Opinion ID: 1779199
Heading Depth: 1
Heading Rank: 4

Heading: Reikes v. Martin

Text: ¶ 19. In 1985, this Court decided Reikes v. Martin, 471 So.2d 385 (Miss.1985), wherein the plaintiff claimed inter alia, that her doctors failed to obtain her informed consent to cobalt therapy for uterine cancer. In their appeal of a jury verdict of $543,750, the doctors assigned as error the granting of a jury instruction which provided that the defendants could be found liable for failing to fully inform [the plaintiff] of the risk of cobalt therapy, where no evidence in the record showed she would have elected not to undergo the therapy had she been so informed. Id. at 391. In briefly discussing a physician's duty to inform a patient of risks, the Reikes Court recognized and cited the authority of Ross v. Hodges . It is important to note at this juncture that, as to the test for material risks, the Reikes Court neither questioned nor overruled Ross v. Hodges . ¶ 20. As to the issue of causation (which was the only informed consent issue raised on appeal and discussed in Reikes ), this Court began by setting forth the jury instruction at issue, which stated: The court instructs the jury that a physician must obtain consent from a patient to perform the procedure or treatment performed on the patient. To obtain the required consent, the physician must explain the procedure to the patient and warn the patient of all material risks or dangers in the procedure or treatment. The purpose of the explanation is to enable the patient such as [the plaintiff] to make an intelligent and informed choice about whether to undergo the treatment or procedure, in this case, cobalt therapy. The physician is negligent if he fails to disclose to the patient... all material information, risks and warnings. A risk or danger is material if it would be important to a reasonable person in the patient's position in making the decision whether or not to undergo the procedure or treatment, in this case, cobalt therapy. The physician is not required to disclose all possible information. The physician need only disclose information for a reasonable person to make an intelligent decision. Reikes, 471 So.2d at 392. Commenting on the instruction, the Reikes Court then stated: Although not referred to by name, this instruction applied [2] the so-called prudent patient or materiality of the risk standard in determining what risks must be revealed to the patient. Under this standard, a physician must disclose those known risks which would be material to a prudent patient in determining whether or not to undergo the suggested treatment. The appellants contend that the above jury instruction was erroneous as it allowed recovery upon proof that informed consent was not given and without any showing of causation, i.e., that Mrs. Martin would not have elected to undergo the treatment if she had been informed of the known risks. Id. The Reikes Court then addressed the causation issue: To recover under the doctrine of informed consent, as in all negligence cases, there must be a causal connection between the breach of duty by the defendant and the injuries suffered by the plaintiff. Some states have adopted a subjective standard, requiring the plaintiff to testify or otherwise prove that she would not have consented to the proposed treatment if she had been fully informed. [citations omitted]. A second test, and the one used by the vast majority of the states, is based upon an objective standard. Under this test, the question becomes whether or not a reasonably prudent patient, fully advised of the material known risks, would have consented to the suggested treatment. Id. The Reikes Court then stated: [W]e think an objective test is the more desirable and adopt that test as the one to be applied in this State. Id. at 393. Critical to an understanding of the holding in Reikes is that the Court adopted the objective test for causation, but did not make any finding with respect to the duty to disclose. ¶ 21. Nevertheless, the Reikes decision would be credited in later cases with adopting the objective patient-need standard for determining the materiality of a risk. See, e.g., Herrington v. Spell, 692 So.2d 93, 98 (Miss.1997) (We have adopted [in Reikes ] an objective test to determine what information a physician must disclose....); Hudson v. Parvin, 582 So.2d 403, 410 (Miss.1991) (We have adopted an objective test [in Reikes ] to determine what information a physician must disclose....); Phillips ex rel. Phillips v. Hull, 516 So.2d 488, 493 (Miss.1987) (However, recently the Court [in Reikes ] recognized the objective patient-need standard....). ¶ 22. Thus, the perceived change from the professional community standard to the objective patient need standard for determining material risks, springs from a misapplication of Reikes. It bears repeating that the adoption by the Reikes Court of the objective standard for purposes of determining causation is unrelated to the obligation of the plaintiff to produce expert testimony to establish the material risks of a medical procedure which should be disclosed. ¶ 23. The use of the objective (as opposed to subjective) standard for establishing causation, as announced in Reikes, is not before us. ¶ 24. As recognized by the Reikes Court, no doctor could comply with a requirement to disclose every possible risk to every procedure. 471 So.2d at 392. Doctors must, however, disclose material risks associated with a particular procedure. Among the many factors which could weigh on the question of materiality are frequency of occurrence, potential severity or danger associated with the risk, and the cost and availability of an alternative procedure. These factors cannot be established absent expert testimony.