Court Opinion

ID: 9710834
Source: CourtListenerOpinion
Date Created: 2023-08-26 04:18:45.145835+00
Date Added: 2024-06-11T18:23:00.170466
License: Public Domain

McEWEN, Judge,
dissenting:
While I am hesitant to differ with the careful and compelling expression of view provided by the author of the *142majority opinion, I must, very respectfully, dissent from the decision of the majority to vacate the verdict of the jury and to enter judgment n.o.v. in favor of appellant, Vicki Via.
The majority correctly recites the standard of review applicable to a request for judgment n.o.v. on direct appeal, but proceeds to the drastic remedy of substituting its judgment for that of the jury after finding
“the Doctor performed the tuboplasty upon the appellant without disclosing the risks of the surgery, and we find that the risks would have been material to a reasonable person in the appellant’s situation. The consent agreement did not discuss tuboplastic surgery or its risks, and the testimony during the trial reveals that [appellee, Dr. Raeuchele] did not advise the appellant of the risks before the operation began. She was not informed that she could refuse the surgery all together, and she was not told that she would have to try to become pregnant immediately after the procedure or that the procedure could leave her barren.”
The majority so finds even though testimony, both expert and lay, on each of these issues was submitted to the jury which, based upon its resolution of the conflicting testimony, found that appellant had been informed of all of the material risks and had given her consent to the procedures performed upon her by the appellee, Dr. Randall R. Raeuchele.
It is settled beyond peradventure that this Court may not reevaluate the evidence and substitute its judgment for that of the jury. Rather, our role is to review the record solely for the purpose of ascertaining whether the evidence, when viewed in the light most favorable to the verdict winner, together with all reasonable inferences therefrom, is sufficient to support the verdict of the jury.
The record, when reviewed in this light, provides abundant basis for the verdict returned by the jury, as evidenced by the following excerpts from the testimony of appellee:
[Doctor Raeuchele]:
*143That’s all right. Then I told her that in her case, we would look down and hopefully see the uterus and the tubes and the ovaries. And I then hastened to tell her that I had no idea what her trouble was at that time and that if we might run into adhesion, complete recovery— completely covering the uterus and the tubes.
And I told her if that happened, I would either have to back out and stop or else I could make a second incision down below in the suprapubic area. And we put an instrument in there. We called it a wand, and we can use it to manipulate the organs. Sometimes the uterus is lying back this way and you can’t see the back of it so you put the wand in. Generally move it forward and you can look in back of the uterus and see the tubes and ovaries. And the tubes and ovaries are generally in back of the uterus so that I have to lift the uterus forward or manipulate it so that you can look back here.
Now, if there are a lot of adhesions down over the uterus, you are not going to see under here to see the tubes and the ovaries. So you have to tell the patient that if the examination would be founded, you are going to have to do one of two things. Either go in there and lift the uterus up and dissect those adhesions away so that you can look down to see the tubes and the ovaries or you are going to have to put instruments in to cut them so that you can subsequently finally pin the uterus forward and see the organs that you are concerned with____
I told her that we had to relieve adhesions perhaps if they were there, and she should expect that there would be a second incision, and that there would be possibly some laparoscopic surgery had to be performed before we could get into her tubes.
And I told her if we didn’t have to perform the dissection, the adhesions and so forth, why, perhaps we could lift the uterus up and see the tubes. But if they were distended, if they were closed, if they were adherent to the undersurface of the uterus or the broad ligaments, *144we would have to dissect them away to determine the full trouble that was causing her infertility.
And I said, now, do you want us to go through with this? If you don’t, you have to tell me and we can just dispense with the whole thing. And she said, well, I’m here. I want to know what’s going on and we’ll go through with it.
Well, I said, Vicki, generally we don’t run into things like this. Generally we can look in there and with a pretty good — pretty short period of time, we can tell what’s going on. But I want you to know that if there’s something wrong, it could be easily adjusted. Do you want me to take care of it? She said, well, yes. It’s took me a long time to get here and while you are here, I want you to do everything that you can.
I said, well, I don’t know how much — what extent — how extensive you want to be. Generally we can do it without too much trouble. But I want you to know that there can be trouble. There is a risk associated with this, and we can get in trouble here.
Now, I said, suppose if you had something wrong with your ovary like cancer, would you want me to take a piece of that ovary off and send it to the laboratory? Because if you had cancer, you should know it and maybe it would be early enough to have something done about it.
I never had any person, when I explained it this way to them, that said, no, no, don’t do anything if I have cancer. Let it alone. If I have something else that you can take care of, I want you to do it because now is the time, I’m going to be asleep. It won’t bother me, and I want you to take care of it.
So I said to Vicki, if I should be taking a piece of tissue from the ovary and would start to bleed, I would have to stop that bleeding. Or if I was doing something — if I released some adhesions around the tube — she wanted to get pregnant. So suppose the fimbriae that she was seeing here are stuck up against the broad ligaments. The broad ligament is the link that holds the tissue of the *145ligaments up. I told her — and I explained this in the office.
