331 P.3d 19
Wash.2014Background
- Christina Palma Anaya, an immunocompromised diabetic, had blood and urine cultures taken after ER visits for UTI symptoms; a preliminary blood culture showed yeast.
- Dr. Sauerwein, covering for her PCP, reviewed the clinical picture (patient reported improved symptoms) and concluded the culture was likely a false positive; he did not inform Mrs. Anaya of the preliminary result.
- Two days later the lab identified Candida glabrata; the lab did not notify the Clinic. Mrs. Anaya later received ineffective initial antifungal therapy and ultimately died of fungal sepsis.
- The estate sued for medical negligence; three weeks before trial it added an informed consent claim based on failure to disclose the positive test.
- The trial court granted judgment as a matter of law dismissing the informed consent claim; the jury later found no malpractice. The Court of Appeals and the Supreme Court affirmed dismissal of the informed consent claim.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether RCW 7.70.050 (informed consent) applies when the provider misdiagnoses | Anaya: informed-consent claim may be pursued alongside negligence based on same facts; Dr. Sauerwein knew of a positive test and should have disclosed it | Respondents: where provider rules out a diagnosis based on clinical picture, there is no duty under RCW 7.70.050 to disclose or obtain consent about that ruled-out diagnosis; misdiagnosis is malpractice, not informed consent | Court: If provider reasonably rules out a diagnosis from available clinical data, informed consent claims tied to that ruled-out diagnosis are unavailable (Backlund rule applies) |
| Whether both negligence and informed-consent claims can proceed from same facts | Anaya: both claims allowed; patient autonomy supports informed-consent liability even if diagnosis is disputed | Respondents: allowing both creates double liability and is inconsistent with statute and medical practice | Held: Theories are distinct and sometimes overlap, but when diagnosis is ruled out there is no duty to inform about that diagnosis; court clarifies Gates is an exception, Backlund governs generally |
| Whether reasonable factfinder could find proximate cause from failure to inform | Anaya: informing would have led to different treatment (e.g., amphotericin B) and survival | Respondents: given clinical limits (need positive glabrata ID before nephrotoxic amphotericin B) and expert testimony, informing would not have altered outcome | Held: No reasonable factfinder could find proximate cause; dismissal also proper on proximate-cause grounds |
| Whether Gates v. Jensen remains good law | Anaya: Gates supports informed-consent duty during diagnostic process | Respondents: Gates is distinguishable and not controlling here | Held: Gates not overruled but is limited/exceptional; Backlund and Keogan govern the typical rule that informed consent requires something to inform the patient about (a diagnosis or treatment option) |
Key Cases Cited
- Backlund v. Univ. of Wash., 137 Wn.2d 651 (1999) (misdiagnosis generally gives rise to negligence claim, not informed consent)
- Gates v. Jensen, 92 Wn.2d 246 (1979) (permissible informed-consent claim during diagnostic process where additional simple tests/treatment choices were available)
- Keogan v. Holy Family Hosp., 95 Wn.2d 306 (1980) (diagnostic disclosure duty depends on patient symptoms and whether diagnosis is effectively completed)
- Davis v. Microsoft Corp., 149 Wn.2d 521 (2003) (standard of review for judgment as a matter of law)