Opinion ID: 2454536
Heading Depth: 2
Heading Rank: 1

Heading: Sufficiency of evidence on informed consent

Text: For his first argument on appeal, Dr. Aronson submits that the trial court erred in denying his various motions for directed verdict, in denying his motion in limine, and in submitting the issue of informed consent to the jury. Particularly, Dr. Aronson asserts that Mr. Harriman failed to present evidence as required by Ark.Code Ann. § 16-114-206(b)(1) (1987), that the information provided to him about the anticipated surgery itself, including the recognized risks and benefits of the procedure, failed to conform with that type of information as would customarily have been given to a patient by orthopedic surgeons practicing in Little Rock or a similar locality in order to obtain Mr. Harriman's informed consent to the surgical procedure. Mr. Harriman concedes in his brief that the trial court refused to allow his expert, Dr. John Warbritton, to testify regarding the standard of care for informed consent; however, he asserts that Dr. Aronson introduced certain evidence into the trial which established that paralysis was a risk of the procedure about which a patient would customarily have been advised by an orthopedic surgeon in Little Rock or a similar locality. Specifically, Mr. Harriman contends that there were four critical pieces of evidence which supported the jury's verdict on informed consent: (1) a notation in the medical chart by Dr. Neal Lenthicum; (2) the consent form; (3) a notation in the medical chart by Dr. Aronson; and (4) the testimony of Dr. Albert Sanders. The framework for considering the issue of informed consent is set out in Act 709 of 1979, codified at Ark.Code Ann. § 16-114-206(b) (1987), which states, in pertinent part, as follows: (1) [T]hat type of information regarding the treatment, procedure, or surgery as would customarily have been given to a patient in the position of the injured person... by other medical care providers with similar training and experience at the time of the treatment, procedure, or surgery in the locality in which the medical care provider practices or in a similar locality. See also Arthur v. Zearley, 320 Ark. 273, 895 S.W.2d 928 (1995). Shortly after the legislature passed Act 709, we discussed the physician's duty to warn in Fuller, Adm'x v. Starnes, 268 Ark. 476, 597 S.W.2d 88 (1980), holding that the physician's duty to disclose risks is measured by the customary practice of physicians in the community in which he practices or in a similar community. In so holding, we stated that the disclosure standard always requires expert medical testimony for the jury to determine whether a physician's failure to disclose constitutes a breach of his duty to disclose. Id. at 479, 597 S.W.2d 88. Twelve years later, in Grice v. Atkinson, 308 Ark. 637, 826 S.W.2d 810 (1992), we reaffirmed our position in Fuller in upholding the trial court's decision to direct a verdict in favor of a dentist where the patient's expert witness merely stated in a conclusory fashion that the information that the dentist had provided the patient in order to obtain her consent for oral surgery was inadequate. In Grice , we held that the expert's testimony lacked the essential constituent of proof mandated by Ark.Code Ann. § 16-114-206(b)(1), where there was no attempt to compare the locale of the expert's practice to that of the dentist, there was no testimony regarding the size, character, availability of facilities, or even the location of the expert's practice, and where there was no attempt to compare the similarity of medical/dental facilities, practices and advantages available in the dentist's locality with those existing in comparable localities with which the expert was familiar. Most recently, we relied on our decision in Fuller in Brumley v. Naples, 320 Ark. 310, 896 S.W.2d 860 (1995), in affirming the trial court's granting of summary judgment in favor of a physician on the issue of informed consent, where, upon the trial court's review of the deposition of the patient's disclosed expert, the expert could not offer testimony as required by § 16-114-206(b). Our standard of review in determining the propriety of the trial court's refusal to direct a verdict is whether the jury's verdict was supported by substantial evidence, that is, evidence that was sufficient to compel a conclusion one way or the other that goes beyond suspicion or conjecture. Barnes, Quinn, Flake & Anderson v. Rankins, 312 Ark. 240, 848 S.W.2d 924 (1993). Dr. Aronson made a directed verdict motion at the close of Mr. Harriman's case specifying the same grounds he now argues on appeal; that is, that Mr. Harriman failed to present the requisite expert testimony pursuant to Ark.Code Ann. § 16-114-206(b)(1). While Dr. Aronson's abstract indicates that he merely renewed [his] motions for directed verdict at the close of Mr. Harriman's case and at the close of all the evidence, we recently held in Durham v. State, 320 Ark. 689, 899 S.W.2d 470 (1995), that a criminal defendant is not required to restate his grounds for directed verdict where he has made a specific motion at the close of the State's case, and incorporates the same arguments by the later renewal. We see no reason not to apply the rule in Durham to civil cases and to this case in particular, as Dr. Aronson made a specific motion at the close of Mr. Harriman's case as required by Ark.R.Civ.P. 50(a), and incorporated the same arguments by the later renewal. As such, we will reach the merits of his arguments. When reviewing the evidence in a light most favorable to Mr. Harriman, as we are required to do, See eg. Quinney v. Pittman, 320 Ark. 177, 895 S.W.2d 538 (1995), we recognize that, had Dr. Aronson stood on his directed verdict motion at the close of Mr. Harriman's case, his argument that there was insufficient expert evidence on the issue of the physician's duty to disclose would be well taken. However, Dr. Aronson waived his objection to the sufficiency of the evidence when he presented his own case. See Durham v. State, supra ; Rudd v. State, 308 Ark. 401, 825 S.W.2d 565 (1992). See also Willson Safety Products v. Eschenbrenner, 302 Ark. 228, 788 S.W.2d 729 (1990). During the presentation of his case, Dr. Aronson testified on his own behalf, through which he provided the required proof on the physician's duty to disclose. Specifically, Dr. Aronson testified that he saw Douglas during preoperative rounds along with Dr. Elaine Barber, the chief resident, Dr. Neal Lenthicum, a junior resident, a medical student, and his nurse. It was Dr. Aronson's testimony that while obtaining Douglas's consent to surgery, he was instructing the young doctors on this procedure. According to Dr. Aronson, he always talk[ed] about the following complications, with spine surgery especially, which included bleeding, infection, the effects of anesthesia, neurological injury, the use of hooks and rods in the procedure, the possibility of hardware failure, and the risk of death. Of particular significance was Dr. Aronson's statement that [w]hen you operate on the spinal cord and do scoliosis surgery, there is no way not to talk about the potential for neurologic injury. Under these circumstances, when considered together with Dr. Albert Sanders's testimony that paralysis is a risk in spinal surgeries about which a patient should be informed, we cannot say that the trial court erred in denying Dr. Aronson's motion for directed verdict made at the close of his case and again at the close of all the evidence. Dr. Albert Sanders, a board-certified orthopedic surgeon practicing in San Antonio, Texas, testified on behalf of Dr. Aronson, stating that, in his opinion, Dr. Aronson's care and treatment of Douglas in September of 1991 was completely appropriate and met the appropriate standard of care of pediatric surgeons in Little Rock or in a similar community. However, on cross examination, Dr. Sanders offered the following testimony concerning the risk of paralysis: COUNSEL FOR MR. HARRIMAN: You've stated that paralysis is a risk of this type of procedure; is that correct? WITNESS: That is correct. COUNSEL FOR MR. HARRIMAN: Is it appropriate to inform a patient of that risk? WITNESS: It is appropriate. COUNSEL FOR MR. HARRIMAN: Is it inappropriate or is it a breach of the standard of care not to inform them of that risk? WITNESS: Paralysis is one of the most devastating complications of scoliosis surgery and patients must be informed of it. COUNSEL FOR MR. HARRIMAN: And if they are not, is it a breach of the standard of care? WITNESS: That would be. When considering Dr. Sanders's testimony that it is a breach of the standard of care to fail to inform a patient of the risk of paralysis, together with Dr. Aronson's own testimony regarding the standard of care, we must conclude that the trial court did not err in denying Dr. Aronson's motion for directed verdict.