Court Opinion

ID: 9576676
Source: CourtListenerOpinion
Date Created: 2023-08-21 21:27:01.075873+00
Date Added: 2024-06-11T13:12:09.188698
License: Public Domain

McMurray, Presiding Judge,
concurring in the judgment only in part and dissenting in part.
In Case No. A99A0302,1 respectfully dissent from the judgment of partial reversal. In my view of the undisputed circumstances of this case, the responsible physician lawfully delegated the task of harvesting the saphenous vein to a qualified physician’s assistant, and this lawful delegation was impliedly consented to by the patient. Furthermore, the circumstantial evidence of the alleged failure to post notices that the hospital employed physician’s assistants cannot overcome the direct evidence that such notice was given. Consequently, in Case No. A99A0619,1 concur in the judgment only.
Plaintiffs Mr. and Mrs. Lonnie G. Gillis brought this tort action against defendants Cardio TVP Surgical Associates, P.C. (“CSA”), Dr. I. J. Shaker, the Medical Center of Central Georgia (“MCCG”), and Jay Livingston, alleging that during a four-vessel aortocoronary artery bypass operation, Dr. Shaker and Livingston committed battery when Dr. Shaker allowed defendant Livingston, a non-physician, to operate on Lonnie G. Gillis’ left leg without plaintiff Lonnie G. Gil-lis’ permission. The complaint further alleged medical malpractice because, as a result of medical negligence in that operation, nerves in plaintiff Lonnie G. Gillis’ left leg were damaged and permanently injured. Defendants Dr. Shaker, MCCG, and CSA were allegedly liable for the acts and omissions of defendant Livingston. Plaintiff Mrs. Lonnie Gillis claimed loss of consortium. Upon cross-motions for partial summary judgment as to the claim of battery, the following undisputed facts were adduced:
Since 1986, Livingston has been certified by the Composite State Board of Medical Examiners (“the State Board”) as meeting the requirements of the Physician’s Assistant Act, OCGA § 43-34-100 et seq., and is authorized to assist Dr. Shaker. In 1987, Livingston was authorized by defendant MCCG to assist in surgery, review charts, make rounds, write verbal orders on charts for physician signature, assist the medical doctors with procedures, obtain patient histories, start or disconnect IVs, change dressings and remove drains, and remove sutures. Since that time, he has assisted Dr. Shaker during coronary bypass graft operations by harvesting saphenous veins and also learned to assist by sewing the vessels on the heart and the aorta and by helping Dr. Shaker close the chest.
Defendants CSA, Dr. Shaker, and Livingston further supported their motion with Livingston’s certification from the State Board to serve as a physician’s assistant (“PA”) under the supervision of Dr. Shaker and the consent form signed by plaintiff Lonnie G. Gillis. The *359letterhead of this two-page consent form expressly lists I. J. Shaker, M.D. and M. Jay Livingston, P.A.C., as CSA medical personnel. The form recites that plaintiff Lonnie G. Gillis had explained to him in general terms that he had coronary artery disease requiring coronary artery bypass grafting to remediate blocked arteries; that possible material risks resulting from this procedure included infection, loss of function of any limb or organ, brain damage or death; that if he did not have this procedure plaintiff Lonnie G. Gillis could suffer from continued angina, possible heart failure or death; and that the likelihood of success was only “Fair[.3” On the signature page, plaintiff Lonnie G. Gillis consented to the performance of the procedures described “by Dr. Shaker [inserted by hand] and any other physicians or other medical personnel who may be involved in the course of [plaintiff Lonnie G. Gillis’] treatment.” (Emphasis supplied.)
Plaintiffs’ cross-motion relied on the undisputed fact that defendant Livingston harvested the saphenous vein from plaintiff Lonnie G. Gillis’ left leg for use in this particular bypass graft, making the initial incision with a “number ten blade.” This was done in the presence of and under the supervision of Dr. Shaker, while Dr. Shaker performed the incision of the chest. Plaintiffs further relied on the undisputed fact that plaintiff Lonnie G. Gillis never expressly consented to defendant Livingston, as a physician’s assistant, wielding a scalpel. Plaintiff Lonnie G. Gillis further deposed he “would not have consented to surgery by a physicians assistant had [he] known that one would be operating on [his] leg.”
Plaintiffs also moved for partial summary judgment as to a claim of negligence per se, based on the alleged breach of OCGA § 43-34-106, directing that “[a]ny physician, clinic, or hospital using a physician’s assistant shall post a notice to that effect in a prominent place.” In support of this motion, plaintiff Lonnie G. Gillis deposed in an affidavit that there were “no notices posted in the Medical Center of Central Georgia that [he] saw notifying [him] of the use of physicians assistants.” But in contrast, Mary Cassidy Freeman, a Registered Nurse and Vice President of the Surgery Center at defendant MCCG, testified that there is a notice, a “fairly small sign that just says that we use physician’s assistants ... in this facility . . .” posted at the entrance to the emergency center, although she did not know how long such notice had been there. Defendant Livingston testified he always wears his license or name tag that specifies his title as a physician’s assistant on his laboratory coat (but not in the operating room) and introduces himself as a physician’s assistant.
Defendant MCCG moved for summary judgment as to all claims against it, supporting its motion with the affidavit of Andrew Watry, Executive Director of the Composite State Board of Medical Examiners for the State of Georgia (“the Board”), who deposed that pursuant *360to the Basic Job Description and the Rules and Regulations of the Composite State Board, defendant Livingston “would be authorized by the State Composite Board to harvest the saphenous vein in a patient undergoing coronary bypass surgery as long as Dr. Shaker was present in the operating room while [the physician’s assistant] was harvesting the vein,” assuming that harvesting the saphenous vein falls within the normal scope of practice of Dr. Shaker. As Executive Director of the Board, Andrew Watry is familiar with the fact that physician’s assistants commonly assist surgeons in performing surgery, including actually performing a surgical procedure under the supervision of the attending physician, and this practice is authorized and accepted by the Composite State Board.
