Opinion ID: 1975422
Heading Depth: 2
Heading Rank: 1

Heading: Preclusion of the Informed Consent Claim

Text: The issue of whether the Wagners would be permitted to assert their claim that Drs. Kobrine and Wiesel were negligent in performing surgery on Mrs. Wagner without obtaining her informed consent has a complicated but pertinent procedural history. The Wagners filed their original complaint on March 23, 1993, within the three-year limitations period for claims of negligence. See D.C.Code § 12-310(8) (1995). That complaint alleged that the defendants were negligent in their care and treatment of Mrs. Wagner, specifically including but not limited to four particular acts of negligence during the performance of the surgery [5] and the negligent selection and supervision of the anesthesiologist who participated in the surgery. Additionally, the complaint alleged, defendants were otherwise negligent. The original complaint did not specifically allege negligent failure to obtain Mrs. Wagner's informed consent to the surgery. On August 13, 1993, after the Wagners had deposed Dr. Kobrine, their then-counsel sent a letter to Dr. Kobrine's counsel offering to dismiss him from the lawsuit without prejudice, on condition, inter alia, that he agree not to raise a statute of limitations defense if I have to bring him back in as a result of something that might surface in discovery, e.g., one of Georgetown's experts blames the whole thing on Dr. Kobrine. This overture led to the preparation of a stipulation among the Wagners, Dr. Kobrine and Georgetown, dismissing Dr. Kobrine without prejudice. In the stipulation, which was filed September 1, 1993, Dr. Kobrine agreed that should it be necessary for Plaintiffs to file an Amended Complaint naming Dr. Kobrine as a defendant, Dr. Kobrine will not assert any legal defenses that were not available to him at the time of the filing of the original Complaint, including the defense of the statute of limitations. (In contrast to the language of the letter, the stipulation did not state that Dr. Kobrine agreed to waive the statute of limitations only if he was brought back into the lawsuit as a result of new information surfacing in discovery.) For its part, Georgetown agreed to the dismissal of Dr. Kobrine, see Super. Ct. Civ. R. 41(a)(ii), on the understanding, confirmed in an August 17, 1993, letter to the Wagners' counsel, that the Wagners do not intend to pursue a lack of informed consent claim against Georgetown. Georgetown sought this assurance so that it would not find itself in the distasteful position after Dr. Kobrine's dismissal of having either to defend an informed consent case on its own, or to file a third-party complaint against Dr. Kobrine (a fellow physician). The stipulation itself does not refer to this side agreement between Georgetown and the Wagners. On January 4, 1994, a few months after Dr. Kobrine's dismissal by stipulation and more than three years after Mrs. Wagner's surgery, the Wagners moved pursuant to Super. Ct. Civ. R. 15(a) for leave to file an amended complaint renaming Dr. Kobrine as a defendant and specifically alleging additional acts of negligence. The Wagners' motion stated that they had determined during discovery that Mrs. Wagner's surgery was unnecessary surgery and should not have been performed in view of the results of pre-operative diagnostic tests. The proposed amended complaint alleged three additional acts of negligence on the part of Dr. Kobrine and Georgetown in their care and treatment of Mrs. Wagner: (i) that they misdiagnosed her underlying medical condition, (ii) that they performed unnecessary and inappropriate surgery, and (iii) that they failed to obtain Mrs. Wagner's informed consent to the surgery, including the failure to accurately inform [her] of the anticipated results of the surgery and the alternatives thereto. As the informed consent claim was elaborated in the subsequent joint pretrial statement, the Wagners contended that Dr. Kobrine and Dr. Wiesel overstated the probability that surgery would alleviate Mrs. Wagner's back pain and failed to disclose that the surgery was not indicated by diagnostic testing; and, further, that Dr. Kobrine secured Mrs. Wagner's consent only by assuring her that there would be no complications arising from [the surgical] procedure [and] that the proposed surgical procedure would alleviate her pain. Dr. Kobrine and Georgetown opposed the motion for leave to file the amended complaint on the ground that the new allegations of negligence were barred by the three-year statute of limitations and did not relate back to the date of the original complaint under Super. Ct. Civ. R. 15(c). In particular, they argued that the informed consent count did not arise out of the conduct, transaction or occurrence set forth in the original complaint, as required by Rule 15(c)(2), because it concerned pre-surgery communications and events rather than the surgery itself. Dr. Kobrine further contended that he did not waive the statute of limitations as to the new claims in the stipulation of dismissal, and that those claims were barred for the additional reason that they were not based on new information generated following his dismissal. Georgetown urged that leave to amend to add the informed consent count should also be denied, even if the new claims were not time-barred, because the Wagners had earlier represented that they would not pursue an informed consent claim against Georgetown. According to Georgetown, allowing the amended complaint would mean robbing Georgetown of the consideration that the Wagners provided to induce Georgetown to assent to the dismissal of Dr. Kobrine  at least if Dr. Kobrine was not reinstated