Shanae Rannow
WRIT 4431
Exam 3
Case with additions (in bold): Mr. Thomas Walton was brought to the St. Luke’s
Hospital in cardiac distress on December 13, 2013. He had been experiencing chest pains for
three days but had refused to let his wife, Lucy, take him to the hospital, complaining that last
time he was there for similar symptoms, “They just blew him off” by asking him to go home
and get rest. In fact, St. Luke’s is located in a small town in northern New York, which has had
problems in the past offering care that meets the standards of larger cities in the state, but St.
Luke’s is only four hours from an excellent teaching hospital in Albany where patients with
more serious conditions and/or needs are usually sent. On December 13th, Mr. Walton was
treated in the St. Luke’s ER by Dr. William Sharp, a long-time staff member at the hospital, who
warned Mrs. Walton that Mr. Walton’s condition was grave. However, Dr. Sharp expressed
confidence that a new and less invasive procedure that consisted of inserting stents into blocked
arteries might be more successful than bypass surgery, given Mr. Walton’s weakened condition
and Dr. Sharp’s previous successes with inserting stents. Dr. Sharp asked Mrs. Walton to give
him permission to do the procedure immediately without informing Mrs. Walton that her
husband could be transported to the teaching hospital in Albany. She signed a generic
consent form even though she expressed doubt that her husband would have really wanted the
procedure given his suspicion of hospitals and doctors. Mr. Walton died on the operating table.
Mrs. Walton later learned that Dr. Sharp was not only using a somewhat new method that he
actually had little experience and success in, but was also using stents made of an
experimental material and that Dr. Sharp was involved in a perhaps profitable research grant to
explore the effectiveness of the new procedure and materials. However, Dr. Sharp was the
principal investigator on the grant and had studied the procedure at SUNY Albany Medical
School the previous summer; moreover, he has received AMA awards for this kind of research in
the past yet had only used the procedure on real patients a handful of times. Then, Mrs.
Walton learned from her nephew, a medical student at SUNY Albany, that the details of her
husband’s case (including his age, weight, and smoking and drinking habits) were included in an
article by Dr. Sharp that appeared in JAMA only two months after her husband’s death. In the
article, his death was attributed to his poor living habits, based on analysis of blood tests done on
and tissue samples taken from Mr. Walton, and the nephew suspects that such deaths might have
to be accounted for and in essence dismissed in an upcoming request for a patent for this
particular stent. However, Mr. Walton’s name was never mentioned in the article. Mrs. Walton
believes now Mr. Walton should have undergone bypass surgery for his massively blocked
arteries, and she contacted three experts in bypass surgery to verify that. Mrs. Walton brought a
suit against Dr. Sharp on the grounds of negligence, performing a procedure without
informed consent, and breach of fiduciary duty.
Questions before the court: Since Dr. Sharp did not disclose to Mrs. Walton
information about the teaching hospital in Albany, his limited experience with stents, and his
relationship to research involving stents does her consent meet the standards for informed
consent? Since Mr. Sharp did not disclose his personal interests involving stents did he breach
his fiduciary duty that he has to a patient? Other experts acknowledge that Mr. Walton should
have undergone bypass instead of a stent procedure. If Dr. Sharp knew the life saving procedure
for his patient would be bypass but instead opted to do a stent to meet his own personal goals
which then resulted in death, is this considered negligence?
Remedy: Mrs. Walton is seeking a monetary remedy which would cover Mr. Walton’s
medical bills as well as damages. Mrs. Walton would also like her husband’s death information
removed from JAMA and any other place that the information would be used for research, as she
believes his poor living habits did contribute to his death but the failed stent operation is what
caused his death. She would also like Dr. Sharp’s medical license to be reviewed as he has
clearly broken Business and Professions code section 654.2.
Mrs. Walton’s Argument:
Mrs. Walton argues that she was not given all relevant information in order to give
informed consent for her husband’s procedure that ultimately resulted in death. Dr. Sharp
explained that he had previous successes with this procedure, when in fact it was still in the
research stages. Dr. Sharp also failed to inform Mrs. Walton that because of Mr. Walton’s
advanced condition he could be sent to the teaching hospital in Albany where they have more
experience dealing with his condition. Mrs. Walton signed a generic consent but did so under
false pretenses. As in the cases of Canterbury v. Spence, Moore v. Regents of UCLA, and
Johnson v. Kokemoor in order for the informed consent to be valid, the physician has a “duty to
disclose” which Dr. Sharp did not.
“True consent to what happens to one’s self is the informed exercise of a choice, and that
entails an opportunity to evaluate knowledgeably the options available and the risks attendant
upon each (Canterbury v. Spence).” Given this case, Mrs. Walton was not given this opportunity
when making a drastic decision regarding her husband’s health. Mrs. Walton having no
experience with cardiac operations like the “average patient who has little or no understanding of
the medical arts… (Canterbury v. Spence)” did not know that stents were not a popular practiced
procedure at the time, Dr. Sharp referred only to them as “new”. Not only was Dr. Sharp not
experienced in the procedure like he led on, but he did not give options of other procedures that
could instead be done on Mr. Walton. Mrs. Walton argues that experience has a direct correlation
to success of a surgery and if Dr. Sharp performed a procedure he was more familiar with; her
husband may still be alive. “When the duty to share comparative risk data is material to a
patient’s exercise of informed consent, an ensuing referral elsewhere will often represent no
more than a modest and logical next step (Johnson v. Kokemoor).”
