Court Opinion

ID: 9592967
Source: CourtListenerOpinion
Date Created: 2023-08-22 00:18:20.097772+00
Date Added: 2024-06-11T18:01:17.933897
License: Public Domain

COMPTON, Chief Justice,
with whom MATTHEWS, Justice, joins (except as to footnote 1), dissenting in part.
I do not agree with the analysis in part III.D of Justice Fabe’s opinion.1 I would conclude that FMH has a statutory duty to ensure that physicians using its facilities obtain the informed consent of their patients.
Alaska Statute 09.55.556(a) provides:
A health care provider is liable for failure to obtain the informed consent of a patient if the claimant' establishes by a preponderance of the evidence that the provider has failed to inform the patient of the common risks and reasonable alternatives to the proposed treatment or procedure, and that but for that failure the claimant would not have consented to the proposed treatment or procedure.
Alaska Statute 09.55.560(1) includes in the definition of health care provider “a hospital as defined in AS 18.20.130.” Alaska Statute 18.20.130 gives an expansive definition of hospital that clearly includes FMH.
There is no textual basis for concluding that, because the statute references a “proposed” procedure, only the health care provider who proposes the procedure is responsible for obtaining informed consent. Until a procedure is proposed there is nothing to which the patient may consent. This court should not blind itself to the everyday practice whereby physicians leave instructions for hospital staff to carry out medical procedures that the physician neither attends nor directly supervises, but that entail risks about which reasonable patients would want to be informed. If a hospital’s duty to obtain informed consent has any real force, it must apply under such circumstances. Hospitals do not practice medicine independently of the individuals they employ. A hospital itself will never “propose” a procedure, as the court suggests, yet the clear intent of the statute is to impose some responsibility on hospitals to obtain patients’ informed consent. To the extent that hospitals may be *1041said to propose procedures through physician employees, they are already subject to liability under a respondeat superior theory for any failure by such employees to obtain informed consent. The liability imposed by AS 09.55.556(a) becomes wholly superfluous under Justice Fabe’s reading, since the statute would impose no new liability on hospitals. A logical construction of AS 09.55.556(a) requires imposition of liability for failure to obtain informed consent on both the health care provider proposing the procedure and on any health care provider performing the procedure. Hospitals would be responsible for obtaining informed consent, or ensuring that it is obtained, when one of their employees performs a procedure proposed by an independent physician.
Courts of other states have held that only the patient’s physician is in a position to decide whether to seek the patient’s informed consent. Those courts have therefore exempted hospitals from the informed consent duty, in order to protect physicians’ discretion.2 But these cases, for the most part, did not involve a statute specifically imposing on hospitals the duty to obtain informed consent.
Giese v. Stice, 252 Neb. 913, 567 N.W.2d 156 (1997) presents an exception. In Giese the Nebraska Supreme court did indeed elect to ignore clear statutory language (defining “health care provider” and imposing a duty to obtain informed consent on “health care providers”) based on its own notion that following the language would be a bad idea. Id. 567 N.W.2d at 164. I can comment only that such a. ease is poor precedent at best. It is not the function of this court to rewrite clearly constructed statutes. “It is true that there is no longer a plain meaning rule as such in Alaska law. Where a statute’s meaning appears clear and unambiguous, however, the party asserting a different meaning bears a correspondingly heavy burden of demonstrating contrary legislative intent.” University of Alaska v. Tumeo, 933 P.2d 1147, 1152 (Alaska 1997). No such showing has been made in this case. Following an example such as that set by Giese puts one in mind of a story about a certain intoxicated farmer who left a tavern in his wagon late one night, took a wrong turn, and found himself in a field of potholes. The next morning many others followed the wagon ruts left by the farmer, with predictable consequences.
Were it not for AS 09.55.556(a) and AS 09.55.560(1), I might find the reasoning of the out-of-state cases discussed in Justice Fabe’s opinion to be persuasive, particularly in light of the deference to physician discretion expressed in AS 09.55.556(b)(4) and Korman v. Mallin, 858 P.2d 1145 (Alaska 1993). The language of AS 09.55.556(a), however, is clear. • It imposes a duty on hospitals to take measures to ensure that their patients are fully informed of common risks and reasonable alternatives to any proposed procedures that the hospitals undertake to perform, whether at the direction of the treating physician or on their own initiative.
Any duty imposed on hospitals by AS 09.55.556(a) would have to be tempered by the discretion not to seek informed consent that is guaranteed by AS 09.55.556(b)(4).3 This position is in accord with the consensus among other jurisdictions that the patient’s physician is in the best position to decide whether to inform the patient of the risks attendant to treatment. The role assigned to hospitals by AS 09.55.556(a) does not displace *1042the physician’s discretion. The hospital may fulfill its duty simply by determining from a patient’s chart that an informed consent form has been signed under a physician’s supervision. If no informed consent is attached to the patient’s chart, the duty may require that the hospital contact the physician. The hospital must then either determine that the physician has exercised his AS 09.56.556(b)(4) discretion not to obtain informed consent or request that the physician obtain an informed consent. That failing, the hospital must obtain its own informed consent or exercise its discretion not to obtain informed consent. The hospital as well as the physician is performing the medical procedure. Should the hospital neglect to carry out this duty, it would be liable for failure to obtain informed consent under AS 09.55.556(a).
In this case, it does not appear that FMH adopted measures to ensure that its patients are fully informed of common risks and reasonable alternatives to proposed procedures that the hospital undertakes to perform. I would remand for a determination of this issue, requiring the superior court to allow FMH to supplement the record with information on any such measures it had in place at the time of Ward’s transfusion.4

