Opinion ID: 1286646
Heading Depth: 1
Heading Rank: 1

Heading: Adequacy of Jury Instruction

Text: Defendants objected to the trial court's instruction on informed consent, contending that plaintiffs had failed to present expert testimony establishing the existence or the extent of defendants' duty to disclose the risks of the amniocentesis procedure. In rejecting defendants' motion for directed verdict on plaintiffs' informed consent claim, the trial court, while acknowledging that the question has not yet been expressly decided by this court, ruled that expert testimony is not necessary on the question of informed consent. Rather, the trial court concluded, the issue could be resolved by the jury's employing an objective, reasonably prudent person test notwithstanding the absence of expert testimony. The trial court's instruction on the issue of informed consent to the jury read as follows: 16. It is the duty of a physician to obtain the consent of a patient before treating or operating on him. Such consent may be express or may be implied from the circumstances. In this regard, it is the duty of the physician or surgeon to disclose to his patient all material information to enable the patient to make informed decision regarding the proposed operation or treatment. Material information is information which the physician knows or should know would be regarded as significant by a reasonable person in the patient's position when deciding to accept or reject a recommended medical procedure. To be material a fact must also be one which is not commonly appreciated. There is no duty to discuss minor risks inherent in common procedures, when such procedures very seldom result in serious ill effects. However, when a procedure inherently involves a known risk of death or serious bodily harm it is the physician's or surgeon's duty to disclose to his patient the possibility of such outcome and to explain in lay terms the complications that might possibly occur. Even though the patient has consented to a proposed treatment or operation, the failure of the physician or surgeon to inform the patient as stated in this instruction before obtaining such consent is negligence and renders the physician or surgeon subject to liability for any injury proximately resulting from the treatment if a reasonably prudent person in the patient's position would not have consented to the treatment if he had been adequately informed of all the significant perils. Plaintiffs contend that this instruction does not adequately reflect the current law in this state on informed consent. They proposed an instruction as follows: A doctor has the duty to make a reasonable disclosure to his patient of the significant risks in view of the gravity of the patient's condition, the probabilities of success, and any alternative treatment or procedures, if such are reasonably appropriate, so that the patient has the information reasonably necessary to form the basis of an intelligent and informed consent to the proposed treatment or procedure. This proposed instruction was based upon our decision in Cunningham v. Yankton Clinic , P.A., where we held in part: A doctor has the duty to make a reasonable disclosure to his patient of the significant risks in view of the gravity of the patient's condition, the probabilities of success, and any alternative treatment or procedures, if such are reasonably appropriate, so that the patient has the information reasonably necessary to form the basis of an intelligent and informed consent to the proposed treatment or procedure. 262 N.W.2d 508, 511 (S.D.1978). See also Alberts v. Giebink, 299 N.W.2d 454 (S.D. 1980). Specifically, plaintiffs argue that Instruction 16 is deficient because it does not sufficiently explain the requirement of disclosure of significant risks and alternative treatment or procedures. In testing the sufficiency of a trial court's instructions, we have held that jury instructions must be considered as a whole in determining if error was committed in giving or refusing to give certain instructions. Degen v. Bayman, 90 S.D. 400, 241 N.W.2d 703, 706 (1976). When considered as a whole, jury instructions are adequate when they correctly state the law applicable to the case. Arcon Const. Co. v. South Dakota Cement Plant, 349 N.W.2d 407 (S.D.1984); Black v. Gardner, 320 N.W.2d 153 (S.D.1982). Nor is it error for the trial court to refuse to expand upon instructions given to the jury when those instructions substantially cover the principles embodied in the requested instruction. Jahnig v. Coisman, 283 N.W.2d 557 (S.D. 