Dr. Sharp failed to disclose information about how he may profit from using a stent in
this procedure. He failed to disclose any information regarding his relationship to stents to Mrs.
Walton at all. The fact that Dr. Sharp had prior formed intent to use stents in a procedure as well
as use the results for research to get stents patented should have been shared with Mrs. Walton as
this could have influenced Dr. Sharp’s decision to treat as well as Mrs. Walton’s decision to
receive the treatment for her husband. This situation is very similar to the case in Moore v.
Regents of UCLA where the court found that the physician did in fact breach his fiduciary duty to
his patient by not informing his patient of his other interests for treating him.
Mrs. Walton also argues that as a physician, Dr. Sharp should have recognized that
bypass surgery would be more successful in her husband’s condition. With this knowledge Dr.
Sharp was negligent as he still performed the stents procedure which ultimately cost Mr. Walton
his life. Experts can attest to this fact and believe that bypass surgery would have been the
preferred procedure in Mr. Walton’s case.
Dr. Sharp’s Argument:
It is a physician’s duty to disclose all risks of a procedure not necessarily his experience
in the procedure. The physician in Johnson v. Kokemoor also argues this point. After informing
Mrs. Walton of all risks she gave informed consent to the procedure by use of a generic consent
form.
When Mr. Walton arrived in the ER his condition was too grave to send him to the
teaching hospital in Albany. Even if his condition were not grave, Mr. Walton was confident he
could handle the situation and does not have the responsibility of handing every challenging case
off to a more successful hospital. “Finally, the defendant argues that if his duty to procure the
plaintiff’s informed consent includes an obligation to disclose that she consider seeking
treatment elsewhere, then there will be no logical stopping point to what the doctrine of informed
consent might encompass (Johnson v. Kokemoor).” If Dr. Sharp referred Mr. Walton to Albany’s
teaching hospital, that hospital should then consider referring Mr. Walton to an even better
hospital, and that trend could continue until the patient is deceased and no longer needs care.
This would leave only the best hospital in the country with all cases, for if a physician does not
tell a patient of better providers, then they must not have legally received informed consent.
The stent procedure, while new, was thought to give Mr. Walton a better chance of a
healthy life than bypass would have. Just as in Canterbury v. Spence, Dr. Sharp believed this
would be the best procedure for his patient at the time given his condition.
Mr. Walton’s death was a result of his life habits of smoking and drinking, as well as
older age and his weight (slightly overweight). This brings light to the cause and effects of Mr.
Walton’s condition. As in Canterbury v. Spence, Mr. Walton may have also died from receiving
bypass surgery because as established through blood tests after death, his lifestyle is what
actually caused his death, not the stent procedure performed by Dr. Sharp.
Holding:
If Dr. Sharp would have provided Mrs. Walton with “all of the viable alternatives
available to her and thereby aided her exercise of informed consent (Johnson v. Kokemoor)” then
the ruling would be in his favor. Because Dr. Sharp failed to explain other viable alternatives
such as bypass surgery or being transported to Albany hospital, Mrs. Walton was not able to give
informed consent as was also the case in Johnson v. Kokemoor and Martin v. Richards.
Even with urgency of Mr. Walton’s condition, an effort should have been made to let
Mrs. Walton know that she could choose to attempt to seek treatment at Albany teaching hospital
where there was more experience with all types of conditions, including Mr. Walton’s. This was
a breach in Dr. Sharp’s fiduciary duty to his patient. This decision was held in Johnson v.
Kokemoor and will continue in this case.
Expert testimony shows that a bypass surgery should have instead been practiced. With
Dr. Sharp’s personal interest in using a stent, it seems as though he was negligent in handling
Mr. Walton’s case. Although blood tests say that Mr. Walton’s death was caused by his poor
lifestyle habits, there is no way that Dr. Sharp could have known this before the procedure and
does not give him the right to use an experimental procedure on a patient that could have
possibly been saved by following the standard procedure in this case. If Mrs. Walton knew all
the risks as well as Dr. Sharps inexperience in using stents, and still gave informed consent, then
the court would not have reason to believe negligence.
As stated in the case of Moore v. Regents of UCLA, there are three well established
principals, one of them being that “in soliciting the patients consent, a physician has a fiduciary
duty to disclose all information material to the patient’s decision.” The same case also states that
“a physician must disclose personal interests unrelated to the patient’s health, whether research
or economic, that may affect the physician’s professional judgment.” Dr. Sharp chose to not
disclose his research interests with stents. He also did not share he would potentially profit from
doing this procedure on Mr. Walton, or that his outcome of the procedure could potentially be
used to gain a patent on the stent used as it was still an experimental material. We find that Dr.
Sharp did not gain informed consent as he did not follow his duty to disclose.