. I have written that this court should have retained its former practice, when affirming a decision by an evenly-divided vote, of issuing an order stating only that the decision is affirmed. See Taylor Constr. Servs., Inc. v. URS Co., 758 P.2d 99, 103 (Alaska 1988) (Compton, J., stating reason for declining to express basis of disagreement with superior court's decision). Because such affirmances are not precedent, "[s]tating personal opinions for affirmance or reversal ... is at best advisory, at worst confusing and misleading. Individual justices' opinions are simply immaterial.” City of Kenai v. Burnett, 860 P.2d 1233, 1246 (Compton, J., concurring) (Alaska 1993). In this case, however, I feel that Justice Fabe’s advisory discussion of her reasons for voting to affirm the superior court’s judgment requires a reply, albeit equally advisory. Justice Fabe and I obviously each hope that some future party will persuade a majority of this court to adopt our respective views as law. While I think that it would be better for us each to leave those views unexpressed until then, it seems the lesser of two evils that the Pacific Reporter print advice on both sides of the issue for Future parties to peruse.

. See, e.g., opinions quoted and summarized in Justice Fabe's opinion, supra, at 1039 n. 15.

. Alaska Statute 09.55.556(b)(4) provides:
It is a defense to any action for medical malpractice based upon an alleged failure to obtain informed consent that
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(4) the health care provider after considering all of the attendant facts and circumstances used reasonable discretion as to the manner and extent that the alternatives or risks were disclosed to the patient because the health care provider reasonably believed that a full disclosure would have a substantially adverse effect on the patient's condition.
Similarly, we have held that
[t]he physician retains a qualified privilege to withhold information on therapeutic grounds, as in those cases where a complete and candid disclosure of possible alternatives and consequences might have a detrimental effect on the physical or psychological well-being of the patient.
Korman v. Mallin, 858 P.2d 1145, 1150 (Alaska 1993) (quoting Sard v. Hardy, 281 Md. 432, 379 A.2d 1014, 1022 (1977)).

. The superior court would also consider on remand whether Ward was owed a duty of informed consent at the time she was treated at FMH. If it was too late to pursue alternative sources of blood or alternatives to blood transfusion by the time Ward was admitted to FMH, then Ward could not have been harmed by a failure by FMH to ensure that its physicians would seek informed consent, and Ward would have no cause of action against FMH.