Opinion ID: 1697418
Heading Depth: 1
Heading Rank: 5

Heading: Cain's Lack-of-Consent Claim

Text: As noted, Cain alleged in her complaint that she was advised [by Dr. Howorth] that she should and would undergo a left total hip arthroplasty, but that he performed instead a bipolar procedure. She further alleged that he told her on a number of postoperative occasions that she had in fact undergone a total hip arthroplasty. She testified in deposition that Dr. Howorth told her that her injury should be repaired by a total hip replacement and that he discussed no other procedure. Specifically, there was no discussion of any sort of bipolar procedure. She learned of it as a type of hip repair only when she consulted Dr. Featheringill, who told her she had the wrong one in there and [h]e couldn't understand why. [6] Dr. Featheringill told Cain, according to her, that he felt like if I'd had the total hip replacement done at first, I would have been able to walk and been without pain; that I should have had a total hip replacement [two years ago]. She went on to testify that Dr. Featheringill told her that if she had had a total hip replacement originally, she should not have had any restrictions or impairment and should be able to walk and do anything that I did before. In connection with her work in the hospital, she had seen pictures in books and pamphlets of the hardware used in a total hip replacement. Cain testified that if Dr. Howorth had told her that she needed a bipolar procedure, she would have had him explain it, and would have asked about the difference between that and a total hip replacement. She said that if he had explained to her that he believed she needed a bipolar procedure, rather than a total hip replacement, she would not have accepted his recommendation. She testified that she would have told him that she would much rather have a total hip replacement and probably would have asked for another doctor to obtain a second opinion to see if that was, you know, okay. As it was, [h]is recommendation was a total hip replacement and I agreed. Reviewing the evidence in a light most favorable to Cain, we conclude that she presented substantial evidence indicating that she did not consent to a BHA, but consented only to a THA. In reaching this conclusion, we are mindful that we, like the trial judge, are not allowed to make any assessments of the plausibility or credibility of Cain's testimony versus that of Dr. Howorth, unless her testimony were to be so incredible and implausible as to lack the status of substantial evidence. Lyons v. Walker Reg'l Med. Ctr., Inc., supra. Accordingly, we accept her testimony as true, resolving all conflicts in her favor, and thereby conclude that there was substantial evidence creating a genuine issue of material fact as to whether Cain consented to a BHA. Was there also a genuine issue of fact as to the element of proximate cause, i.e., probable causation? We look to Golden, 670 So.2d 904, for the answer. In that case the physician performed what was alleged to be an unnecessary surgical procedure. The Golden Court stated that a medical malpractice plaintiff must produce substantial evidence that `the alleged negligence probably caused the [complained of] injury,' in order to survive a summary judgment motion, if the defendant has made a prima facie showing that no genuine issue of material fact exists as to the issue of causation. 670 So.2d at 907. The Court further noted that in most medical-malpractice cases probable causation must be established by expert testimony because issues of proximate cause in medical malpractice cases are ordinarily `beyond the ken of the average layman.' 670 So.2d at 907. The Court went on to explain, however: [I]n cases like this one, involving allegations that a defendant performed unnecessary medical procedures, the issue of proximate cause is not always `beyond the ken of the average layman.' Clearly, the average layman, without the assistance of an expert, can recognize a causal connection between the performance of an unnecessary operation and most items of harm or injury claimed by the plaintiffs in this case. The cost of the unnecessary procedure, any provable pain and suffering or lost consortium associated with the unnecessary procedure, and any wages that can be proven to have been lost during the normal recovery period for such an operation would constitute harm or damage the proximate cause of which would be `within the comprehension of average laymen.' See Williams v. Spring Hill Memorial Hospital, 646 So.2d 1373, 1375 (Ala.1994). However, any claims for damages based on complications from the unnecessary procedure would be subject to the general rule that expert testimony is normally required to establish proximate cause in the medical malpractice context. 670 So.2d at 908. Even more so, in a case of surgery to which the patient has not consented (viewed as such for the purpose of summary-judgment review, based on Cain's testimony), proximate cause may be shown through lay testimony. Here, Cain stated under oath on deposition that she would not have submitted to a BHA had she known it was what Dr. Howorth planned to perform. Therefore, genuine issues of material fact existed as to all elements of Cain's claim that a BHA was performed without her consent, and the summary judgment as to that claim was not warranted, and it is hereby reversed.