The trial court granted partial summary judgment in favor of defendants CSA, Dr. Shaker, and Livingston while denying plaintiffs’ motions for partial summary judgment. In Case No. A99A0302, plaintiffs appeal from that grant of partial summary judgment. The trial court also granted a complete summary judgment in favor of defendant MCCG, and in Case No. A99A0619, plaintiffs appeal from that order.
1. The term “Physician’s assistant” means a skilled person qualified by academic and practical training to provide patients services “not necessarily within the physical presence but under the personal direction or supervision of the applying physician.” OCGA § 43-34-102 (5). Plaintiffs first enumerate the grant of partial summary judgments as to the claim of battery because neither plaintiff would have consented to surgery performed by a physician’s assistant. In my view, this enumeration depends in part upon the lawfulness of Dr. Shaker’s delegation and in part upon the scope of the consent form signed by plaintiff Lonnie G. Gillis.
(a)
The relation of physician and patient is a consensual one, and a physician who undertakes to treat another without express or implied consent of the patient is guilty of at least a technical battery. [Cit.] Generally, it is settled law that an unauthorized surgical operation by a physician upon the body of [the] patient is a wrongful and unlawful act for which the surgeon will be held liable in damages. [Cits.]
(Emphasis supplied.) Mims v. Boland, 110 Ga. App. 477, 481 (1) (a) (138 SE2d 902). Conversely, “no tort can be committed against a person consenting thereto if that consent is free, is not obtained by fraud, and is the action of a sound mind.” OCGA § 51-11-2.
The public policy of Georgia is to encourage the more effective utilization of the skills of physicians by enabling them to delegate *361health care tasks to qualified assistants where such delegation is consistent with the patient’s health and welfare. OCGA § 43-34-101 (b). Under OCGA § 43-34-105, a physician’s assistant may perform the tasks detailed in the job description as approved by the State Board, but nothing in this Code section shall make unlawful the performance of a medical task by the physician’s assistant not specified in the general job description when it is performed under the direct supervision and in the presence of the responsible physician. Thus, under the plain reading of the Physician’s Assistant Act as applied to the facts of this case, a certified and otherwise qualified physician’s assistant is authorized to harvest the saphenous vein, when such medical task is performed under the direct supervision and in the presence of the responsible physician.
(b) After the enactment of the Georgia Medical Consent Law, OCGA § 31-9-1 et seq., the “informed consent doctrine” was not a viable principle of law in Georgia because the General Assembly required disclosure of only the general terms of treatment. McMullen v. Vaughan, 138 Ga. App. 718, 721 (3) (227 SE2d 440). Accord Butler v. Brown, 162 Ga. App. 376, 377 (290 SE2d 293). In the case sub judice, the consent form signed by plaintiff Lonnie G. Gillis tracks the notice requirements of OCGA § 31-9-6.1 (a) (1) through (6), and so is presumed valid by operation of OCGA § 31-9-6.1 (b) (2). In my view, this general consent to undergo the described coronary artery bypass grafting as performed by Dr. Shaker “and any other physicians or other medical personnel who may be involved in the course of [his] treatment. . .” is unambiguous and gave implied permission, to the extent allowed under Georgia law, for the use of a physician’s assistant listed in the letterhead of the consent form to harvest the saphenous vein, as conducted in this instance during the coronary artery bypass graft in the presence of and at the direction of the responsible physician. Consequently, I conclude the trial court correctly granted summary judgment to defendants CSA, Dr. Shaker, Livingston, and MCCG as to any claim for battery based on an allegedly nonconsensual use of the physician’s assistant, defendant Livingston. Compare Harris v. Tatum, 216 Ga. App. 607, 609 (1) (b) (455 SE2d 124) (ambiguity in consent form construed against defendant physicians).
2. Next, plaintiffs contend the trial court erred in granting defendants’ motions for summary judgment regarding the claim of negligence per se, based upon the alleged failure to post the notice required by OCGA § 43-34-106 that physician’s assistants were employed during surgeries performed at defendant MCCG.
The evidence of Nurse Freeman that a notice was in fact posted in the emergency room of MCCG is an affirmative statement of fact, whereas the affidavit of plaintiff Lonnie G. Gillis is only the passive *362statement that he did not see any notice.
Decided July 14, 1999
Reconsideration denied July 29, 1999
Sutton & Associates, Berrien L. Sutton, Ronald W. Hallman, Keith H. Solomon, for appellants.
Martin, Snow, Grant & Napier, John C. Edwards, Blair K Cleveland, Sell & Melton, Mitchel R House, Jr., Jeffrey B. Hanson, for appellees.
Circumstantial evidence which does not demand a finding for a plaintiff constitutes a mere inconclusive inference and is thus insufficient to defeat a defendant’s motion for summary judgment on that question. Allen Kane’s Major Dodge v. Barnes, 243 Ga. 776, 781 (257 SE2d 186). Upon the evidentiary posture of the case sub judice, it is my view that the trial court correctly granted defendants’ motions for summary judgment as to this claim of negligence per se, because plaintiffs’ circumstantial evidence of the absence of notice is not inconsistent with defendants’ direct evidence establishing the same. Therefore, in Case No. A99A0619,1 concur only in this Court’s judgment of affirmance.
I am authorized to state that Presiding Judge Andrews joins in this opinion.