Court Opinion

ID: 9551884
Source: CourtListenerOpinion
Date Created: 2023-08-07 19:01:35.330457+00
Date Added: 2024-06-11T15:24:55.363702
License: Public Domain

Hicks, J.
(concurring in part, dissenting in part) — As has been said, the "retrospectroscope” of hindsight is an infallible method of diagnosis, but unfortunately it is not available at the time the patient is first seen. By the use of this infallible method, the majority diagnoses heart disease as existing in Timothy Keogan when he was seen by Dr. Kenneth Snyder in mid-February 1972.
By thereafter focusing on the diseased heart to the exclusion of everything else, the majority seizes upon a suspicion by Dr. Snyder of a possibility that Keogan may have had angina pectoris to decree that the informed consent doctrine as applied in Gates v. Jensen, 92 Wn.2d 246, 595 P.2d 919 (1979), controls here. In Gates, the court held that a physician has a duty of disclosure whenever he becomes aware of a bodily abnormality which may indicate risk or danger, whether or not the diagnosis has been completed.
*330The Court of Appeals held that no duty to inform had yet arisen in this case because when "there is no diagnosis nor diagnostic procedure involving risk to the patient, there is nothing the doctor can put to the patient in the way of an intelligent and informed choice." Keogan v. Holy Family Hosp., 22 Wn. App. 366, 370, 589 P.2d 310 (1979). Under the circumstances of this case, I agree with the Court of Appeals.
In the course of two office calls within a 2-week period, Dr. Snyder had become aware of no bodily abnormality in his patient. A suspicion of a possibility of an abnormality (angina pectoris) hardly seems sufficient to trigger, as a matter of law, a duty to inform a patient of tests that could be given to diagnose the severity of such an evanescent bodily abnormality. By this opinion, this court establishes, as a matter of law, a medical standard in this state that a patient complaining to his doctor of chest pain must be given a short course in medicine — in heart disease and everything else that could cause chest pain.
Angina pectoris did cross Dr. Snyder's mind as a possible cause of Keogan's chest pain. After taking a history and examining Keogan, however, the doctor settled upon costo-chondritis as a probable cause of the chest pain.
E. Goldberger in his text Heart Disease (Lea & Febiger 1951), in the chapter on "The Anginal Syndrome," has this to say at page 248:
C. Noncardiac disease may simulate the symptoms of angina pectoris. Some of the more common noncardiac conditions that may cause substernal or precordial pain are the following: [Eleven conditions are discussed.]
1. Lesions of the Cervical or Thoracic Vertebrae. . . .
2. Subdeltoid Bursitis, Periarthritis, or Fibrositis of the Left Shoulder. . . .
3. The Scalenus Anticus Syndrome. . . .
4. Slipping Rib Cartilage Syndrome. . . .
5. Herpes Zoster of the Intercostal Nerves. . . .
6. Hiatus Hernia of the Stomach. . . .
*3317. Esophageal Diverticula. . . .
8. Cardiospasm. . . .
9. Ulcers of the Esophagus, Stomach or Duodenum . . . [chronic gall bladder pain listed also].
10. Mediastinal Emphysema. . . .
11. Diaphragmatic Flutter. . . .
The above lists only the common noncardiac conditions that may cause chest pains. Costochondritis, an inflammation of the cartilage connecting the ribs to the sternum, a condition Dr. Snyder diagnosed as a probable cause of Keogan's chest pain apparently is another noncardiac condition causing such pain. At trial in this case, one doctor testified that 200 different things might cause chest pain, only 3 of which related to the heart.
If Dr. Snyder was negligent because he should have discovered Keogan's diseased heart and failed to do so, that is what should be alleged and proved in this case. It was alleged. The jury did not find that it was proved. This court with its benefit of hindsight should not now enter the fray on the plaintiffs' side with rulings as a matter of law as to what the doctor should have told the patient.
It is common knowledge that the cost of medical attention is escalating, seemingly at an ever increasing rate. As this court dictates what doctors must do to protect themselves in malpractice actions, it adds to that escalation. Aside from higher costs, however, the utilization of comparatively scarce medical resources to conduct tests whose primary if not sole purpose is to provide a defense to a court action is simply a social waste. Yet, that is exactly what the majority opinion may foster.
As to the emergency room doctor and his employer, Holy Family Hospital, I would prefer to leave the matter of their negligence to the jury. Since, however, the majority has determined that the evidence supports finding negligence as a matter of law for failure to administer an electrocardiogram to Keogan upon his presentation at the *332hospital emergency room, I concur in that part of the majority opinion.
Rosellini, Stafford, Brachtenbach, and Dolliver, JJ., concur with Hicks, J.
Reconsideration granted April 9, 1981.
Cause dismissed by stipulation of parties June 23, 1981.