Court: The appeal case “Cobb v. Grant” for medical malpractice and negligent claims against the surgeon was decided in the Supreme Court of California.
Procedural History
The defendant (appellant), Dr. Grant, performed a surgical operation on the plaintiff (respondent), Mr. Cobbs, to treat a small duodenal ulcer. The operation caused further complications, and Mr. Cobbs had to be repeatedly hospitalized and had to undergo further surgeries. The plaintiff filed a malpractice suit against the defendant surgeon, Dr. Grant, and the jury returned its verdict against Dr. Grant amounting to $23,800. Dr. Grant appealed challenging the Court’s ruling, asserting that there was insufficient evidence to support medical malpractice and negligence claims verdict. The appellant argued that the trial court committed prejudicial error in its instruction to the jury on the issue of informed consent.
Legal issues
- Whether there was sufficient evidence to support the verdict on medical malpractice and negligence claims when performing the surgical operation?
- Whether the jury’s instruction adequately outlined the duty of a medical doctor to obtain informed consent from the patient before undertaking operation and treatment under the plaintiff’s alternative theory?
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Facts
In August 1964, plaintiff Cobbs was admitted to the hospital for a duodenal ulcer’s treatment and received several tests to assess the severity of his disease. Although some medications were administered to ease pain and discomfort, Cobbs continued complaining pain in the lower abdomen and nausea conditions. Dr. Jerome Sands, Cobbs’ family physician, concluded that surgery was indicated, where he advised the plaintiff about the risks of undergoing general anesthetic and discussed with him the prospective surgery. Dr. Sand requested the defendant surgeon, Dr. Dudley F. P. Grant, to perform further assessments on the plaintiff, and Dr. Grant agreed with Dr. Sandy that surgery was indicated, mainly because the plaintiff had an intractable peptic duodenal ulcer. Dr. Grant discussed the nature of surgery with the plaintiff but failed to indicate any risks of undergoing surgery.
After surgical operation, ulcers disappeared, and the plaintiff was discharged from the hospital. However, he started experiencing intense lower abdominal pain and contacted Dr. Sand, who advised him to go back to the hospital. The plaintiff went into shock after readmission, and an emergency operation was conducted, which discovered severe internal bleeding due to injury at his spleen’s hilum. Given the seriousness of the hemorrhaging conditions and the fact that the adult’s spleen can be removed without adverse effects, the defendant Dr. Grant removed the plaintiff’s spleen. Spleen injuries that compelled subsequent surgery are risk inherent.
After this operation, Cobbs recuperated in the hospital for two weeks, and after he was discharged, he was readmitted a month later when he experienced sharp pains in the stomach. X-rays revealed that he had a gastric ulcer, another risk inherent in an operation conducted to treat the duodenal ulcer. When Dr. Sands’ attempt to treat the condition with a strict diet and antacids failed, the plaintiff was readmitted again. The plaintiff started vomiting blood, and the defendant and Dr. Sands concluded that a third surgery was indicated. They performed a gastrectomy, removing 50% of his stomach, intending to reduce its capacity to produce acid. However, even after the operation, the plaintiff was subsequently hospitalized due to internal bleeding, which began to decrease after treatment.
Decision/Holding and Rationale
No. The trial Court’s ruling against the appellant doctor and in favor of the respondent was reversed and remanded by the Supreme Court, mainly on the ground that it was not possible to determine the basis for the verdict that the appellant surgeon was negligent during the operation. The Court found that there was insufficient evidence to support the trial Court’s ruling, specifically on the issue of the appellant’s liability for negligence, on his decision to conduct the operation or when performing the surgical operation. It was not clear whether the trial Court found liability on the doctor’s decision to perform surgery or under the alternative theory by failing to obtain informed consent for surgery from the respondent. As a crucial part of a medical doctor’s duty to the patient, the Court found that it constituted a negligence action, and there was a duty of reasonable disclosure of available alternatives based on the proposed therapy as well as risks inherently and could be involved in each option.
Dr. Grant and two other surgeons testified that the appellant followed the standard of care laid down by the medical community when performing the operations on the plaintiff. The complications were inherent risks in the surgery performed. The respondent contended that the standard of care had to be looked at from a layperson’s perspective. However, the Court disagreed and held that medical professionals entailed a highly specialized field, and it was the experts, i.e., surgeons that were qualified to conclude the standard of care. The Court agreed with the experts that Dr. Grant had followed the proper standard of care. The Court argued that patients are individuals unlearned in the medical fields, and thus, Courts could safely assume the knowledge of physicians and patients are not in parity.
Concerning the second issue, Mr. Cobbs had argued under the theory of consent vitiation–that he did not receive enough information to make an informed decision and that if he had received enough information, he could have decided not to undertake the surgery. Therefore the surgery conducted was a battery. The Court disagreed with Mr. Cobbs. Following the ruling from other courts, the Court looked at this issue from a “negligence” perspective as opposed to the consent vitiation–battery theory that Mr. Cobbs had argued. The Court held that there has to be a reasonable amount of disclosure to the patient about a procedure and its inherent risks that a reasonable patient chooses to proceed or not to go ahead with the procedure and that the absence such reasonable amount of disclosure would amount to negligence on the surgeon’s part.
The decision was unanimous, and there were no dissents.
Analysis
The case is essential for healthcare administrators because it lays down a standard for informed consent. Any healthcare administrator has to be aware of various standards and must ensure that all healthcare practitioners abide by such professional standards. From an ethical standpoint, I believe this decision clearly established the significance of obtaining consent from patients before treatment. I think that it would be unethical and against the professional standards for a doctor to proceed with operations without the patient’s consent to treatment, which should be informed consent to be effective.