Opinion ID: 1905888
Heading Depth: 2
Heading Rank: 5

Heading: application of standards to act in question

Text: We have briefly noted above some of the ways in which Chapter 26-40.1, N.D.C.C., modifies previous law. These include a limitation of recovery to $300,000 [Sec. 26-40.1-11], which will be discussed below. Section 26-40.1-08 abolishes the collateral-source doctrine, previously approved by this court in Ostmo v. Tennyson, 70 N.D. 558, 296 N.W. 541 (1941), and Regent Cooperative Equity Exchange v. Johnston's Fuel Liners, Inc., 122 N.W.2d 151 (N.D.1963). The new statute will allow the tortfeasor to have the advantage of nonrefundable insurance benefits purchased by or for the injured plaintiff, except for refund of five years' premiums. Another change relates to the doctrine of informed consent, under which heretofore a physician was liable for negligent acts or omissions undertaken without first obtaining the informed consent of the patient. Under Sections 26-40.1-05 and 26-40.1-02, subdivision 5, the test of liability for failure to obtain informed consent is changed from a subjective right of the patient to refuse consent to an objective determination of whether a reasonably prudent person would have undergone the treatment had he been properly informed, and requiring information only to the extent that such information would ordinarily be provided to the patient under like circumstances by health care providers. Thus the custom of health-care providers becomes the standard as to what information should be given, and the right to refuse is determined not by the will of the patient but by the determination of a jury as to what a reasonably prudent person would have done. The Legislature attempted to meet some of the anticipated constitutional objections to Chapter 26-40.1 by providing that it applied only to patients who consented to its provisions. Section 26-40.1-04 provides that a patient or his representative (parent, guardian, attorney, spouse, trustee, personal representative, or other legal agent) elects to be bound by signing an acknowledgment of consent on forms to be furnished by the Commissioner. Other provisions are summarized in the early part of this opinion. It is provided that In the event a patient does not consent pursuant to this section, the physician shall decide whether he will or will not provide services to the patient. It is further provided that In the event emergency treatment is required, such person is subject to the terms and provisions of this chapter. Thus it is conclusively presumed that an unconscious patient or other patient requiring emergency care consents to treatment, but in the absence of consent by a nonemergency patient, the physician is under no obligation to provide any care at all. The only choices available to the patient who is refused care apparently are to suffer or die of his ailment or to travel outside the State to obtain medical attention. We do not hold that tort liability may never be waived by contract, [5] but we will consider the apparent harshness of the provision we have outlined as one of the factors to be used in determining whether due process and equal protection are violated. The foregoing list is not exhaustive. We have no doubt that the Legislature has the authority to modify pre-existing law in some of the respects we have mentioned. However, the overall extent and effect of such modifications are matters which we may consider in arriving at our ultimate determination as to whether the statute is arbitrary or unreasonable and violates due process, and whether there is a close correspondence between statutory classifications and legislative goals, or whether equal protection is violated by the lack of such correspondence. We now turn to the question of whether the requirement of $100,000 insurance and participation in a fund to create excess coverage to $300,000 is violative of due process. The Idaho court, page 408, held that due process was not violated. The Kansas court made a similar holding. But these decisions are not as persuasive as they might be, since the Idaho statute has a provision under which physicians unable to obtain insurance may be exempted [I.C. § 39-4211], and the Kansas plan provides for an apportionment plan whereby any health care provider may obtain liability insurance from the plan if insurance from a conventional source (40-3413) is not available. 576 P.2d page 224. The North Dakota statute contains no similar provisions. The nearest approach in the North Dakota procedure is a special rule promulgated by the defendant Board of Medical Examiners which provides for a special license which the Board may grant in the best interests of the State to special applicants. No standards are specified for action by the Board of Medical Examiners; no statutory authority for the issuance of such a special license is apparent; and the term special applicants is nowhere to be found in the statute. We have serious doubts as to the authority of the Board of Medical Examiners to issue such licenses, but, since the matter was not briefed and argued, we express no opinion at this time. A compulsory insurance statute affecting physicians was held unconstitutional in McGuffey v. Hall, 557 S.W.2d 401 (Ky.1977), even though the Kentucky Act contained provisions for self-insurance not present in the North Dakota Act. We express serious doubts as to the reasonableness of the statutory scheme which requires insurance but does not provide for those unable to obtain insurance an alternative means for obtaining the equivalent of insurance, as applied to persons licensed to engage in a profession. In view of our holdings later in this opinion, we do not decide the question at this time. We note, in passing, that some of the other States provide methods for providing equivalent protection, other than insurance, sometimes similar to the assigned-risk plan for insuring uninsured motorists in North Dakota [Sec. 26-41-19, N.D.C.C.], and qualification as a self-insurer under the Auto Accident Reparations Act [Chap. 26-41, N.D.C.C.] and the Financial Responsibility Law [Chap. 39-16, N.D.C.C.]. We do not hold, or even suggest, that no right may be limited or withdrawn without providing a quid pro quo. Ohio says that such a quid pro quo must be given [355 N.E.2d page 910], but Idaho [555 P.2d page 409], Wisconsin [261 N.W.2d pages 447-448], and Nebraska [256 N.W.2d page 671] disagree. The United States Supreme Court recently expressed doubt that a quid pro quo was required when a tort remedy was replaced but did not decide the question, holding that a quid pro quo was provided. Duke Power Co. v. Cardina Environmental Study Group, ___ U.S. ____, 98 S.Ct. 2620, 57 L.Ed.2d 595 (1978). However, we agree with the Illinois court [347 N.E.2d page 743] that while there need not always be a quid pro quo, any limitation or elimination of a pre-existing right may not be arbitrarily imposed.