as a defendant himself. On January 27, 1994, Judge Kaye K. Christian granted the Wagners' motion for leave to amend over the defendants' objections and ordered that the amended complaint be received for filing. Judge Christian's order did not address the objections raised by Dr. Kobrine and Georgetown specifically. The order stated only that discovery was still in process and there appears to be no prejudice to defendants. Following the close of discovery, on November 7, 1994, Dr. Kobrine moved for summary judgment with respect to all of the Wagners' claims of negligence except the claim based on lack of informed consent. As to that claim, Dr. Kobrine conceded that it was supported by expert medical testimony and that a genuine factual dispute existed based upon the deposition testimony of the parties and other witnesses. On November 8, 1994, Georgetown filed its motion for summary judgment. Unlike Dr. Kobrine, Georgetown did seek summary judgment on the informed consent claim. Citing its earlier opposition to the motion for leave to file the amended complaint, Georgetown reiterated without elaboration its contentions that the informed consent claim was time-barred and that the Wagners had waived the claim. In addition, Georgetown argued that Drs. Kobrine and Wiesel did obtain Mrs. Wagner's informed consent before proceeding with surgery, and that, in any event, Mrs. Wagner had not relied on anything Dr. Wiesel said to her in deciding to undergo the operation. On March 31, 1995, Judge Curtis E. von Kann denied Dr. Kobrine's and Georgetown's motions for summary judgment. Judge von Kann's order did not discuss specifically any of the points raised by the motions. Three months later, on June 28, 1995, Georgetown filed a motion in limine to preclude the Wagners from asserting their informed consent claim against Georgetown. In that motion, Georgetown resurrected its contentions that the claim was barred by the statute of limitations and did not relate back to the date of the original complaint, and that the Wagners had waived the claim by representing that they would not pursue it. Dr. Kobrine followed suit with a similar motion, in which he renewed the arguments that he had made in opposing the filing of the amended complaint. The Wagners opposed the motions in limine, arguing inter alia that the informed consent claim related back to the claim of negligence asserted in the original complaint. They also argued that Dr. Kobrine waived his right to assert the statute of limitations against the informed consent claim when he entered into the stipulation of dismissal. Alternatively, the Wagners contended that under the so-called discovery rule, the informed consent claim was still timely because the statute of limitations did not start to run until they acquired requisite evidence of wrongdoing in the course of discovery. [6] The motions in limine were argued before Judge Michael Rankin on January 4, 1996. Persuaded that the earlier rulings of Judge Christian and Judge von Kann had not settled the issue, Judge Rankin concluded that the informed consent claim did not arise out of the conduct, transaction or occurrence set forth or attempted to be set forth in the original complaint, which Judge Rankin deemed to be the actual performance of the surgery on Mrs. Wagner. The focus of informed consent is different, Judge Rankin reasoned: The question of informed consent goes to whether there would have been an operation at all. When a person prevails on a claim of lack of informed consent, they prevail because they show that they didn't have sufficient information on which to make a reasonable judgment and people who were in a position to give them the information failed to honor the duty to give them the information. In other words, because an informed consent claim focuses on what the doctor told the patient prior to the surgery, and not on what the doctor did during the surgery, Judge Rankin ruled that the claim did not relate back to the original complaint under Rule 15(c)(2). [7] With respect to the other issues before him, Judge Rankin was not persuaded by Georgetown's alternative contention that the Wagners waived their informed consent claim against Georgetown when their counsel said that they did not intend to pursue that claim in exchange for Georgetown's acquiescence in the dismissal of Dr. Kobrine. It appears that Judge Rankin found that the agreement between counsel was not sufficiently specific to constitute a waiver of the claim, and that in any event the claim was not waived against Georgetown so long as Dr. Kobrine was brought back into the case. On the other hand, Judge Rankin agreed with Dr. Kobrine that he did not waive the right to assert the statute of limitations against the informed consent claim when he entered into the September 1, 1993, stipulation dismissing him from the lawsuit. Based on the August 13, 1993, letter in which the Wagners' counsel first broached the subject of Dr. Kobrine's dismissal, Judge Rankin found that Dr. Kobrine agreed to waive the statute of limitations only as to claims that might surface in subsequent discovery. Concluding that the Wagners knew or should have known of the factual basis of their informed consent claim before they dismissed Dr. Kobrine, Judge Rankin ruled that Dr. Kobrine was not estopped by his stipulation from contending that it was time-barred. Finally, Judge Rankin rejected the Wagners' reliance on the discovery rule, concluding that the Wagners were on inquiry notice from the date of injury of the potential informed consent claim. Having so ruled, Judge Rankin granted the motions in limine and prohibited the Wagners from asserting lack of informed consent at trial.
