Court Opinion

ID: 9736005
Source: CourtListenerOpinion
Date Created: 2023-08-26 18:39:36.241004+00
Date Added: 2024-06-11T18:27:03.279401
License: Public Domain

CAVANAUGH, Judge,
concurring and dissenting:
I agree with the majority’s determination, based upon Kurtas v. Kurtas, 521 Pa. 105, 555 A.2d 804 (1989), that the issues considered and disposed of by the court below were not waived, and are subject to review by this court.
I respectfully dissent from the majority’s award of a new trial. The majority concentrates on perceived error in the charge to the jury, but in my opinion, overlooks the failure of the appellants to prove their case by the required expert testimony.1 Cooper v. Roberts, 220 Pa.Super. 260, 286 A.2d *394647 (1971) held that in order to establish lack of an informed consent, the patient must prove that the physician did not disclose all of the facts, risks and alternatives that a reasonable person in the situation which the doctor knew or should have known to be the patient’s, would deem significant in making the decision to undergo the recommended procedure. We held that the physician is not required to discuss every risk in order to avoid being liable for battery. “The physician is bound to disclose only those risks which a reasonable man would consider material to his decision whether or not to undergo treatment.” 220 Pa.Super. at 267-8, 286 A.2d at 650-651. In Festa v. Greenberg, 354 Pa.Super. 346, 511 A.2d 1371 (1986), appeal denied by Festa v. Greenberg, 515 Pa. 580, 527 A.2d 541 (1987), we held that the question of whether a physician disclosed risks which a reasonable person would deem material is for the trier of fact. The court further stated that:
Although expert medical testimony is not mandatory to set forth the scope of a physician’s duty to disclose material risks to a patient under the reasonable man standard, we conclude that such testimony is required to establish the existence of risks in a specific medical procedure, the existence of alternative methods of treatment and the existence of risks attendant with such alternatives.
(Emphasis in original).
354 Pa.Super. at 356, 511 A.2d at 1376. In the instant case, the appellant presented no expert testimony on her behalf concerning the existence of risks, alternative medical procedures, or risks attendant to the alternatives. The appellant argues that she was not required to introduce independent, expert testimony to establish the existence of a risk or alternative methods of treatment and that she could rely on Dr. Nagle’s testimony. Dr. Nagle unequivocally stated that the necessity of removing an ovary was not a medically *395recognized risk of the surgery, and the probability of it occurring was almost non-existent.
The necessity of expert testimony in informed consent cases was restated in Maliszewski v. Rendon, 374 Pa.Super. 109, 542 A.2d 170 (1988), appeal denied 520 Pa. 617, 554 A.2d 510 (1989). In that case, we affirmed the order of the court below, denying a new trial after entry of summary judgment. The plaintiffs informed consent case was properly dismissed for failure to provide expert testimony that the plaintiff had suffered additional injuries as a result of the surgery. We held that Festa v. Greenberg, supra, pointed out that Cooper v. Roberts, supra, merely exempted a plaintiff from presenting expert testimony to establish the materiality of a risk and that Cooper does not exempt a plaintiff from providing expert testimony as to all aspects of a case where it would be otherwise necessary. The court stated at 374 Pa.Super. 113, 542 A.2d 172-3: “We explained in Festa that, although expert testimony was not required to establish the materiality of risks, it was required to establish the existence of risk, the existence of alternative treatments, and the feasibility of these alternatives in the patient’s case.” (Emphasis added.)
In Neal v. Lu, 365 Pa.Super. 464, 530 A.2d 103 (1987) we alluded to Festa v. Greenberg, supra, as indicative that Pennsylvania is one of a growing number of jurisdictions adopting a “prudent patient” standard of informed consent which tests the adequacy of the physician’s disclosures by requiring the fact finder to determine whether the patient received all of the information that a reasonable person would have deemed material. “We concluded in Festa that even though the ultimate assessment of ‘materiality’ is for the fact finder to make, expert testimony is nevertheless necessary on the important secondary issues that lie outside the knowledge of the layperson.” (Emphasis added.) 365 Pa.Super. at 480, 530 A.2d at 112. We further stated in Neal v. Lu, 365 Pa.Super. at 480-481, 530 A.2d at 112:
*396Thus, only an expert is able to explain the harms that can arise from the procedure in question and estimate the likelihood that those harms will occur. Only an expert, moreover, can identify viable alternative treatments and discuss the risks involved. See, Festa, supra, 354 Pa.Super. at 356-60, 511 A.2d at 1376-78. Without an informed discussion of the risks and alternatives, the fact finder cannot determine rationally whether a reasonable person would have deemed the undisclosed knowledge “material”.
(Emphasis added.)
The appellant’s case, which was based on lack of an informed consent to the removal of her remaining ovary, must fail, in my opinion, because she did not establish by expert testimony the existence of the risk in the surgical proceeding undertaken by Dr. Nagle, the existence of alternative methods of treatment, and the risks attendant with such alternatives. This is the evidentiary threshold that must be met, and appellant has failed to carry that burden.
The majority adroitly sidesteps the requirement of expert testimony and cites Jozsa v. Hottenstein, 364 Pa.Super. 469, 528 A.2d 606 (1987), Opinion by Del Sole, J., Dissenting Opinion by Popovich, J., in support of its proposition that: “The claim made by each individual plaintiff will dictate to what extent expert testimony is necessary to establish each of three factors: the risks of the particular surgery, the existence of alternative methods of treatment, and the risks attendant with such alternatives.” In my opinion, Jozsa should not be read to conflict with Festa v. Greenberg, supra. We stated in Jozsa, 364 Pa.Super. at 474, 528 A.2d at 608:
Festa holds that expert testimony is mandatory to establish existence of risks, existence of alternative methods of treatment and existence of risks attendant with such alternatives. It does not hold that expert testimony must establish all of the above before the question of whether there was an informed consent can go to the jury. We emphasize that once expert testimony estab*397lishes the existence of an undisclosed risk of a recommended medical procedure (or of any of the above-mentioned factors), it is the role of the jury to decide whether that type of harm if it occurs, is a risk which a reasonable patient would consider in deciding on whether to undergo or reject the procedure.
(Emphasis added.)
Festa v. Greenberg, supra, stated that expert testimony is required: (1) to establish the existence of risks in a specific medical procedure; (2) to establish the existence of alternative methods of treatment; and (3) to establish the existence of risks attendant with such alternatives. Jozsa, if followed literally would substantially change the requirements of Festa concerning expert testimony and instead of requiring it to establish all three factors, it would be required only to establish one factor. Indeed, in Maliszewski v. Rendon, supra, we reiterated that expert testimony is required to establish the existence of risks, the existence of alternative procedures and the feasibility of the alternatives.
In my view, the court below properly disposed of the other issues raised and these are not addressed by the majority.
I would affirm the judgment of the court below.

