743 F.3d 170
6th Cir.2014Background
- Pauline Shuler, known to be allergic to heparin (noted in records and on a medical bracelet), allegedly was injected with heparin despite prior directives refusing heparin and died shortly after the injections.
- Her heirs (the Shulers) sued doctors, the hospital, and a clinic for negligence and medical battery, alleging the heparin injections caused her death.
- The district court construed the complaint as medical malpractice only and dismissed for failure to satisfy the Tennessee Medical Malpractice Act (TMMA) notice and pleading requirements.
- The district court relied on Cary v. Arrowsmith to treat therapeutic drug administration as malpractice, not battery.
- The Shulers moved to alter the judgment; the motion was denied and they appealed.
- The Sixth Circuit reviewed de novo whether the complaint plausibly alleged medical battery and whether TMMA applied.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether injections of heparin despite a patient’s refusal can constitute a medical battery under Tennessee law | Shulers: injections were nonconsensual "procedures" and thus battery because Pauline had refused heparin | Defendants: drug administration is a component of treatment and falls only under malpractice/informed consent caselaw (Cary) and thus subject to TMMA | The court held injections can be "procedures" and support a medical battery claim; the complaint plausibly alleged nonconsensual injections |
| Whether prior general consent to treatment bars a later refusal of a specific component | Shulers: a patient may revoke consent; explicit refusal to a component negates authorization | Defendants: general authorization for treatment covers component parts | The court held a prior general consent does not trump a later explicit refusal absent exigency or incapacity |
| Whether the TMMA’s notice/pleading requirements apply to a properly pleaded medical battery claim | Shulers: battery is an intentional tort outside TMMA; TMMA applies only to malpractice claims | Defendants: the gravamen should be treated as malpractice and therefore subject to TMMA | The court held TMMA does not apply to medical battery and declined to recharacterize the timely-pleaded battery claim as malpractice |
| Whether the complaint pleaded battery with sufficient plausibility to survive 12(b)(6) | Shulers: alleged known allergy, bracelet, prior refusals, and heparin given shortly before death — supports inference of nonconsensual injections causing death | Defendants: pleadings are unclear and should be characterized as malpractice | The court found the complaint sufficiently pled medical battery and reversed dismissal of that portion |
Key Cases Cited
- Blanchard v. Kellum, 975 S.W.2d 522 (Tenn. 1998) (articulates the two-question inquiry to identify medical battery versus informed consent)
- Ashe v. Radiation Oncology Assocs., 9 S.W.3d 119 (Tenn. 1999) (applies Blanchard framework distinguishing battery and informed consent)
- Cary v. Arrowsmith, 777 S.W.2d 8 (Tenn. Ct. App. 1989) (held therapeutic drug administration treated as malpractice for informed consent analysis)
- Cardwell v. Bechtel, 724 S.W.2d 739 (Tenn. 1987) (recognizes informed consent claims in Tennessee and their relation to battery)
- Estate of French v. Stratford House, 333 S.W.3d 546 (Tenn. 2011) (discusses scope of TMMA and when negligence claims fall under the statute)
- Bell Atl. Corp. v. Twombly, 550 U.S. 544 (2007) (plausibility standard for pleading)
- Ashcroft v. Iqbal, 556 U.S. 662 (2009) (applies plausibility standard to survive motion to dismiss)