On appeal, the Wagners challenge Judge Rankin's ruling that the informed consent claim did not relate back to the original complaint and was, therefore, barred by the statute of limitations. The Wagners have abandoned their arguments that the claim was timely under the discovery rule and that Dr. Kobrine waived his right to raise the statute of limitations as a defense. [8] Georgetown asks us to affirm Judge Rankin's ruling on relation back, and also argues that a lack of sufficient credible evidence to support an informed consent claim against it constitutes an independent ground on which to uphold the preclusion of that claim. Georgetown has not, however, pursued in this court its argument that the Wagners waived their informed consent claim. [9] Dr. Kobrine also argues that we should affirm the ruling on relation back. As an alternative basis on which to uphold the trial court's ruling, Dr. Kobrine argues that because the original complaint was dismissed against him, the informed consent claim in the amended complaint cannot relate back to it and was for that reason properly held to be time-barred as to him.
Rule 15(c)(2) of the Superior Court Rules of Civil Procedure provides that an amendment of a pleading relates back to the date of the original pleading for statute of limitations purposes when the claim or defense asserted in the amended pleading arose out of the conduct, transaction, or occurrence set forth or attempted to be set forth in the original pleading. The original pleading in this case, the complaint of March 23, 1993, alleged negligence in the care and treatment of Mrs. Wagner, including but not limited to negligence in the execution of particular aspects of her surgery and the selection and supervision of the anesthesiologist who participated in that surgery. The amended complaint added the allegation that Dr. Kobrine and Georgetown were negligent in performing Mrs. Wagner's surgery without her informed consent. Thus both the original and the amended complaint sought to recover damages for injuries resulting from Mrs. Wagner's surgery because her physicians were negligent, either in performing that surgery (original complaint) or in obtaining her consent to perform it (amended complaint). Does the new claim in the amended complaint therefore arise out of the same conduct, transaction or occurrence set forth or attempted to be set forth in the original complaint for purposes of Rule 15(c)(2)? This is a question of law, subject to our de novo review. For the reasons that follow, we answer it in the affirmative. No prior decision of this court has addressed whether a claim of lack of informed consent to medical treatment relates back to a claim of negligence in the provision of that treatment. Other courts have split rather evenly on that question. For example, in Jolly v. Russell, 203 A.D.2d 527, 611 N.Y.S.2d 232, 233 (1994), the court (one judge dissenting) held that there was no relation back under the New York analog of Rule 15(c)(2). The majority reasoned that because lack of informed consent is a distinct cause of action requiring proof of facts not contemplated by an action based merely on allegations of negligence, the allegations of general medical negligence in the original pleading did not provide notice of the series of transactions or occurrences to be proved in a cause of action based on lack of informed consent. Id. at 233. Accord, Bigay v. Garvey, 575 N.W.2d 107, 110 (Minn.1998); Keenan v. Yale New Haven Hospital, 167 Conn. 284, 355 A.2d 253, 254 (1974). [10] In contrast, the court in Neeriemer v. Superior Court of Maricopa County, 13 Ariz.App. 460, 477 P.2d 746 (1970), held that an informed consent claim would relate back under the Arizona counterpart of Rule 15(c)(2) to a claim of negligence in the performance of surgery. The court rejected the argument that the informed consent claim could not relate back because it required proof of additional acts not encompassed in the original claim: This argument, in our opinion, takes too narrow a view of Rule 15(c). Logically applied, it would prohibit relation back even where the plaintiff alleged an additional specific act of negligence during the operation itself, unless the newly alleged act was related to the previously alleged specific acts. But the general fact situation involving petitioner's claim against the respondent doctors did not spring into existence at the moment that petitioner was allegedly sutured improperly. Suturing was but one incident or part of a broader focal event  the surgical operation. Petitioner emphasizes the term transaction and the entire physician-patient relationship, but in our view, the most reasonable reading of Rule 15(c) makes the operation the