Court Opinion

ID: 9704463
Source: CourtListenerOpinion
Date Created: 2023-08-26 00:36:36.041361+00
Date Added: 2024-06-11T18:22:02.632002
License: Public Domain

SULLIVAN, Judge,
concurring in result.
I agree with the majority that the giving of an instruction on contributory negligence was not reversible error in this case. I write separately, however, because of my concern that the majority's approach might be construed as embracing a more expansive view of a patient's duties within the physician-patient relationship than has generally been recognized, and I cannot endorse such an expansion.
As an initial matter, I agree with the majority that the cases of Harris v. Cacdac (1987) Ind.App., 512 N.E.2d 1138, trans. denied and Fall v. White (1983) Ind.App., 449 N.E.2d 628 do not evince a specific intent to limit a patient's duties in all respects within the physician-patient relationship to providing complete information and following a doctor's instructions. Indeed, I agree that with respect to his actions taken while under a physician's care, a patient owes himself a duty of due care which extends beyond these narrow categories. However, this duty does not extend to diagnosing his own condition or questioning his physician's diagnosis of his condition. In fact, quite the contrary ap*193pears to be true; the fiduciary nature of the physician-patient relationship and the special skill of the physician bestow upon the patient the right to rely upon his physician's diagnosis and treatment. See 61 Am.Jur.2d Physicians, Surgeons, and other Healers § 308 (1981). "Since the patient may rely on the directions of his physician, it follows that he incurs no liability by doing so." Id. Rather, the patient's duties to himself would appear to extend to his engagement in "everyday"type activities; or in other words, activities which, though perhaps undertaken while at a hospital or under a physician's care, are not themselves related to the diagnosis or treatment of the patient's condition. For example, Memorial Hospital of South Bend v. Scott (1973), 261 Ind. 27, 300 N.E.2d 50, the case which the majority cites as stating the seope of a patient's duties, Maj. Op. at 191, is itself such a case. There, the patient's action which was alleged to be in contravention of a duty owed to himself was mistakenly turning on a bedpan flusher spout instead of the toilet flusher which the plaintiff was seeking to use. 800 N.E.2d at 52. I have not discovered, nor is there present in either the majority opinion or the briefs of the parties (despite citation in the briefs to numerous cases from a variety of jurisdictions), any case law for the proposition that a patient has a duty to question his physician's diagnosis of his condition or seek, of his own accord, a second opinion.4 Thus, while I agree that a patient's duties to himself while under a physician's care may extend beyond merely providing truthful and complete information to the physician and heeding the physician's instructions, and to the exercise of due care in his conduct of lay activities, I respectfully disagree with any reading of the majority opinion which infers that a patient has a general duty, with respect to the diagnosis and treatment of his condition, beyond those two areas. "[Blecause of the doctor's ability to understand and interpret medical matters, the doctor generally owes a greater duty to his patient than the patient owes to himself." Morrison v. MacNamara (1979) D.C., 407 A.2d 555, 567.
Despite this, upon the particular facts of this case, I am able to agree that Smith's actions could constitute contributory negligence. The reciprocal side of a patient's right to rely upon his physician's diagnosis and advice is the idea that the patient, not being a physician, cannot ascertain for himself the nature and cause of his medical condition. However, where the patient seeks to make a decision to direct a specific treatment for himself, he is no longer relying in a fiduciary sense on his physician, and could be said to "assume" a greater duty upon himself than would otherwise exist. In 61 Am.Jur. Physicians, Surgeons, and other Healers, su-pro § 308, titled "Particular acts as constituting contributory negligence", this proposition is stated:
"It seems that where a patient is fully cognizant of the nature of the specific treatment that he is about to get, or if he actually directs a specific act, such as an operation, which should not be performed, he eannot complain later that such treatment or act constituted malpractice for which he should recover. In that case he *194has sought to rely on his own judgment rather than that of the physician..."5
Here, it appears that Smith was fully aware of the risks of both the hair replacement and sealp reduction procedures, and actually directed the performance, despite Dr. Hull's reluctance, of the scalp reductions. The complications related to the performance of the sealp reductions appear to have resulted from the inability of Dr. Hull to "undermine" Smith's sealp, which occurred due to Smith's unwillingness to wait the recommended time for his sealp to regain its flexibility. Under this factual scenario, I cannot say that there was no evidence in the record to support the giving of an instruction upon the issue of Smith's contributory negligence.
I wish to reiterate that I do not mean to imply support for a more expansive view of the scope of a patient's duties relative to the diagnosis and treatment of his condition; rather, in my view, this is one of the very rare cases where, based upon a thorough understanding of the risks and alternatives available, a patient has sought to pursue a course of treatment that has led to injuries which he knew were possible.6 Under the particular factual scenario presented here, I agree with the conclusion reached by the majority.