[Defense Counsel]:
Q. Excuse me, Doctor. I’m just going to put this exhibit up.
[Doctor Raeuchele]:
The broad ligament, the two egg-shaped things there are the ovaries and that band of tissue that runs out on either side. That’s the broad ligament. Can you see that? There’s the pyramid. Now, it’s very, very common for these fimbria to fall in here, and they are generally not stretched out like that and lay against this broad ligament. This is one broad ligament. Here’s the other broad ligament. I try to stay away from that. And this could be stuck here.
Now, we can take the instrument and just peel that away like that very often, and then that allows these to be loose and open and functional again.
Now, I explained this to Vicki and said, do you want me to do this if we find it? I have no idea what we’re going to find, but if we do, do you want me to do it? And she said, well, of course. Anybody would say, well, I’m there, that’s what I’m here for. But I told her that if we peel this away and there is some bleeding here, we would have to stop it. All we do is take an instrument and insert it in here and just set it and that will seal the vessels off and stop the bleeding.
While we are doing this, suppose a spark would drop off and hit the bowel that’s lying down here, put an opening in the bowel. Then we would have to — then we would tell her that we would have to repair that. So that is a reason for opening her abdomen. We couldn’t send her back to bed and say, hey, you are bleeding in there. Is it all right to get permission to go back in and open your abdomen. And I went through this with Vicki in the office. And that would be one reason we would have to open your abdomen without your knowing it, because we’d have to stop the bleeding.
*146Second would be if there was a bowel burn and there was an opening in the bowel, we would have to go in and close that opening up.
The third reason is to open the abdomen without her knowing would be when we are putting the instruments in or if we tore — or we touched the ovary here and that got to bleeding or the bowel was lying up here and we put the instrument in and then we started the bowel and start some bleeding in the vessel here or anything else when we were inserting the instrument, we would have to open her abdomen without her knowing it.
And this was all discussed with Vicki before the — before the permission slip was signed. And naturally, she said, well, if this — if that’s the way it is and if you can find something like that you can repair, I want you to go ahead and do it. I said, all right. As long as you understand that you may have to have an incision.
Q. Doctor, what is a Rubin and retrograde x-ray?
A. Well, during her history — I forgot to mention that. I should have followed my notes here.
I told her that there were other ways of finding out whether her tubes were open. One would be to inject air into the cervix, the mouth of the womb down there, and the air would go out through the tubes and be expelled into her abdomen. And she would know and we would know that the tubes are open if the air got out into the abdomen. And that’s sort of a painful test because when the air goes out into the abdomen, it causes discomfort and she gets pain up here in her shoulders and so forth. That’s probably the least desirable test, and it’s painful.
The other is to inject x-ray material in the cervix down there in here, and the dye goes out through the tubes and comes off — and you can see the dye out here. And the effect — that’s called the hysterosalpingogram.
We told her that she has two tests could be performed, but they are not as accurate as the laparoscopic procedure because with the laparoscope, when you are looking in there and you inject dye just like you do the x-ray *147material, the dye comes out through the tubes and rolls off the fimbrial end. You can see the blue dye here and over here. And if that happens, you knew the tubes are open. It’s a hundred percent puncture proof, plus the fact that when you are doing this procedure, and we call it a tubal patency test, when you are doing this, you have the advantage of being there with other instruments to correct any situation that might be present that was causing the tubes to be blocked off.
I told her if the tubes are blocked — and I want to reiterate this again — do you want me to try to open them if it’s logical? She said, yes, naturally. That’s why she’s here, to see if she can get pregnant and to do any minor surgery or even major surgery, if you please, with the laparoscope. And I have been trained in that, and she accepted that description and signed the paper.
Q. And when you say she signed the paper, you are referring to Defendant’s Exhibit No. 1, is that correct? And I’ll show that to you if I can find it.
I place in front of you Defendant’s Exhibit No. 1. A. Yes, that is the operative permit that she signed.
[N.T. 267-276]
The lengthy consent form executed by the appellant at the conclusion of the discussion with appellee contained, on the reverse side, the following paragraph, typed while appellant waited, and read by her prior to signing the consent form:
Examination of the abdomen with a telescopic instrument with the treatment of any condition with the ovaries, tubes or other tissue that might be deemed necessary, including fulgeration (burning of tissue) at this time. I understand that in an emergency, such as bleeding or a bowel burn or puncture my abdomen may have to be opened, [emphasis supplied].
Injection of a dye through the tubes to determine if the tubes are open.
*148Appellee also presented the expert testimony of a gynecologist, Dr. Clifford R. Wheeless, who testified that drainage of the right hydrosalpinx was consistent with the
“standard of care known throughout the United States and the world for managing a clubbed fallopian tube---The second thing they do [procedures for draining hydrosalpinx] though, they provide drainage of the hydrosalpinx and reduce the chance of recurrent pelvic inflammatory disease and reduce the chance of the dreaded and deadly tubal ovarian abscess, which still is a very high killer of women with tubal infections. Every year someone at the Johns-Hopkins dies of a tubal ovarian abscess. So the drainage of those are a very important part of the health care of women.”
