Brady, M. v. Urbas D.P.M., W., Aplt.
111 A.3d 1155
| Pa. | 2015Background
- Maria A. Brady underwent four surgeries (2008–2010) by podiatrist William Urbas for a hammer-toe deformity; she signed consent forms before each operation describing risks and complications.
- Complications persisted after the first surgery and three follow-up procedures; Brady later had a successful bone-graft by another surgeon that improved length, stability, and pain.
- Brady sued Urbas in 2010 alleging negligence for the three follow-up surgeries; she did not plead lack of informed consent and invoked the discovery rule for timeliness.
- At trial the defense introduced evidence of the consent forms and testimony that Brady had been informed of risks; the jury reviewed the consent forms during deliberations and returned a defense verdict on negligence.
- The Superior Court vacated and remanded, adopting a per se rule excluding informed-consent evidence in negligence cases; the Pennsylvania Supreme Court granted review to decide whether that bright-line rule is correct.
- The Pennsylvania Supreme Court held that a patient’s affirmative consent to a procedure after being informed of risks is generally irrelevant to a negligence claim and may be excluded because it can confuse the jury and suggest consent to negligence.
Issues
| Issue | Plaintiff's Argument (Brady) | Defendant's Argument (Urbas) | Held |
|---|---|---|---|
| Admissibility of informed-consent evidence in a medical malpractice (negligence-only) case | Consent evidence is irrelevant and prejudicial; jurors may equate consent with waiver of recovery | Consent communications are relevant to show doctor met standard of care, rebut claim plaintiff was "lulled" and explain known risks | Evidence that patient consented after being informed of risks is generally irrelevant to negligence and may be excluded; trial court abused discretion by admitting it here |
| Whether consent evidence can establish standard of care | Not relevant to standard of care; standard should be proven by expert testimony | Consent forms and risk discussions reflect doctor’s awareness of risks and thus inform standard of care | Some consent-related information (e.g., enumerated risks) can be relevant to the standard of care in limited circumstances, but not the patient’s assent to those risks |
| Whether plaintiff’s allegation of being "lulled into a false sense of security" made consent evidence material | That allegation was only for tolling under the discovery rule, not substantive liability | Needed to rebut allegation and show plaintiff understood risks | The allegation was procedural (timeliness) and not material to negligence; consent thus not necessary to rebut it |
| Standard of review for evidentiary rulings and propriety of a per se exclusionary rule | Supports exclusion; consent evidence inherently confusing and prejudicial | Superior Court erred by creating a per se rule and failing to apply abuse-of-discretion/Rule 403 balancing | Trial courts have discretion; however, broad per se exclusion is unwarranted — but consent assent is irrelevant to negligence and admissible only in limited contexts; vacatur affirmed due to prejudicial use here |
Key Cases Cited
- Scampone v. Highland Park Care Ctr., 57 A.3d 582 (Pa.) (malpractice requires proof deviation from standard of care)
- Toogood v. Rogal, 824 A.2d 1140 (Pa.) (definition and elements of medical malpractice)
- Wright v. Kaye, 593 S.E.2d 307 (Va. 2004) (consent to risks does not constitute consent to negligence; risk of jury confusion)
- Viera v. Cohen, 927 A.2d 843 (Conn. 2007) (admitting informed-consent evidence where disclosure obligations formed part of standard of care)
- Hayes v. Camel, 927 A.2d 880 (Conn. 2007) (enumerated surgical risks can help establish standard of care if used properly)
- Baird v. Owczarek, 93 A.3d 1222 (Del. 2014) (assumption of risk is not a defense to medical negligence)