913 N.W.2d 526
Iowa2018Background
- In 2004 Alan Andersen underwent a Bentall procedure performed by Dr. Sohit Khanna, who had no experience or specialized training in that procedure; complications led to coma, a second surgery, and eventual heart transplant.
- Andersen and his family sued Khanna and Iowa Heart alleging specific medical negligence and failure to obtain informed consent (two theories: failure to disclose physician's lack of experience; failure to disclose increased surgical risk due to Andersen's poor preoperative heart condition).
- The district court granted partial summary judgment holding, as a matter of law, Iowa does not require disclosure of physician-specific characteristics (experience/training); that ruling dismissed the inexperience-based informed-consent claim.
- A later ruling (after deposition testimony from defense expert Dr. Cuenoud) reopened an informed-consent theory focused on failure to disclose the increased mortality risk from Andersen’s poor heart, but at trial a different judge excluded testimony and effectively barred that informed-consent theory mid-trial.
- The case proceeded to trial on negligence claims only; jury found no negligence. Plaintiffs appealed; Iowa Supreme Court affirmed negligence result but held the court erred in removing both informed-consent claims and remanded to allow them to proceed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a physician must disclose personal characteristics (experience/training) as part of informed consent | Andersen: physician's lack of experience can be material and must be disclosed when a reasonable patient would consider it material | Khanna: no duty to disclose physician-specific info; statute and policy limit disclosures; bright-line rule preferable | Court: Reversed summary judgment; physician experience/training can be material; materiality is fact-dependent and generally for the jury unless immaterial as a matter of law |
| Whether trial court abused discretion by excluding evidence/testimony supporting informed-consent claim based on increased surgical risk from Andersen’s poor heart | Andersen: trial exclusion prevented him from presenting Dr. Cuenoud’s testimony quantifying increased risk and rebuttal; prior order allowed the claim | Khanna: issue was previously closed; reopening mid-trial prejudicial | Court: Exclusion was an abuse of discretion; prior rulings and proffered testimony kept the claim in the case and exclusion prejudiced Andersen; remand for further proceedings on that claim |
| Whether jury finding of no negligence bars informed-consent recovery | Khanna: non-negligent performance forecloses damages for nondisclosure | Andersen: informed-consent claim is distinct; liability can exist even if procedure was properly performed | Court: Jury’s finding on negligent performance does not preclude an informed-consent claim; damages and causation analyses differ; informed-consent claims remain available |
| Whether trial court erred by refusing a separate jury specification that Khanna was negligent for lack of training/experience | Andersen: requested explicit specification that lack of training was a distinct negligent act | Khanna: experience is embedded in existing specifications | Court: No error; instructions already required specialist standard and permitted consideration of training/experience within submitted specifications |
Key Cases Cited
- Cowman v. Hornaday, 329 N.W.2d 422 (Iowa 1983) (adopting the patient rule for informed consent)
- Pauscher v. Iowa Methodist Med. Ctr., 408 N.W.2d 355 (Iowa 1987) (extending patient rule and discussing scope of required disclosure)
- Doe v. Johnston, 476 N.W.2d 28 (Iowa 1991) (explaining disclosure duties under the patient-focused standard)
- Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972) (landmark informed-consent rule requiring materiality and discussing need for unrevealed risk to materialize)
- Johnson ex rel. Adler v. Kokemoor, 545 N.W.2d 495 (Wis. 1996) (holding lack of surgeon experience can be material depending on facts)
- Goldberg v. Boone, 912 A.2d 698 (Md. 2006) (materiality of physician experience is typically a jury question)
- Moore v. Regents of Univ. of Cal., 51 Cal.3d 120 (Cal. 1990) (broad view of informed consent and duty to disclose physician interests/characteristics)
- Hidding v. Williams, 578 So.2d 1192 (La. Ct. App. 1991) (physician’s personal condition material where it increased risk of poor performance)