Pennsylvania Appellate Court Holds Consent Forms Admissible In Medical Malpractice Case To Show Knowing Refusal For Treatment

162017_132140396847214_292624_nThe Superior Court of Pennsylvania (“Appellate Court”) affirmed in its July 18, 2017 decision that the trial court did not commit error in admitting into evidence during the Pennsylvania medical malpractice wrongful death trial the consent for treatment forms signed by a Jehovah’s Witness patient who gave birth at the defendant hospital that stated, in part: “I …  request that no blood (whole blood, red cells, white cells, platelets and plasma) be administered to me during this hospitalization.”

On November 19, 2010, the Jehovah’s Witness signed the above referenced consent for treatment form after consulting with the defendant hospital’s administrative staff. When she went into labor five days later, she was admitted to the defendant hospital, where she quickly began to experience difficulties with her labor. The attending obstetrician/gynecologist insisted that the woman speak with the hospital’s staff to again review her treatment choices.

Less than two hours after being admitted to the hospital, the woman signed a form entitled “Consent for Refusal for Transfusion of Blood and/or Human Source Products” in which she again expressly indicated that she refused to accept blood transfusions as part of her treatment at the defendant hospital, stating that: “I understand from Dr. Musselman that it may be advisable for me to receive a transfusion of blood, blood components or other human source products. I understand the circumstances that might make a transfusion necessary and the benefits of such a transfusion to my health. I have been given the attached information sheet, which describes the risks, benefits, and alternatives to the transfusion of blood and/or human source products … I refuse all blood components and human source products.”

After over 12 hours of labor, the woman developed a fever and her unborn child’s heart rate spiked. The baby was successfully delivered by cesarean section. Following the delivery, the woman was transferred to the Post-Anesthesia Care Unit (“PACU”) where her blood pressure subsequently dropped but she was not exhibiting any other signs of internal bleeding such as shortness of breath, palpitations, pain, or a distended stomach. However, PACU staffers subsequently began to suspect that the woman was suffering from internal bleeding. The decision was made to bring the woman back to the operating room for an exploratory laparotomy, in order to determine the exact cause of her distress.

A PACU physician tried, unsuccessfully, to convince the woman that she should consent to a blood transfusion, but the woman was adamant about not receiving blood and was instead given one liter of albumin before her transfer to surgery. After that surgery, another surgery (a supracervical hysterectomy) was required. The surgeon determined that the woman’s survival hinged on the ability to give her blood transfusions but the woman’s family members refused to authorize blood transfusions because of her faith.

The surgeon repeatedly asked the woman’s parents over the following two days to override their daughter’s advance directive but, each time the topic was broached, they rebuffed the surgeon’s requests. Further efforts were made to try to convince the parents to authorize blood transfusions but they rejected all such efforts. The woman’s condition continued to deteriorate and, on the morning of November 28, 2010, she died, in spite of her doctors’ uniform belief that a blood transfusion would have almost certainly saved her life.

The woman’s father, on behalf of his daughter’s estate and on his own behalf, filed a Pennsylvania medical malpractice wrongful death lawsuit on September 6, 2012. The Pennsylvania medical malpractice jury determined that the conduct of the two defendant treating physicians did not fall below the applicable standard of care. The plaintiff appealed.

The plaintiff argued on appeal that the trial court erred in denying his motion in limine in which he sought to preclude the admission of the consent-for-treatment evidence. The Appellate Court agreed with the trial court’s ruling that, generally, with regard to medical consent and release forms, in situations where a plaintiff only asserts negligence, and not lack of informed consent, evidence that a patient agreed to go forward with the operation in spite of the risks of which she was informed is irrelevant and should be excluded; nonetheless, evidence about the risks of surgical procedures, in the form of either testimony or a list of such risks as they appear on an informed-consent sheet, may also be relevant in establishing the standard of care.

The trial court reasoned, and the Appellate Court agreed, that the unique circumstances of this case rendered the woman’s consent and release forms absolutely relevant and essential to the truth seeking function of a jury trial, and that it would have been manifestly unjust and improper to not allow them into evidence. Rather than allowing for misconceptions to arise about the woman consenting to substandard medical care at the defendant hospital, the consents and releases made clear that the woman, of her own free will, consistently refused to accept safe, effective, routine, and life-saving medical treatment when she barred her doctors from administering blood transfusions, and even refused to collect and store her own blood in the event an emergency arose. There was not a shred of doubt that the woman fully understood the life-threatening ramifications of her decision to be a bloodless patient, and that she specifically agreed to hold the doctors harmless for any negative outcomes of her decision.

The Appellate Court held that the consent for treatment forms were not admitted merely to show that the woman understood the risks of treatment yet elected to proceed; rather, the consents were admitted to prove that she knowingly refused treatments that would have saved her life. Accordingly, the Appellate Court held that the plaintiff was not entitled to relief on this issue.

Source Seels v. Tenet Health System Hahnemann, LLC D/B/A Hannemann University Hospital, 2017 PA Super 227.

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This entry was posted on Sunday, August 6th, 2017 at 5:29 am. Both comments and pings are currently closed.

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