April J. Hitzelbergeri Attorney with Waranch and Branch

April Hitzelberger

Make Plaintiffs Prove the Element of Causation in their Informed Consent Claims

Recently, in our first Covid-19 trial, we successfully defended a surgeon against the claim that he failed to obtain the plaintiff’s informed consent for an endoscopic carpal tunnel surgery.

The doctrine of informed consent requires physicians to explain a procedure to patients, discuss alternatives, if any, and to warn of any material risks.

In trial, an issue arose as to whether a separate causation question — as an element of the informed consent claim — should be included on the verdict sheet. Plaintiff argued that a causation question was unnecessary, pointing to the Maryland pattern jury instruction for informed consent, which omits any specific instruction on causation. Plaintiff proposed the verdict sheet read as follows:

Do you find that the physician failed to obtain the patient’s informed consent for the surgery?

On behalf of the defense, we proposed the following addition regarding causation:

Do you find that a reasonable person in the patient’s position would have withheld consent to the surgery had material information been disclosed?

Maryland’s seminal informed consent case, Sard v. Hardy, 281 Md. 432 (1977), makes clear that a claim for informed consent requires proof of causation. The test is an objective one — whether a reasonable person in the patient’s position would have withheld consent to surgery had all the material risks been disclosed.

In the end, the Judge refused our request. While we felt that an appeal point had been preserved, we did not have to go that route since the jury concluded that the patient gave her informed consent for the proposed care and found in favor of the doctor.

Bottom Line: Just like a negligence claim, causation is a required element for informed consent claims. Don’t overlook it — it’s worth fighting for!

If you have a case involving issues of informed consent, please contact us. We’re here to help.

April J. Hitzelbergeri Attorney with Waranch and Branch

April Hitzelberger

April Hitzelberger is a Partner at Waranch & Brown, where her practice is dedicated to appellate advocacy. In her role as Chair of Waranch & Brown’s Appellate Division, Ms. Hitzelberger counsels clients on a wide range of appellate issues, beginning with a proper strategy for preserving the trial record for appeal. She honed her written advocacy skills in drafting appellate briefs for all levels of Maryland’s appellate courts, as well as for the 4th Circuit. Ms. Hitzelberger has argued before the Appellate Court of Maryland (formerly Maryland Court of Special Appeals) and previously served on the Appellate Committee for the Maryland Defense Counsel.