[N.T. 368].
Dr. Wheeless further testified that the cuffed tuboplasty procedure performed by the appellee was medically indicated due to the danger of future infection:
Q. Doctor, following that repair of the ovarian artery then Dr. Raeuchele went on to perform additional surgery on the right tube.
Do you have an opinion that you hold to a reasonable degree of medical certainty as to whether or not his conduct at that point in time was consistent with the standard of medical care?
A. Yes. I have an opinion.
Q. What is that opinion?
A. The opinion was the best attempt at fixing a diseased tube — this woman by this time had — her chances of pregnancy were small, quite crystal clear. By having the abdomen open, better exposure to the tube, he could make the hole in the tube, he could make the hole in the tube, the opening, the salpingostomy larger.
He could also have the opportunity to take back with fine sutures in a cuffed technique the opening like a morning glory flower to keep that tube open to give her the best chance she had of obtaining a pregnancy. But the more important thing than obtaining the pregnancy *149was to prevent further infection that I’ve already mentioned can be life-threatening in these women.
[N.T. 370-371].
Dr. Wheeless, in addition, further testified that microsurgery had the exact same success rate as the type of procedure performed by appellee upon appellant.
This Court, in Sauro v. Shea, 257 Pa.Super. 87, 94-95, 390 A.2d 259, 263 (1978), noted that
“Pennsylvania case law explicitly holds that the issue of informed consent is a question for the finder of fact.... Accordingly, the jury as fact-finder must evaluate the severity of the condition resulting from surgery, whether the result was a meaningful or only slight possibility of the surgical procedure, and whether a reasonable person would have considered the possibility of the resulting condition material to the decision to undergo treatment. Moreover, the jury must consider whether the physician adequately informed the patient of the nature and possible consequences of the procedure, as well as its alternative, and whether, under all the circumstances, the description was adequate to inform a reasonable person and render the consent valid.”
Accord: Jozsa v. Hottenstein, 364 Pa.Super. 469, 473, 528 A.2d 606, 607-608 (1987).
The learned trial court, noting that appellee had not informed appellant, prior to the procedure, of the alternative of “microsurgery, of the comparative risks to fertility, or that she should attempt to have a child immediately after the surgery”, nevertheless rejected the motion for judgment n.o.v., reasoning as follows:
Dr. Raeuchele explained that diseased fallopian tubes have a propensity to close over time and therefore, even though Vicki’s right tube was devoid of viable fimbria, there is still a slight chance that an egg would pass through the tube and ultimately become fertilized. He thus encouraged her to attempt a pregnancy immediately after the surgery, before the tube could close. Defendant, in effect, created a window of time in which Vicki *150had an increased chance of becoming pregnant; but for which she was admittedly unprepared, as she was not even married.
Notwithstanding this failure to inform, materiality is an objective question for the jury, based on all of the surrounding facts and circumstances. Plaintiffs argument that she should have been informed of microsurgery overlooks Defendant’s testimony that there were no viable fimbria on her right tube. Though this was not discovered until after the operation began, both the Defendant and Dr. Wheeless testified that microsurgery would not have been more successful. Even Plaintiff’s expert testified that without the fimbria, there is almost no chance of pregnancy. Plaintiff complains that this analysis frames the issue in negligence terms, but it must be remembered that the same evidence which negates negligence also bears directly on whether microsurgery was a material alternative. The testimony of Dr. Raeuchele and his expert discounted microsurgery and the jury agreed.
Plaintiff’s importance of timing argument must fail for essentially the same reason.[1] We are bound to accept the Defendant’s testimony that the right tube was devoid of fimbria. For that reason, microsurgery was not a viable alternative, regardless of when it would be performed. Secondly, should the tube close, there is nothing to prevent further surgery to open it. Finally, Dr. Raeuchele did testify that he told Vicki surgery may be required and that she consented. Although there was no emergency, he stated that a cuffed tuboplasty was necessary to prevent a recurrence of hydrosalpinx, which according to Dr. Wheeless can be fatal.
We áre mindful that the law of informed consent “does not mandate that a risk is material only if its disclosure *151would result in the patient’s decision to refuse medical treatment.” Sagala, supra at 580, 533 A.2d at 168. Competent adults do have the right to be well informed prior to surgery and that it is their choice, whether it be rationale or irrational. Id. Full disclosure preserves the highest level of bodily autonomy. But the Court cannot overlook the defense testimony that microsurgery was not a viable alternative. The jury was charged that “A physician is bound to disclose only those risks which a reasonable person would consider material to her decision whether or not to undergo the treatment.” By its verdict, the jury obviously decided it was immaterial. We are not in a position to substitute our judgment for that of the jury.
Since, in my view, there was sufficient competent evidence to support the verdict of the jury, I would affirm the judgment entered upon that verdict.

. It should be noted that appellant testified that she had engaged in sexual relations with her fiancee for a number of years without any form of birth control and in fact, due to the information provided by her, appellee suspected that she was pregnant on the day before her surgery was scheduled. As a result, appellee ordered certain tests to rule out pregnancy prior to performing the laparoscopy.