The Pennsylvania Supreme Court has agreed to hear a case that could affect what evidence physicians may present in defense of medical liability claims.
In Mitchell v. Shikora et al., the plaintiff, Lanette Mitchell, contends that evidence concerning the known risks and complications of a surgical procedure are irrelevant as to the question of negligence. The case stems from injuries Ms. Mitchell suffered while undergoing a hysterectomy. Despite Ms. Mitchell's objections, evidence of the risks and complications associated with hysterectomies was presented at trial. Ms. Mitchell claims this evidence was unfairly prejudicial and should have been excluded as irrelevant.
In May 2012, Dr. Evan Shikora performed a hysterectomy on Ms. Mitchell at Magee Women's Hospital of UPMC. During the procedure, Dr. Shikora severed Ms. Mitchell's bowel.
Ms. Mitchell subsequently filed a medical liability action against Dr. Shikora, Magee, and Dr. Shikora's practice group. By failing to identify her bowel prior to cutting it, Ms. Mitchell claimed Dr. Shikora had breached his duty of care. Dr. Shikora countered that Ms. Mitchell's injury was a complication of injury, not an indication that negligence occurred.
The case proceeded to a jury trial. During the trial, Ms. Mitchell sought to exclude all consent-related evidence and all evidence pertaining to the known risk/complications of hysterectomies. Since Ms. Mitchell did not raise any consent-related claims in her suit, the trial court excluded all evidence regarding Ms. Mitchell's consent to undergo a hysterectomy. The trial court, however, allowed evidence regarding the known risks and complications of hysterectomies to be presented to the jury.
Following a jury verdict in favor of the defendants, Ms. Mitchell filed a motion seeking a new trial excluding the risk/complications evidence. The trial court denied Ms. Mitchell's motion.
Ms. Mitchell subsequently appealed to the Pennsylvania Superior Court. Ms. Mitchell claimed that the trial court had erred in allowing the defendants to present evidence on the risks and complications of a surgical procedure in a medical liability case that asserted only physician negligence and not any consent-related claims. Evidence of a procedure's known risks, Ms. Mitchell argued, is irrelevant as to the question of negligence. Ms. Mitchell also argued that the risk/complications evidence misled the jury by inferring that her injuries were the result of surgical complication and not medical negligence.
The Superior Court reversed the judgment of the trial court and ruled that the risks and complications evidence was irrelevant to the issue of whether Dr. Shikora's treatment of Ms. Mitchell met the applicable standard of care. This evidence, the Superior Court held, was inadmissible and a new trial without admission of risks and complications evidence is required.
In rendering this decision, the Superior Court relied heavily on the Pennsylvania Supreme Court's recent holding in the case of Brady v. Urbas. In Brady, the Pennsylvania Supreme Court held that evidence that a patient affirmatively consented to treatment after being informed of the risks of that treatments is generally irrelevant to a medical liability suit. Such evidence, however, may be admitted under limited circumstances if it is relevant to establishing an applicable standard of care. In a trial on a medical liability suit where only negligence is asserted and not lack of informed consent, the Brady decision holds, evidence that a patient agreed to go forward with a procedure in spite of the risks of which they were informed is irrelevant and should be excluded.
Applying the Brady rationale to the circumstances of Ms. Mitchell's case, the Superior Court reasoned that although evidence of a surgical procedure's risks and complications may be introduced to establish the relevant standard of care, determination of whether such evidence should be admissible is to be conducted on a case-by-case basis. The evidence in the Mitchell case, the Superior Court opined, was irrelevant in determining whether Dr. Shikora acted within the applicable standard of care. The Superior Court further reasoned that the fact that one of the risks and complications of a hysterectomy was the injury suffered by Ms. Mitchell does not make it more or less likely that Dr. Shikora was not negligent.
Additionally, the Superior Court also theorized that risks and complications evidence could be misleading and confusing to the jury. Noting that this evidence was central to Dr. Shikora's defense, the Superior Court opined that risks and complications evidence could lead jurors to believe the plaintiff's injuries were simply the result of surgical complication and lose sight of the ultimate issue of whether the defendant's actions confirmed to the governing standard of care.
Which Issues Will the Pennsylvania Supreme Court Consider?
Following the Superior Court's decision in favor of Ms. Mitchell, the defendants appealed to the Pennsylvania Supreme Court. The Supreme Court granted the defendant's appeal and agreed to hear the case. However, the Supreme Court will consider the defendant's appeal only in regard to one issue:
- Whether the Superior Court's holding directly conflicts with the Pennsylvania Supreme Court's holdings in Brady v. Urbas, which permits evidence of general risks and complications in a medical liability claim?
The defendants maintain that the Superior Court's holding misapplies the Supreme Court's decision in Brady v. Urbas. In agreeing to hear the Mitchell case, it is expected that the Supreme Court will provide further guidelines on how the holding of Brady should be applied.
PAMED Next Steps
On Jan. 8, 2018, the Pennsylvania Medical Society — with support from the American Medical Association (AMA) — filed an amicus brief in support of allowing general risks and complications evidence in medical negligence cases.
The AMA has joined the brief on its own behalf and as a representative of the Litigation Center of the American Medical Association and the State Medical Societies. The Litigation Center is a coalition among the AMA and the medical societies of each state, plus the District of Columbia, whose purpose is to represent the viewpoint of organized medicine in the courts.
The AMA is the largest professional association of physicians, residents and medical students in the United States. Additionally, through state and specialty medical societies and other physician groups seated in its House of Delegates, substantially all U.S. physicians, residents, and medical students are represented in the AMA's policy making process. AMA members practice in every medical specialty area and in every state, including Pennsylvania.
PAMED thanks the AMA for its support.
PAMED will continue to monitor this case and share all updates with members.