. Notwithstanding Dr. Hull's assertions in his brief, Hanley v. Spencer (1941), 108 Colo. 184, 115 P.2d 399, does not support this proposition. In that case, the plaintiff discontinued his treatment with the defendant physician and went on an extended trip to another state without informing the defendant physician, returning for care only several months later. A duty to either return for treatment, or, if the patient chooses not to return for treatment, to seek another opinion, is another of the duties a patient may have within the physician-patient relationship. See 61 Am. Jur.2d Physicians, Surgeons, and other Healers, supra § 303 (citing Hanley); Annotation, Contributory negligence or assumption of risk as a defense on action against physician or surgeon for malpractice, 50 A.L.R.2d 1043, 1055 (1956 & Later Case Service 1987) (citing Hanley); see also 19A Am.Jur. Pleading & Practice Forms Form 396 (Rev. ed. 1985) (pattern jury instruction on "[platient's contributory negligence-[flailure to return for treatment"). Where a plaintiff continues with a course of treatment prescribed by a physician, however, that plaintiff is not under a duty to seek a second opinion.
A patient may also have a duty, when so advised by his physician, to seek a second opinion. See 61 Am.Jur.2d Physicians, Surgeons, and other Healers, supra § 302; see also 19A Am.Jur. Pleading & Practice Forms, supra Form 397 (pattern jury instruction on "[platient's contributory negligence-[flailure to follow physician's advice to consult another physician for further care").

. This proposition is admittedly problematic if applied strenuously in medical situations where the patient's health is at stake prior to seeking treatment. In those circumstances, it is vitally important that a physician not escape liability upon the ground that a patient elected or sought a particular course of treatment, when it is the physician's very function and duty to know what is the most appropriate course of treatment. However, it may have somewhat greater force where, as here, we are dealing merely with nonessential, cosmetic procedures. In such circumstances, where the decision to seek treatment in the first place is itself elective, it seems less troubling to say that a patient could, if he chooses, exercise a somewhat greater degree of control and have greater input into the decision-making process affecting his treatment.

. It is the same sense that Smith, being fully aware of the risks of both the hair injection and scalp reduction procedures, nevertheless chose to proceed and directed Dr. Hull to proceed with the procedures, that leads me to believe that this case might more appropriately be analyzed under an assumption of risk approach. Unlike contributory negligence, which connotes a careless disregard for a risk, assumption of risk connotes a voluntary assumption of a risk the nature and extent of which is fully appreciated. See Kroger Co. v. Haun (1978), 177 Ind.App. 403, 379 N.E.2d 1004; 57A Am.Jur. Negligence § 815 (1989). Smith's actions in this case, as opposed to being of a careless and unappreciating nature such as would normally be associated with contributory negligence, were certainly voluntary and motivated by his desire to stem or reverse the baldness he was experiencing. Further, analysis under the assumption of risk doctrine eliminates the need for an examination of whether the plaintiff's actions constituted a proximate cause of his injuries. See 57A Am.Jur. Negligence, supra § 818.
I am aware of the perils of this approach, however. Generally, and with good reason, courts are reluctant to apply the assumption of risk doctrine to the patient within the physician-patient relationship, on the theory that, given the inherently unequal nature of the relationship and the special knowledge and training of the physician, a patient cannot fully appreciate the risks of a given procedure, and thus cannot assume the risks of that procedure. See Morrison, supra, 407 A.2d at 566; see generally Comment, Contributory Negligence in Medical Malpractice: Are the Standards Changing to Reflect Society's Growing Health Care Consumerism? 17 U.Dayton L.Rev. 151 (1991), and cases cited therein. Indeed, it is said that a plaintiff cannot assume the risk of a physician's negligence, see 61 Am.Jur.2d Physicians, Surgeons, and other Healers, supra § 304, and I agree that merely signing a consent form and having a procedure explained by the physician does not evidence a plaintiff's assumption of risk, especially with regard to whether a procedure was negligently performed.