Shinal, M., et ux, Aplts. v. Toms M.D., S.
2017 Pa. LEXIS 1385
| Pa. | 2017Background
- Megan Shinal consulted neurosurgeon Dr. Steven Toms (employed by Geisinger Clinic) about resection of a recurrent benign pituitary-region tumor; she ultimately underwent an open craniotomy total resection and suffered carotid injury, stroke, and partial blindness.
- The Shinals sued for medical malpractice alleging lack of informed consent—specifically that Dr. Toms failed to explain risks and the less‑risky alternative of subtotal resection plus radiation.
- Prior to trial the Shinals sought to strike prospective jurors employed by, insured by, or with family employed by any Geisinger entity; the trial court excused some but denied for‑cause strikes as to four jurors with indirect Geisinger ties.
- At trial the court instructed the jury it could consider information communicated to the patient by “any qualified person acting as an assistant” to Dr. Toms (e.g., physician assistant).
- Jury returned verdict for Dr. Toms; the Shinals appealed arguing (1) the trial court erred by refusing to strike jurors for cause given their employer/family‑employer ties to Geisinger, and (2) the informed‑consent instruction erroneously allowed delegation of the physician’s non‑delegable duty.
- Supreme Court of Pennsylvania: affirmed that denial of for‑cause strikes was not error under the record, but reversed on the jury instruction—holding the physician’s duty to obtain informed consent is non‑delegable and the charge misstated the law—remanded for new trial.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether jurors with employment or family employment ties to non‑party corporate affiliates of the defendant physician must be stricken for cause | Shinal: Indirect employment ties to the Geisinger system create a presumption of prejudice; trial court’s refusal forced exhaustion of peremptory strikes and prejudiced plaintiffs | Toms: Relationships were attenuated; jurors denied bias and could be impartial; Cordes plurality not controlling | Court: No presumption of prejudice here—relationships were indirect/attenuated and voir dire showed no perceived financial impact; trial court did not abuse discretion. |
| Standard of appellate review for for‑cause juror rulings | Shinal: Denial raises legal question warranting de novo review where presumption of prejudice is claimed | Toms: Such determinations rest with trial court and are reviewed for abuse of discretion | Court: Dual approach—presumed bias (close relationships) reviewed de novo; actual bias (revealed in answers/demeanor) reviewed for abuse of discretion. |
| Whether information provided to the patient by physician’s qualified staff can satisfy physician’s duty to obtain informed consent | Shinal: Only the physician may fulfill the duty; staff communications cannot substitute | Toms: Focus should be on whether the patient received the information, not who delivered it; prior Superior Court cases allowed qualified staff to convey consent info | Court: Duty to obtain informed consent is non‑delegable; physician cannot shift the obligation to staff; jury instruction permitting staff communications to satisfy consent was erroneous. |
| Effect of erroneous jury instruction on outcome | Shinal: Instruction misstates law and likely affected verdict | Toms: Precedent and statute permit consideration of staff communications; instruction proper | Court: Error of law in charge controlling the informed‑consent issue; requires new trial. |
Key Cases Cited
- Valles v. Albert Einstein Med. Ctr., 805 A.2d 1232 (Pa. 2002) (physician’s duty to obtain informed consent belongs to the physician and is non‑delegable)
- McHugh v. Proctor & Gamble Paper Prods. Co., 776 A.2d 266 (Pa. Super. 2001) (direct employer/employee relationship with a party evokes a presumption of juror prejudice)
- Cordes v. Associates of Internal Medicine, 87 A.3d 829 (Pa. Super. 2014) (en banc plurality opinions exploring whether indirect employment ties and juror perceptions can warrant exclusion)
- Commonwealth v. Bridges, 757 A.2d 859 (Pa. 2000) (framework for when close familial, financial, or situational relationships require disqualification or presumption of prejudice)
- Quinby v. Plumsteadville Family Practice, Inc., 907 A.2d 1061 (Pa. 2006) (standard for review of jury charge errors and when erroneous instructions require new trial)