Opinion ID: 3163349
Heading Depth: 3
Heading Rank: 2

Heading: Battery Under Massachusetts Law

Text: A diversity suit such as this is governed by Massachusetts substantive law. See Nett v. Bellucci, 269 F.3d 1, 5 (1st Cir. 2001). In Massachusetts, battery is defined as an intentional offensive touching of a person done without consent. Moore v. Eli Lilly & Co., 626 F. Supp. 365, 368 (D. Mass. 1986) (citing Belger v. Arnot, 183 N.E.2d 866, 869 (Mass. 1962)). In the medical context, battery qualifies as medical treatment of a competent patient without his consent. In re Spring, 405 N.E.2d -8- 115, 121 (Mass. 1980). The Bradleys contend that Dr. Sugarbaker committed battery by failing to obtain consent to remove a large section of Mrs. Bradley's lung before performing the wedge resection procedure. For medical battery claims, Massachusetts courts distinguish lack of consent from a lack of informed consent. Moore, 626 F. Supp. 2d at 368. Accordingly, while an allegation that there was no consent may be brought as a battery claim, where the question of consent touches on the appropriate standard of care -- for example, whether a patient was informed of the risks accompanying a procedure -- the action is better understood as sounding in negligence. See, e.g., id. (While early cases treated lack of informed consent as vitiating the consent to treatment so there was liability for battery, the modern view is that the action is in reality one for negligence in failing to conform to the proper standard. (quoting Mink v. Univ. of Chi., 460 F. Supp. 713, 716 (N.D. Ill. 1978))); Feeley v. Baer, 679 N.E.2d 180, 182 n.4 (Mass. 1997) (Most authorities prefer to treat informed consent liability solely as an aspect of malpractice or negligence. (internal citation omitted)). The reasoning in Heinrich v. Sweet sheds light on the difference between battery claims and medical malpractice claims premised on a lack of informed consent. Dismissing a medical battery claim, the -9- district court explained, [t]he Plaintiffs do not contend that [they] gave no consent at all; rather, the district court noted, they claimed that relevant risks had not been disclosed. Heinrich v. Sweet, 49 F. Supp. 2d 27, 38 (D. Mass. 1999) (emphasis added). As a result, the claim should be treated as a claim for medical malpractice. Id. The Bradleys identify documents leading up to the surgery as evidence that she never consented to a wedge resection procedure. For example, while Mrs. Bradley's consent form explicitly refers to a bronchoscopy, mediastinoscopy, and minithoracotomy, it contains no mention of a wedge resection. Similarly, while bronchoscopy, mediastinoscopy, minithoracotomy, and biopsy are marked on Mrs. Bradley's surgical booking form, the box for wedge resection is not marked. Mrs. Bradley essentially argues that she consented to certain enumerated procedures, and that the lack of references to a wedge resection before surgery indicates that there was no consent for that procedure. But Mrs. Bradley's focus on nomenclature is unavailing. To be sure, Mrs. Bradley identifies critical differences between the first five samples and the final sample. She asserts that the timing of the test results for the first five samples suggests that Dr. Sugarbaker confirmed that the mass was not malignant before he performed the wedge resection, and that -- -10- whereas the other samples were tested in their entirety -- only a small portion of the wedge resection was tested. As a result, Mrs. Bradley's argument appears to be that she only consented to diagnostic procedures, whereas the removal of scar tissue (the wedge resection) was a treatment to which she did not consent. While the record is viewed in the light most favorable to the nonmovant on summary judgment, Casas Office Machs., Inc. v. Mita Copystar Am., Inc., 42 F.3d 668, 679 (1st Cir. 1994), the evidence here simply does not support the contention that the wedge resection had no diagnostic purpose. To the contrary, the mass was tested for malignancies and those results were incorporated into Dr. Sugarbaker's conclusion that Mrs. Bradley did not have cancer. Mrs. Bradley consented to surgery for the purpose of diagnosing an irregular mass on her lung. And there is no genuine dispute that Dr. Sugarbaker's surgery furthered that purpose. The dispute concerns, instead, whether Dr. Sugarbaker adequately described the extent of the cutting and the tissue removal that would be involved depending on the results of initial biopsies during the surgery. Massachusetts law distinguishes between touching without consent which all concede is a battery, and a consented touching for which consent was induced by inadequate information, which is addressed under the malpractice rubric. -11- Erikson v. Garber, No. 1511, 2003 WL 21956025, at  (Mass. App. Div. Aug. 13, 2003). The circumstances here do not quite fall into either category because the inadequacy of the information included a failure to describe the extent of the cutting. Nevertheless, where a surgery and its purpose were agreed to, and where the actual extent of the surgery was in keeping with the purpose, we would expect Massachusetts courts to treat the inadequacy under a theory of malpractice. See Feeley, 679 N.E.2d at 183 (quoting approvingly from a treatise discussing the policy reasons for funneling claims of this type into the malpractice rubric). We do not foreclose the possibility that a question as to the scope of consent may sustain a medical battery claim in some instances. See Reddington v. Clayman, 134 N.E.2d 920, 922 (Mass. 1956) (recognizing a battery claim where a doctor removed the uvula after only receiving consent to remove the adenoids and tonsils); 14C Mass. Prac., Summary of Basic Law § 17.151 ([I]f the patient has consented to one type of treatment and the physician performs another, a case of battery is also established.). But there was a logical nexus between the wedge resection and the other five samples: the wedge resection came from the general area for which Mrs. Bradley had consented to surgery, and samples from the wedge resection were tested for -12- cancer. As Mrs. Bradley contends, questions remain as to whether she was adequately apprised of the potential scope of the surgery beforehand. But, because this claim ultimately centers on the standard of care used by Dr. Sugarbaker, it should be treated as an action in negligence, not battery. Feeley, 679 N.E.2d at 183 (stating that the problem of informed consent is essentially one of professional responsibility, not intentional wrongdoing, and can be handled more coherently within the framework of negligence law than as an aspect of battery (internal quotation marks omitted)). The Bradleys also focus on the relative size of the samples, contending that Mrs. Bradley understood that Dr. Sugarbaker would only be extracting much smaller samples of tissue. The Bradleys explain, if [Mrs. Bradley] had asked Dr. Sugarbaker to . . . avoid major surgery, her battery claim would succeed because the wedge resection, which was major surgery, would have fallen outside the scope of her narrow consent. But even were we to accept Mrs. Bradley's contention that a wedge resection qualified as a major surgery, there is no evidence in the record that Mrs. Bradley ever asked Dr. Sugarbaker to remove only small samples. During her deposition, Mrs. Bradley stated that Dr. Sugarbaker did not indicate how many samples he would take or how large those samples would be. Rather, Mrs. Bradley assumed that -13- the surgery would only consist of little snippets of the mass. Viewed in the light most favorable to Mrs. Bradley, such testimony does not support the inference that Dr. Sugarbaker ever affirmatively represented that he would take only small samples; at worst, it suggests that Dr. Sugarbaker failed to provide adequate information as to the size of the samples that would be removed.