critical    occurrence    set forth in the original pleading. Id. at 749. Considering the operation to be the occurrence set forth in the original pleading, the court found it more significant for purposes of relation back that the plaintiff was not substantially wronged in the sense of his amended claim until he actually underwent the operation to which he now alleges he did not intelligently consent. In other words, the term `lack of informed consent' demands an object, or predicate: consent to what? The operation itself is an indispensable element of the wrong. Id. at 750. Accord, Wall v. Brim, 145 F.2d 492, 493 (5th Cir.1944); Wagner v. Olmedo, 323 A.2d 603, 604-05 (Del.Super.Ct.1974); Brown v. Wood, 202 So.2d 125, 128-30 (Fla.App.1967). [11] Although the question before us is an open one on which other courts have divided, the principles that guide our resolution of the question are settled. Relation back is designed to foster the resolution of disputes on their merits rather than on the basis of pleading technicalities, to the extent that resolution on the merits is consistent with the policies underlying statutes of limitations. Accordingly, in Hartford Accident & Indemnity Co. v. District of Columbia, 441 A.2d 969 (D.C. 1982), this court held that under Rule 15(c)(2) an amended complaint relates back where `the initial complaint put the defendant on notice that a certain range of matters was in controversy and the amended complaint falls within that range.' Id. at 972 (quoting Jackson v. Airways Parking Co., 297 F.Supp. 1366, 1382 (N.D.Ga.1969)). Cases construing the identical federal rule from which our Rule 15(c)(2) derives, [12] see Fed.R.Civ.P. 15(c)(2), confirm that the central inquiry is to determine whether the adverse party, viewed as a reasonably prudent person, ought to have been able to anticipate or should have expected that the character of the originally pleaded claim might be altered or that other aspects of the conduct, transaction, or occurrence set forth in the original pleading might be called into question. 6A CHARLES ALAN WRIGHT, ARTHUR R. MILLER & MARY KAY KANE, FEDERAL PRACTICE AND PROCEDURE: CIVIL 2D § 1497, at 93 (2d ed.1990). The rationale of the relation back rule is that the filing of a suit . . . warns the defendant to collect and preserve his evidence in reference to it. . . . [T]he defendant knows that the whole transaction described in it will be fully sifted, by amendment if need be, and that the form of the action or the relief prayed or the law relied on will not be confined to their first statement. Barthel v. Stamm, 145 F.2d 487, 491 (5th Cir.1944). Thus, [t]he fact that an amendment changes the legal theory on which the action initially was brought is of no consequence if the factual situation upon which the action depends remains the same and has been brought to defendant's attention by the original pleading. WRIGHT ET AL., § 1497, at 95. It is not unreasonable to require [the defendant] to anticipate all theories of recovery [for the damages claimed in a complaint] and prepare its defense accordingly. Zagurski v. American Tobacco Co., 44 F.R.D. 440, 443 (D.Conn.1967) (where original complaint sought damages from smoking cigarettes based on theories of negligent manufacture and implied warranties of fitness for personal use, amended complaint charging negligent failure to warn the plaintiff of the dangers of smoking held to relate back). [13] In light of these principles, we conclude that the requirements of Rule 15(c)(2) were met by the informed consent allegation in the Wagners' amended complaint. At a minimum, the original complaint notified Dr. Kobrine and Georgetown that the Wagners sought to recover damages for injuries resulting from the surgery that they had performed on Mrs. Wagner. The occurrence set forth in that complaint was the surgery; the legal theory justifying recovery of damages was that the defendants had performed that surgery in a negligent manner. [14] The amended complaint merely added another legal theory, that the defendants had performed that surgery without Mrs. Wagner's informed consent to accept the risk of surgery which proximately caused her injuries. See Lasley v. Georgetown Univ., 688 A.2d 1381, 1384 (D.C.1997); Jones v. Howard Univ., Inc., 589 A.2d 419, 422 (D.C.1991). Although that theory was new, it was still a theory for recovering the same damages for the same injuries attributable to the same event. The informed consent claim in the amended complaint still arose, therefore, out of the same occurrence-the surgery-as was set forth in the original complaint. As reasonably prudent defendants, Dr. Kobrine and Georgetown ought to have expected that other aspects of that surgery might