Case Note: Smith V. Shannon

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Case Note
Smith v. Shannon, 100 Wn. 2d 26, 666 P.2d 351 (1983)
In February 1976, Vera Smith was referred by her attending physician Dr. Raymond Lynberg to Dr. Roger Shannon, a radiologist with defendant Radiology Associates of Spokane. Regarding Ms. Smith’s possible kidney complications, Dr. Shannon chose to administer an intravenous pyelogram (IVP) to Ms. Smith and took X-rays on her kidneys and ureters. Before administering the IVP, Dr. Shannon informed the patient of some possible risks along with the treatment. She might become flushed, nauseous and unconscious. However, he did not inform her of 10 other risks mentioned in the Physician’s Desk Reference (PDR). In this case, Renographin-60, as the contrast agent, might cause thrombophlebitis to the patient, but Dr. Shannon did not inform his patient of this information. Ms. Smith began to sneeze and experienced a shooting pain down her arm while receiving the injection. But Dr. Shannon viewed these reactions as insignificant and didn’t notice her pain. A week after the IVP, Ms. Smith visited Dr. Lynberg for the pain in her arm persisted. And Dr. Lynberg diagnosed reactive phlebitis, an inflammation of the vein in reaction to the Renographin-60. The plaintiff’s pain has continued and she has seen several physicians and been through related surgery twice. Specialists have diagnosed her pain as caused by damage to the nerves in her arm. But the record does not disclose whether or how this damage is related to Dr. Lynberg’s initial diagnosis of reaction phlebitis.
Procedural History Ms. Smith filed a suit under two cause of action against Dr. Shannon. One is that Dr. Shannon is negligent; the other is that he failed to obtain her informed consent. However, the trial court dismissed Ms. Smith’s claim of the physician’s negligence, since she had not demonstrated any deviation by Dr. Shannon from the established standard of medical practice. Also, the trial court rejected Ms. Smith’s second claim, on the ground that though Dr. Shannon didn’t inform her of all risks described in the PDR, the plaintiff had failed to prove that the information “was in fact medically important or recognized risks”. The trial court especially noted that Ms. Smith had failed to provide sufficient expert testimony on the issue and it considered such testimony necessary. Ms. Smith appealed and the Washington Supreme Court affirms the trial court’s judgment that a valid disclosure was made and that the claimed error in determining negligence had not been preserved for appeal
As to the lacking informed consent claim, the Court firstly points out that the doctrine of informed consent is premised on the fundamental principle that “every human being of adult years and sound mind has a right to determine what shall be done with his own body”. Schloendorff v. Society of N.Y. Hosp., 211 N.Y. 125, 129, 105 N.E. 92 (1914) (Cardozo, J.). A physician should inform his or her patient of the attendant risks of the treatment and obtain the patient’s consent. In Washington state, Miller v. Kennedy, 85 Wn.2d 151, 152, 530 P.2d 334 (1975) is the seminal case on this doctrine. In Miller, the Court of Appeals emphasized that it is for the patient to evaluate the risks of treatment and that the only role to be played by the physician is to provide the patient with information as to what those risks are. It is the patient to determine what information should be disclosed; otherwise, it would be in direct conflict with the underlying principle of patient sovereignty. However, it does not mean that every risk, no matter how minute, must be disclosed. Only when the possible risks are of a serious nature should them be disclosed by the physician. That is, “the guide for disclosure is materiality”. Miller, at 287. The test of materiality is an objective one incorporating the underlying concept of patient sovereignty. If the specific risk is