Opinion ID: 1697418
Heading Depth: 1
Heading Rank: 4

Heading: Claims Argued by Cain in Her Brief to this Court

Text: In her initial brief, Cain asserts that in her complaint she specifically alleged that all healthcare providers ... on December 30, 1997 [1] [n]egligently, wantonly, and/or intentionally advised her that she was to undergo a left total hip arthroplasty; [2] negligently, wantonly, and/or intentionally failed to advise Cain upon her complaint of pain, that she had undergone a left biopolar endoprosthesis, something less than a left total hip arthroplasty; [3] negligently, wantonly, and/or intentionally failed to install an acetabulum component at the time of Cain's left total hip arthroplasty; and [4] negligently caused Cain to develop post-operative complications including gluteus medius aurch [ [5] ] as a result of the failure to perform a left total hip arthroplasty. (Cain's brief, p. 6.) She states that her claims against Howorth relate to Howorth's failure to perform a left total hip arthroplasty, also known as a left total hip. (Cain's brief, p. 8.) Cain claims that Howorth advised her that he would perform a left total hip because it was the procedure of choice for her, whereas he now claims that he advised Cain that he suggested and did perform a left bipolar endoprosthesis. (Cain's brief, p. 8.) She also states that Howorth claims he performed a left hip arthroplasty rather than left total hip arthroplasty, but that she disputes that claim. She further asserts that Howorth failed to prove, as a matter of law, that he obtained an informed consent from Cain for the performance of anything less than a left total hip. (Cain's brief, p. 16.) She acknowledges, however, that her claims in that regard are not like most lack of informed consent cases in which the failure to obtain consent relates to complications which arose during the procedure for which the patient was not fully informed that were associated with the procedure. (Cain's brief, p. 21.) She asserts that had Howorth performed the left total hip procedure, she would not have suffered pain in her hip and would not have had to undergo a subsequent left total hip revision by Dr. Featheringill. (Cain's brief, pp. 21-22.) She argues alternatively that Howorth planned to perform a THA, but failed to install an acetabulum component. (Cain's brief, p. 24.) She states that he actually performed a BHA but reamed the acetabulum and that reaming of the acetabulum in the performance of a left bipolar hip arthorplasty would be below the standard of care in the national medical community. (Cain's brief, p. 25.) Comparing the claims Cain pleaded in her complaint with the claims she argues in her brief to this Court, we find that she adequately brings forward for our consideration her claims, as rephrased for convenience, that Dr. Howorth planned to perform a THA, but negligently, wantonly, or intentionally failed to install an acetabulum component; that he negligently, wantonly, and/or intentionally advised her that she was to undergo, and had undergone, a left THA and she had consented only to a THA; and that he negligently performed a bipolar endoprosthesis, i.e., a BHA, by excessively reaming the acetabulum. As noted, Cain also argues the viability of a claim of lack of informed consent. Dr. Howorth asserts that Cain never pleaded that claim in any fashion and that she is simply arguing on appeal a claim she did not plead or otherwise present to the trial court. (Dr. Howorth's brief, pp. 27-28.) Citing Andrews v. Merritt Oil Co., 612 So.2d 409, 410 (Ala.1992), for the proposition that [t]his Court cannot consider arguments raised for the first time on appeal; rather, our review is restricted to the evidence and arguments considered by the trial court, Dr. Howorth contends that Cain cannot rely on a basis for reversal she is presenting for the first time on appeal. (Dr. Howorth's brief, pp. 28-29.) We recently restated that proposition in Ex parte Elba General Hospital & Nursing Home, Inc., 828 So.2d at 311-12: As a general rule, an appellate court will not reverse a summary judgment on a ground not presented in the trial court. `[T]he appellate court can consider an argument against the validity of a summary judgment only to the extent that the record on appeal contains material from the trial court record presenting that argument to the trial court before or at the time of submission of the motion for summary judgment.'  