be called into question; that the circumstances of the surgery would be fully sifted; that they would have to anticipate all theories of recovery for the injuries caused by the surgery; and that they would therefore need to collect and preserve their evidence and prepare to defend against any such theories. For the amended claim to relate back, Rule 15(c)(2) requires nothing more. For these reasons, we do not think it fatal to relation back that, as Dr. Kobrine and Georgetown argue, informed consent claims concern a duty of the physician `which is completely separate and distinct from his responsibility to skillfully diagnose and treat the patient's ills.' Cleary v. Group Health Ass'n, 691 A.2d 148, 155 (D.C.1997) (quoting Wilkinson v. Vesey, 110 R.I. 606, 295 A.2d 676, 685 (1972)). [15] Nor can Dr. Kobrine and Georgetown legitimately claim surprise because the informed consent claim focuses on events occurring prior to rather than during the surgery itself. Any competent lawyer defending a physician accused of performing surgery in a negligent manner would investigate not only the narrow issue of how the surgery was conducted, but also the facts and circumstances surrounding the surgery, including the events leading up to it. Whether or not an informed consent claim had been asserted, communications between physician and patient prior to the surgery would be a prime subject of inquiry. Defense counsel would need to learn what the physician said in obtaining the patient's consent to the surgery, because counsel would need to know, for example, whether the physician said anything  e.g., about the condition of the patient, the surgery to be performed, or the risks involved  that could be evidence of negligence on the physician's part. Thus, even if the original complaint in this case did not mention lack of informed consent specifically, that complaint was nonetheless calculated to cause counsel for Dr. Kobrine and Georgetown to focus on the facts that would underlie such a claim as a routine part of defense preparation. To say that is to say that Dr. Kobrine and Georgetown could not claim surprise when the Wagners eventually advanced an informed consent claim based on those facts. There is corroboration in the record that the Wagners' original complaint sufficed to require the defendants to anticipate a potential informed consent claim. Georgetown argues that it had no notice of a possible informed consent claim until after the running of the statute of limitations because counsel for the Wagners represented that they did not intend to make such a claim when they asked Georgetown to agree to the stipulation dismissing Dr. Kobrine. But the fact that Georgetown inquired about an informed consent claim demonstrates that Georgetown actually did anticipate that the claims in the original complaint might be broadened to include lack of informed consent. Although that fact is not the basis for our conclusion that the Wagners' original complaint put Dr. Kobrine and Georgetown on notice that an informed consent claim might be added, it confirms the soundness of that conclusion. Nor have Dr. Kobrine and Georgetown made a credible claim of unfair prejudice from the late assertion of a claim of lack of informed consent. At the hearing on the motion in limine, Judge Rankin asked Georgetown's counsel, how are you hurt by the amended complaint bringing in this claim [i.e., informed consent] since the amended complaint also brought your co-defendant back in the case? Counsel responded that we're not hurt in respect of Dr. Kobrine being brought back into the case. It is true that now we are in the situation where we're defending the case and Dr. Kobrine is defending the informed consent claim and we both can present the evidence on those issues. Judge Rankin then asked if it was true that you're not in a worse position than you would have been if they [the Wagners] had phoned it in initially [i.e., asserted lack of informed consent in the initial complaint against both defendants]. Counsel responded, That's true. We therefore conclude, contrary to the trial court, that an amended complaint adding a claim of lack of informed consent to surgery relates back under Rule 15(c)(2) to an earlier complaint alleging negligence in the performance of that surgery. [16] Since the original complaint against Georgetown was filed within the three year period prescribed by the applicable statute of limitations, we conclude that the Wagners' informed consent claim against Georgetown was not time-barred. We do not, however, reach the same conclusion as to Dr. Kobrine. As we now explain, because the original complaint against Dr. Kobrine was dismissed, the amended complaint cannot relate back to it.
