Opinion ID: 2607347
Heading Depth: 1
Heading Rank: 1

Heading: facts

Text: The facts forming the basis of the dispute in the present case are exhaustively set forth in the ICA's decision. See Bernard, 79 Hawai`i at 373-76, 903 P.2d at 678-81. We therefore briefly recount only the facts pertinent to this decision. On January 10, 1987, Bernard went to Dr. Char's office, complaining of a toothache. An x-ray revealed that Bernard's second molar on the upper left side of his mouth (tooth no. 15) was extensively decayed. Dr. Char also noted that Bernard's adjoining wisdom tooth (tooth no. 16) was unusually small and crooked and that the gum surrounding tooth nos. 15 was red and inflamed. Dr. Char further noted that the bone containing teeth nos. 15 and 16 seemed to be thin, and Dr. Char suspected that tooth no. 15 might be ankylosed, or fused, to the bone. There was conflicting testimony at trial as to what transpired after Dr. Char examined Bernard. Dr. Char testified that he recommended that a root canal procedure be performed in order to save the decayed tooth no. 15 and that he explained the risks and benefits of a root canal procedure. According to Dr. Char, when Bernard stated that he could not afford to undergo a root canal procedure, Dr. Char discussed with Bernard the alternative of tooth extraction, again explaining the risks and benefits of the procedure. Dr. Char claimed that he specifically advised Bernard that extraction was a last resort. He also informed Bernard that: (1) Bernard's buccal plate (a bone near his cheek) was thin; (2) Bernard could suffer bone loss; and (3) Bernard might require an additional extraction of tooth no. 16 if tooth no. 15 were removed. Bernard, on the other hand, testified that Dr. Char advised him that extraction was the best alternative because tooth no. 15 was badly decayed. Bernard claimed that Dr. Char did not inform him of the possible adverse consequences that could result from the extraction procedure. Dr. Char's two dental assistants corroborated Bernard's testimony in that neither heard Dr. Char inform Bernard of any possible problems or complications that could result from undergoing the extraction procedure. Because Bernard financially could not afford the root canal procedure, he opted for the relatively less expensive extraction procedure. [1] Dr. Char's suspicion regarding the fused teeth was apparently well-founded. While extracting tooth no. 15, Dr. Char felt something crack, and, in addition to tooth no. 15 being extracted, Dr. Char removed tooth no. 16, as well as portions of Bernard's buccal plate and antrum bone, all of which were fused together. The extraction left Bernard with a dime-sized hole leading from his mouth to his sinus cavity, causing blood from his mouth to flow out through his nose. After several bleeding episodes and follow-up visits, Bernard filed a six-count complaint against Dr. Char alleging: (1) negligent performance of dental procedures; (2) lack of informed consent; (3) breach of fiduciary duty and warranties; (4) negligent rendering of follow-up care; (5) negligent and/or fraudulent and/or unethical prescription of herbal compounds and unfair and deceptive trade practices; and (6) punitive damages. At the close of his case-in-chief at trial, Bernard voluntarily withdrew counts 3 and 5, and the trial court granted Dr. Char's motion for a directed verdict as to count 6. The jury returned a special verdict in favor of Bernard, finding that Dr. Char was negligent and that his negligence was the legal cause of Bernard's injury. In addition, the jury concluded that Bernard was contributorily negligent, but that his negligence was not the legal cause of his injuries. The jury awarded Bernard $56,000.00 in general damages and $400.00 in special damages. Judgment was entered on June 26, 1991. Thereafter, Dr. Char filed a motion for remittitur, or, in the alternative, for new trial. The trial court granted the motion for remittitur but denied the motion for new trial in an order filed on September 17, 1991; [2] an amended judgment, pursuant to that order, was entered on February 25, 1992, in the total amount of $37,788.30, reflecting $35,400.00 in remitted damages and $2,388.30 in costs awarded in favor of Bernard. Dr. Char timely appealed, challenging the judgment and amended judgment in favor of Bernard, as well as the orders pertaining to Dr. Char's motion for remittitur, or, in the alternative, for new trial. As previously indicated, the ICA affirmed the trial court's judgments and orders. On appeal, the ICA held that Bernard sufficiently established both: (1) the standard for the physician's duty to disclose risks of harm prior to treatment; and (2) causation, so as to withstand Dr. Char's motion for a directed verdict. In so holding, the ICA applied the patient-oriented standard of disclosure, which does not require presentation of expert medical testimony, thus essentially rendering moot Dr. Char's contention that Bernard failed to meet his burden of presenting expert medical testimony. As to causation, the ICA applied the modified objective standard for causation first announced by the ICA in Leyson v. Steuermann, 5 Haw.App. 504, 705 P.2d 37 (1985). Under the modified objective standard, causation is determined from the viewpoint of the actual patient acting rationally and reasonably. Bernard, 79 Hawai`i at 384, 903 P.2d at 689. The ICA therefore concluded that, because the record showed that Bernard was in excruciating pain, was unemployed, and had no dental insurance, there was sufficient evidence under the modified objective test for a jury to find that, had he been advised of the risks of tooth extraction, Bernard, acting rationally and reasonably, would have chosen to undergo the more expensive but less risky root canal procedure that Dr. Char had recommended. Dr. Char subsequently filed an application for a writ of certiorari, which this court granted by order dated May 30, 1995.