Opinion ID: 1536111
Heading Depth: 2
Heading Rank: 2

Heading: Assumption of Risk Instruction

Text: Before turning to the requested instruction on assumption of risk, we first review the grounds for liability. Failure to obtain informed consent is a variety of medical negligence. Jones v. Howard Univ., Inc., 589 A.2d 419, 422 n. 4 (D.C. 1991). `In order to prevail in an action based on a theory of informed consent, the plaintiff must prove [1] that if he had been informed of the material risk, he would not have consented to the procedure and [2] that he had been injured as a result of submitting to the procedure.' Miller-McGee v. Washington Hosp. Ctr., 920 A.2d 430, 439 (D.C.2007) (quoting Cleary v. Group Health Ass'n, Inc., 691 A.2d 148, 155 (D.C.1997)). A doctor need only inform the patient of material risks  those risks which a reasonable person would consider significant in deciding whether to undergo a particular medical treatment. Abbey v. Jackson, 483 A.2d 330, 332 (D.C. 1984). In the present case, the jury found that Dr. Dennis failed to obtain Ms. Jones's informed consent. However, the verdict does not make clear which material risk(s) the jury found Dr. Dennis failed to discuss with Ms. Jones. For purposes of this analysis, and viewing the evidence in the light most favorable to Dr. Dennis, we will assume the jury may have found that Dr. Dennis informed Ms. Jones of the risks associated with smoking. We turn next to the requested instruction on assumption of risk, which the trial court denied. Assumption of risk, like contributory negligence, is an affirmative defense in negligence cases and may operate as a complete bar to liability. See Morrison, 407 A.2d at 566. We have often held that the two defenses are very similar, overlapping but not always congruent. See Washington Metropolitan Area Transit Authority v. Johnson, 726 A.2d 172, 175 (D.C.1999); Janifer v. Jandebeur, 551 A.2d 1351, 1352 (D.C.1989); Sinai v. Polinger Co., 498 A.2d 520, 524 (D.C.1985); Scoggins v. Jude, 419 A.2d 999, 1004 (D.C. 1980). While assumption of risk focuses on the plaintiff's subjective knowledge of the existence of the risk and his voluntary assumption of it, see Scoggins, 419 A.2d at 1004, contributory negligence focuses on the objective reasonableness of the plaintiff's conduct. Sinai, 498 A.2d at 524. Contributory negligence is found where the plaintiff, by encountering the risk created by the defendant's breach of duty, departed from an objective standard of reasonable care. Id. The defenses sometimes merge, because a plaintiff who knowingly and voluntarily exposes herself to a danger may also be found to have departed from an objective standard of reasonable care by encountering the risk. Because of the disparity in knowledge between a doctor and his patient, the defense of assumption of risk is rarely available in medical malpractice cases. Morrison, 407 A.2d at 567-68. However, the defense may be sustained where the patient was specifically warned about a risk, and refused to follow the doctor's instructions. Id. at 568 (citing Levett v. Etkind, 158 Conn. 567, 265 A.2d 70, 74-75 (1969); De Blanc v. Southern Baptist Hospital, 207 So.2d 868, 871 (La.Ct.App.1968); Munson v. Bishop Clarkson Memorial Hospital, 186 Neb. 778, 186 N.W.2d 492, 493-94 (1971) (cases where patients suffered injuries after they refused assistance, or failed to call for assistance, against the advice of medical caregivers)). But cf. Hall v. Carter, 825 A.2d 954, 956-57, 961 (D.C.2003) (jury found abdominoplasty patient contributorily negligent where her doctor warned her that smoking deterred wound-healing, she continued to smoke until the day of surgery, misrepresented the extent of her smoking, then had difficulty healing). While acknowledging that the defense is sometimes (but rarely) available in medical malpractice cases, Ms. Jones asserts that assumption of risk does not apply on this record because the doctor's failure to disclose all of the risks of the combined surgeries completely negated [his] contention that Ms. Jones fully comprehended and assumed all of the risks and dangers. . . . Ms. Jones's argument certainly is bolstered by the jury's finding that Dr. Dennis failed to obtain her informed consent to the surgeries. Nevertheless, reviewing the evidence in the light most favorable to Dr. Dennis, this may have been one of those rare cases where assumption of risk was a viable defense to a claim of failure to obtain a patient's informed consent. See Nelson, 694 A.2d at 901 (a requested instruction should be given if there is some evidence supporting a party's theory of the case). The verdict indicates that Dr. Dennis did not inform Ms. Jones of all the material risks, but it does not reveal what advice was lacking. Smoking may well have created the most significant risk, however. The doctor insisted that he informed Ms. Jones of the risks of smoking and told her that continued smoking might cause her injury. Ms. Jones admitted that she continued smoking until the day of her surgeries. Both expert witnesses and Dr. Dennis himself testified that her continued smoking contributed to the post-surgical complications. Based on this evidence, a jury in theory could have found that the plaintiff actually knew and understood the full scope and magnitude of the danger arising from smoking and voluntarily exposed herself to that danger. Moreover, Dr. Dennis testified that he would not have performed the surgeries if he had known the truth  that Ms. Jones had continued to smoke. Therefore, the jury could have found that Ms. Jones proximately caused her own injuries by continuing to smoke (contrary to the doctor's instructions) and by falsely assuring the doctor that she had stopped smoking. There is a dearth of case law on this subject, however, and we need not decide whether Dr. Dennis was entitled to an instruction on assumption of risk. Assuming (without deciding) that it was error to deny that instruction, we nevertheless are satisfied that any error was harmless.