. The court's instruction concerning informed consent included the following:
"— so it will be incumbent upon the plaintiff to prove that there was an offensive touching without the consent of the plaintiff. The offensive touching is the taking of the ovary and without consent, in this type of situation means without the knowing or informed *393consent. You can’t be deemed to give your consent on a complex issue such as a medical issue unless you have been informed by a doctor or somebody who knows about medicine. The law is that every human being and thus every medical patient of adult years and sound mind has a right to determine what shall be done with his or her own body or any part thereof. The question is whether or not there was an offensive touching and whether it was without the informed consent of the plaintiff. If you find that the Plaintiff has carried her burden of proving to you that those two things occurred and further that she was injured as a result of that battery, she will prevail and she will obtain a verdict from you.
If you find that a reasonable person in the position of the plaintiff under all of the circumstances as you find them to be would have said go ahead anyway, she cannot recover. You have heard some testimony that at a prior time when she had her hysterectomy the doctor did talk it over with her before and she did say well go ahead and do everything you want, you need to do, but that was a different time and under a different circumstance, but you may consider it. But you have got to put that reasonable person in the place of the plaintiff at the time of this particular operation, given the facts, some of the facts are that she had already had one ovary gone and that she just had an operation three months before and the doctor took everything that that doctor felt was needed to be taken at that time. This is one of the circumstances which you have to consider. So question No. 1, did the doctor have the duty to inform the plaintiff before his surgical intervention, before he cut anything, to disclose to her that this might involve an organ which has been misplaced and I may have to take it if it is in the way. Do you want me to do that? That as I have indicated, every human being and that is every medical patient of adult years and a sound mind, has a right to determine what shall be done with his own body.
It is a prerogative of the patient, not the physician, to determine for herself the direction in which her interests seem to lie to enable a patient to make a determination or to chart her course understandably, some familiarity with therapeutic alternatives and their hazards become essential. A physician’s duty to inform the patient is not dependant upon the patient’s request for disclosure.”
In Gouse v. Cassel, 385 Pa.Super. 521, 561 A.2d 797 (1989), appeal granted by Gouse v. Cassel, 524 Pa. 608, 569 A.2d 1367 (1989), we determined that it was error for the trial court to submit an interrogatory to the jury which stated that even if the plaintiff was not advised of material risks and alternatives, would it find that a reasonable person in the plaintiff’s condition would, nevertheless, have agreed to the operation. Relying on Sagala v. Tavares, supra, the court held that recovery is based on the surgical procedure being performed without an informed consent and not on whether the patient would have gone ahead with the operation even if he or she had been warned of the particular risk. In the instant case, the trial court did not have the decision in Gouse, supra, to guide it at the time the *394charge was given, and the law set forth in the charge was correct at the time given. In any event, the appellant did not present the required expert testimony to establish a case based on informed consent.