1979). Also, the trial court has a duty to instruct the jury on the law applicable to all issues properly raised at trial, but only on those issues which find support by competent evidence in the record. Black v. Gardner, supra ; Moor v. Iowa Manufacturing Co., 320 N.W.2d 927 (S.D.1982); Wolf v. Graber, 303 N.W.2d 364 (S.D.1981). Finally, an appellant who seeks to set aside a civil verdict because of an incomplete or ambiguous instruction must establish that it was prejudicial, ... i.e., that under the evidence, the jury might have, and probably would have, returned a different verdict if a correct instruction had been given. Schmidt v. Wildcat Cave, Inc., 261 N.W.2d 114, 119 (S.D.1977) (citation omitted). See also Ryken v. Blumer, 307 N.W.2d 865 (S.D.1981). Mere assertions of what the jury may have concluded are insufficient to satisfy the burden of establishing that an instruction was prejudicial. Duncan v. Pennington County Housing Authority, 283 N.W.2d 546, 553 (S.D.1979). Although plaintiffs' reliance on Cunningham is not misplaced, we cannot say that Instruction 16 incorrectly or inadequately explained the duty of a physician to disclose significant risks to his patient. As indicated above, Instruction 16 defined material information as information which the physician knows or should know would be regarded as significant by a reasonable person in the patient's position when deciding to accept or reject a recommended procedure. This language does not differ substantially from plaintiffs' proposed instruction. Accordingly, we conclude that the trial court did not err in giving Instruction 16 and in refusing plaintiffs' proposed instruction. Plaintiffs' second objection to Instruction 16 is that it failed to inform the jury that a doctor has a duty to make a reasonable disclosure to his patient of any alternative treatment or procedure if such is reasonably appropriate. Again, plaintiffs rely on Cunningham v. Yankton Clinic , P.A., supra, as supportive of their position on this issue. Plaintiffs claim that the alternative treatment or procedure to the amniocentesis was simply to forego the amniocentesis. Clearly, the patient has the right to elect not to undergo a recommended treatment or procedure. This election is an alternative to treatment, but it is not an alternative treatment or procedure. Expert witnesses for both plaintiffs and defendants agreed that there presently is no alternative diagnostic tool available in lieu of the amniocentesis procedure to obtain the type of information Dr. Madison reasonably sought to obtain. Thus the options available to Mrs. Wheeldon were either to submit to an amniocentesis or not to submit to an amniocentesis. These two options were sufficiently addressed in that portion of Instruction 16 that read: [I]t is the duty of a physician or surgeon to disclose material information ... which the physician knows or should know would be regarded as significant by a reasonable person in the patient's position when deciding to accept or reject a recommended medical procedure. (emphasis added) We reach this conclusion not unmindful of Wheeldons' contention on appeal that Dr. Madison should have discussed with Mrs. Wheeldon alternative methods of treatment after blood was obtained during the September 8, 1982, amniocentesis procedure. This claim, however, was not pursued by the Wheeldons at trial. It is clear from the record that Wheeldons' action against Dr. Madison was premised on three distinct theories: (1) that Dr. Madison carelessly and negligently failed to inform Mrs. Wheeldon of the possible risks of injury incident to the amniocentesis procedure; (2) that Dr. Madison was negligent in performing the amniocentesis procedure; and (3) that Dr. Madison negligently failed to render proper post-operative care to Mrs. Wheeldon. This court has held that the theory on which a case is tried below must be adhered to on appeal. State Highway Comm'n v. Sweetman Const. Co., 83 S.D. 27, 31, 153 N.W.2d 682, 684 (1967); Berry v. Benner, 81 S.D. 610, 617, 139 N.W.2d 285, 289 (1966). Inasmuch as Wheeldons neither pleaded nor tried their informed consent claim so as to encompass Mrs. Wheeldon's post-amniocentesis care, we will not entertain such claim for the first time on appeal. Accordingly, we are satisfied that the trial court's instruction to the jury on this question encompassed the relevant issues pertaining to plaintiffs' informed consent claim. Had the evidence disclosed that an alternative procedure existed, then plaintiffs would, of course, have been entitled to the instruction they requested.