Ex parte Ryals, 773 So.2d 1011, 1013 (Ala.2000) (citing Andrews v. Merritt Oil Co., 612 So.2d 409 (Ala.1992)). Put another way, on an appeal from a summary judgment, this Court cannot hold the trial court in error on the basis of arguments made for the first time on appeal. See Barnett v. Funding Plus of America, Inc., 740 So.2d 1069 (Ala.1999); West Town Plaza Assocs., Ltd. v. Wal-Mart Stores, Inc., 619 So.2d 1290 (Ala.1993). In her reply brief to this Court, Cain responds by stating that her complaint, although not exactly [asserting] a lack of informed consent claim, relates to her claim that [Dr.] Howorth advised her that he would perform a left total hip and performed something less, namely, he reamed the acetabulum as though he was going to insert an artificial acetabulum component but failed to insert an artificial acetabulum component thereby causing the components to rub together due to the lack of an acetabulum component and absence of acetabulum cartilage thus producing pain in her left hip which she endured for 13 and ½ months until Dr. Featheringill performed a left total hip. (Cain's reply brief, p. 21.) However, nowhere in Cain's complaint, her other submissions to the trial court, or her deposition testimony did she ever contend that she had consented to a BHA but that her consent to that procedure was not informed. Rather, she adamantly insisted throughout that the only procedure identified and recommended to her by Dr. Howorth, and the only procedure she consented to, was a THA. At no time, so far as the record reveals, was the concept of informed consent ever mentioned to the trial judge. The affidavit of Cain's expert, Dr. Nehmer, does not allude to that issue in any way and does not otherwise discuss the nature of the operative procedure Cain consented to or whether her consent to that procedure was informed. This Court has considered the nature of a lack of informed consent claim in a number of cases, including Johnson v. McMurray, 461 So.2d 775 (Ala.1984), Fain v. Smith, 479 So.2d 1150 (Ala.1985), Otwell v. Bryant, 497 So.2d 111 (Ala.1986), Fore v. Brown, 544 So.2d 955 (Ala.1989), Craig v. Borcicky, 557 So.2d 1253 (Ala.1990), Horton v. Shelby Med. Ctr., 562 So.2d 127 (Ala.1990), Bodiford v. Lubitz, 564 So.2d 1390 (Ala.1990), Phelps v. Dempsey, 656 So.2d 377 (Ala.1995), and Golden v. Stein, 670 So.2d 904 (Ala.1995). In Horton, 562 So.2d at 130, this Court summarized one of the holdings in McMurray, supra, as follows: [I]n the medical malpractice context, those claims that involved allegations of lack of informed consent are essentially fraud cases. 562 So.2d at 130. In McMurray, the patient who suffered a bad result after surgery performed by a doctor he had expressly rejected sued, alleging, among other things, fraud and assault and battery. The thrust of the claim was that after the patient had refused to sign a consent form with that surgeon's name on it, he had been presented with, and signed, a consent form identifying another surgeon as the surgeon authorized to perform the procedure, along with his assistant. 461 So.2d at 777. This Court held that there was evidence from which it could be reasonably inferred that the rejected physician, who performed the operation as an assistant, had failed to inform the patient of that plan, and that those circumstances were sufficient to support the fraud claim. 461 So.2d at 778-79. Independent of the heightened pleading requirements imposed in a medical-malpractice action by § 6-5-551, Code of Ala.1975, Rule 9(b), Ala. R. Civ. P., states, in pertinent part, that [i]n all averments of fraud ... the circumstances constituting fraud ... shall be stated with particularity. The elements of a cause of action against a physician for failure to obtain informed consent are: (1) the physician's failure to inform the plaintiff of all material risks associated with the procedure, and (2) a showing that a reasonably prudent patient, with all the characteristics of the plaintiff and in the position of the plaintiff, would have declined the procedure had the patient been properly informed by the physician. Phelps, 656 So.2d at 380. Cain acknowledges that formulation of elements in her brief, citing Phelps. As we noted, she concedes in her reply brief that what she alleges in her complaint is not exactly a lack of informed consent claim, but relates to her claim that Howorth advised her that he would perform a left total hip and performed something less.... (Cain's reply brief, p. 21.) Cain did assert in her complaint, as the last of her listing of acts or omissions on the part of Dr. Howorth, that he negligently cared for and treated her. Cain does not argue in either of her briefs that this allegation is broad enough to satisfy the special rules for pleading in a medical-malpractice action as to a claim of lack of informed consent. Moreover, in Horton, supra, this Court implicitly held that a bare-bones allegation of negligent treatment would not suffice as pleading lack of informed consent. Just as we concluded in Craig, supra, we now conclude, based on a thorough analysis of what Cain pleaded and argued to the trial court, that this is not a case of `informed' consent where the question is whether the patient would have consented if all known risks had been disclosed; rather, it is a question of whether she consented at all to the injury-producing procedure, which was significantly different from the ... procedure[ ] to which she concededly did consent. 