When the Wagners voluntarily dismissed their original complaint against Dr. Kobrine without prejudice, the running of the statute of limitations on their claims was not tolled. See Sayyad v. Fawzi, 674 A.2d 905, 906 (D.C.1996); York & York Constr. Co. v. Alexander, 296 A.2d 710, 712 (D.C.1972). To preserve the Wagners' ability to rename Dr. Kobrine as a defendant after the statute had run, the stipulation of dismissal therefore had to provide expressly that he would not assert the statute as a defense to a new complaint against him. The trial court found, however, that the stipulation did not prevent Dr. Kobrine from invoking the statute as to the Wagners' informed consent claim, because that claim was not brought on the basis of newly discovered evidence. The Wagners have abandoned any challenge to that ruling, which in any event we do not find to be either clearly wrong or without evidence to support it. D.C.Code § 17-305(a) (1997). The three-year statute of limitations had run by the time the Wagners first asserted their informed consent claim against Dr. Kobrine. The original complaint against him having been dismissed, there was no earlier pleading extant to which the claim could relate back under Rule 15(c)(2). While the order of Judge Christian granted the Wagners leave to file their amended complaint against Dr. Kobrine, it did not reinstate, nunc pro tunc to its filing date, the original complaint that the Wagners had filed against him. [17] We therefore affirm Judge Rankin's decision to grant Dr. Kobrine's motion in limine.
Georgetown argues that even if the informed consent claim did relate back to the original complaint against it, we should affirm Judge Rankin's decision to grant its motion in limine because independent grounds preclude the Wagners from pursuing the claim against Georgetown. Specifically, Georgetown argues that no reasonable jury could find that Dr. Wiesel failed to disclose accurately the probability of success of the surgical procedure he proposed. Additionally, Georgetown argues that Mrs. Wagner did not rely on Dr. Wiesel's statements in deciding to proceed with surgery, and that those statements therefore could not have been the proximate cause of her injuries. In asking us to uphold Judge Rankin's ruling on these grounds, Georgetown invokes the principle that if the decision below is correct, it must be affirmed, although the lower court relied upon a wrong ground or gave a wrong reason. Helvering v. Gowran, 302 U.S. 238, 245, 58 S.Ct. 154, 82 L.Ed. 224 (1937); see also Marinopoliski v. Irish, 445 A.2d 339, 340 (D.C.1982). Judge von Kann rejected Georgetown's arguments about the inadequacy of the evidence, and found that only a jury could resolve the merits of the Wagners' informed consent claim, when he denied Georgetown's motion for summary judgment. Georgetown is, in effect, asking us to review that denial in light of the entire record, including the testimony and other evidence adduced at trial. The denial of a motion for summary judgment is usually not reviewable on appeal, as it is not a final judgment. Even on appeal from a final judgment after trial, the correctness of a pretrial denial of summary judgment is ordinarily not subject to review, because that denial is superseded by the trial of the case on the merits. See Morgan v. American Univ., 534 A.2d 323, 326-29 (D.C. 1987). In this case, however, a trial on the merits did not moot the issue of the viability of the Wagners' informed consent claim that was presented by Georgetown's motion for summary judgment. Judge Rankin's determination that the informed consent claim was time-barred was akin to a grant of summary judgment for the defendants on that theory. An appellate court has discretion to uphold a summary judgment under a legal theory different from that applied by the trial court, and rest affirmance `on any ground that finds support in the record,' provided it proceeds cautiously so as to avoid denying the opposing party a fair `opportunity to dispute the facts material' to the new theory. United States v. General Motors Corp., 171 U.S.App. D.C. 27, 48, 518 F.2d 420, 441 (1975) (citations omitted). This principle has been applied where the trial court erroneously relied on the statute of limitations to grant summary judgment. See, e.g., Holt v. KMI-Continental, Inc., 95 F.3d 123, 131, 134-35 (2d Cir.1996); Lindsey v. Dayton-Hudson