose “all relevant information concerning a proposed treatment, including the collateral hazards attendant thereto, so that the patient’s consent to the treatment would be an intelligent one based on complete information[,]” 5 Haw. App. at 512, 705 P.2d at 44 (quoting Nishi, 52 Haw. at 191, 473 P.2d at 119), “but then it alternatively describe[d] the doctrine as a duty to comply with relevant medical standards[]” by requiring 22  FOR PUBLICATION IN WEST’S HAWAII REPORTS AND PACIFIC REPORTER  plaintiffs to prove the applicable medical standard of disclosure. 5 Haw. App. at 513, 705 P.2d at 44. Second, the ICA noted that the duty to inform had been codified in HRS § 671-3; however, it was “not clear from the language or history of chapter 671 whether the legislature’s intent was to supplant Nishi’s ambiguously defined duty of disclosure.” 5 Haw. App. at 516, 705 P.2d at 46. The ICA also noted that under the common law, a “physician [was] not required to disclose risks that are unexpected or immaterial, by whatever standard, nor . . . risks that are commonly understood, obvious, or already known to the patient.” 5 Haw. App. at 513-14, 705 P.2d at 45 (footnote omitted) (quoting W. Page Keeton, Dan B. Dobbs, Robert E. Keeton, and David G. Owen, Prosser and Keeton on The Law of Torts, § 32 at 192 (5th ed. 1984)). The ICA then set out five material elements for the tort of a physician’s negligent failure to disclose risks of harm prior to treatment, which this court adopted in Bernard II, 79 Hawaiʻi 362, 903 P.2d 670. The five elements are as follows:
patient] the risk of one or more of the collateral injuries that [the patient] suffered; (2) [the physician] breached [his or her] duty; (3) [the patient] suffered injury; and (4) [the physician’s] breach of duty was a cause of [the patient’s] injury in that: (a) [the physician’s] treatment was a substantial factor in bringing about [the patient’s] injury and (b) [the patient], acting rationally and reasonably, would not have undergone the treatment had he [or she] been informed of the risk of the harm that in fact occurred; and (5) no other cause is a superseding cause. 23  FOR PUBLICATION IN WEST’S HAWAII REPORTS AND PACIFIC REPORTER  Bernard II, 79 Hawaiʻi at 365, 903 P.2d at 670 (alterations in original) (quoting Leyson, 5 Haw. App. at 516–17, 705 P.2d at 47); see also Barcai, 98 Hawaiʻi at 483-84, 50 P.3d at 959-60 (reaffirming the five elements required to establish a claim of negligent failure to obtain informed consent under Hawaiʻi law). HRS § 671-3 was amended in 1983,13 and provided that the applicable general standard of information a physician was required to disclose, among other things, was “all recognized 13 HRS § 671-3 (Supp. 1983) provided: (a) The board of medical examiners, insofar as practicable, shall establish standards for health care providers to follow in giving information to a patient, or to a patient’s guardian if the patient is not competent to give an informed consent, to insure that the patient’s consent to treatment is an informed consent. The standards may include the substantive content of the information to be given, the manner in which the information is to be given by the health care provider and the manner in which consent is to be given by the patient or the patient’s guardian.