557 So.2d at 1259. In concluding that Cain alleged and argued to the trial court only a claim of no consent to the BHA, we do not ignore the fact that the second medical authorization form she signed described the proposed procedure as an open reduction internal fixation/left hip arthroplasty. Given that Dr. Howorth took the position in his deposition that left hip arthroplasty could mean many things, including both a total hip and a bipolar hip, and reiterated in his subsequently filed affidavit that, [a]s I stated in my deposition, the [left hip arthroplasty] procedure can be called a number of things including left total hip arthroplasty, bipolar endoprosthesis, left hip arthroplasty, etc., we do not find the use of term left hip arthroplasty in the consent form to be significant. Accordingly, Cain's claim that she was aware of only, that Dr. Howorth recommended only, and that she consented to only, a total hip, and that she had never even heard of a bipolar procedure until Dr. Featheringill explained it to her, is not refuted by the use in the authorization form of the all-purpose term left hip arthroplasty. Dr. Howorth acknowledged that he was not present in the room when the nurse talked with [Cain] to get the informed consent signed. The parties do not discuss, and the record does not inform us of, the circumstances surrounding the execution of either of the authorization forms or the voiding of the first one. In Donald v. Swann, 24 Ala.App. 463, 137 So. 178 (1931), the Court of Appeals held that a medical procedure performed without the consent of a patient constituted an assault and battery or a trespass to the person. This is likewise the view taken in Daum v. SpineCare Med. Group, Inc., 52 Cal.App.4th 1285, 61 Cal.Rptr.2d 260 (1997), where, quoting an earlier opinion of the California Supreme Court, the court stated: The battery theory should be reserved for those circumstances when a doctor performs an operation to which the patient has not consented. When the patient gives permission to perform one type of treatment and the doctor performs another, the requisite element of deliberate intent to deviate from the consent given is present. However, when the patient consents to certain treatment and the doctor performs that treatment but an undisclosed inherent complication with a low probability occurs, no intentional deviation from the consent given appears; rather, the doctor in obtaining consent may have failed to meet his due care duty to disclose pertinent information. 52 Cal.App. 4th at 1313, 61 Cal.Rptr.2d at 276. Similarly, in Doe v. Noe, 293 Ill.App.3d 1099, 1113, 690 N.E.2d 1012, 1021, 228 Ill.Dec. 937, 946 (1997), vacated, 303 Ill.App.3d 139, 707 N.E.2d 588, 236 Ill.Dec. 461 (1998), the court commented that [t]he law distinguishes between a total lack of consent for the contested act (battery) and the lack of informed consent (negligence). In Collins v. Ashurst, 821 So.2d 173 (Ala.2001), we expressly held that counts alleging assault and/or battery and trespass to the person could be maintained in a medical-malpractice action, although such an action was otherwise governed by the Alabama Medical Liability Act of 1987. Accordingly, because this Court will not reverse a summary judgment on a ground not pleaded and argued to the trial court, although we will affirm the judgment on a basis not asserted in the trial court ( Smith v. Equifax Servs., Inc., 537 So.2d 463, 465 (Ala.1988)), we do not further consider whether, under the circumstances of this case, Cain could have pleaded a viable claim for lack of informed consent. We simply hold that a lack-of-consent claim explicitly pleaded and argued does not embrace the separate concept of lack of informed consent, the latter requiring averment and proof that the doctor failed to inform the patient of the significant perils, or all material risks, associated with the procedure for which consent was given. Otwell, 497 So.2d at 118; Craig, 557 So.2d at 1258; Phelps, 656 So.2d at 380.