Corp., 592 F.2d 1118, 1124 (10th Cir.1979). Nonetheless, it usually will be neither prudent nor appropriate for this court to affirm summary judgment on a ground different from that relied upon by the trial court. Often it will be wise to deny review because the summary judgment questions are quite separate from the issues resolved by the final judgment, because the trial court is in a better position to reconsider the summary judgment question in light of the disposition on appeal, because the summary judgment issues are not ripe or are not clearly presented by the record, or because it is better to leave to the [trial] court the arduous task of being first to sift through a lengthy summary judgment record. 15B CHARLES ALAN WRIGHT, ARTHUR R. MILLER & EDWARD H. COOPER, FEDERAL PRACTICE AND PROCEDURE: JURISDICTION 2D § 3914.28, at 213-15 (2d ed.1991). Virtually all these considerations counsel against accepting Georgetown's invitation to uphold the preclusion of the Wagners' informed consent claim on the alternative ground of evidentiary insufficiency. Most important, we think, is the fact that Georgetown relies on testimony that it elicited at trial, after its motion in limine was granted. While Georgetown may have a strong defense to the claim that Mrs. Wagner was misinformed, we are loath to preclude that claim based on the record of a proceeding in which the Wagners were denied a fair opportunity to present their side of the issue. See General Motors, 171 U.S.App. D.C. at 48, 518 F.2d at 441. Our concern that the Wagners might be able to rebut Georgetown's evidentiary contentions if they were given a fair chance to prove their informed consent claim at trial, as Judge von Kann concluded, is not merely theoretical. The evidence of record is not as conclusive as Georgetown suggests. On the issue of whether Mrs. Wagner was misadvised about the likelihood of a favorable outcome to her surgery, Dr. Wiesel testified that he told her that a laminectomy (with foraminotomy) together with a spinal fusion would have a 50-60 percent chance of success. Dr. Austin, the Wagners' expert witness, opined that the laminectomy had only a 20-30 percent chance of success. Because Dr. Austin conceded that he would defer to an orthopedic surgeon's opinion as to any additional benefit from the fusion, Georgetown contends that a reasonable jury could not find that a laminectomy with spinal fusion had less than a 50-60 percent probability of success. But Georgetown's own orthopedic expert, Dr. Hanley, testified that a spinal fusion without a laminectomy would have been of only slight benefit to Mrs. Wagner. [18] A reasonable jury, crediting Dr. Hanley and Dr. Austin rather than Dr. Wiesel, therefore could conclude that Dr. Wiesel materially overestimated the odds of surgical success. We are also unconvinced by Georgetown's contention that Dr. Wiesel's advice to Mrs. Wagner could not have been the proximate cause of her injuries. Mrs. Wagner testified that when Dr. Wiesel advised her of the risks of the proposed surgery, she decided to step back from the procedure. Only after Dr. Kobrine reassured her, she said, did she resolve to go forward. Georgetown argues that Mrs. Wagner therefore did not rely on Dr. Wiesel's statements in deciding to proceed with surgery. This argument is wide of the mark. A causal connection exists when, but only when, disclosure of significant risks incidental to treatment would have resulted in a decision against it. Canterbury v. Spence, 150 U.S.App. D.C. 263, 281, 464 F.2d 772, 790 (1972). [19] The record in its present state does not establish conclusively that Mrs. Wagner would still have undergone surgery if Dr. Wiesel had told her that there was only a 20-30 percent chance of success rather than a 50-60 percent chance. [W]here the correctness of the lower court's decision depends upon a determination of fact which only a jury could make but which has not been made, the appellate court cannot take the place of the jury. Securities & Exchange Comm'n v. Chenery Corp., 318 U.S. 80, 88, 63 S.Ct. 454, 87 L.Ed. 626 (1943); see also Ibn-Tamas v. United States, 407 A.2d 626, 635-36 (D.C.1979). We cannot, therefore, affirm Judge Rankin's ruling on Georgetown's motion in limine on the alternative grounds, predicated on evidence adduced at trial, that Georgetown proffers. As to Georgetown, reversal of that ruling is required.