Shinal, M., et ux, Aplts. v. Toms M.D., S.
Shinal, M., et ux, Aplts. v. Toms M.D., S. - No. 31 MAP 2016
| Pa. | Jun 20, 2017Background
- Plaintiff Megan Shinal underwent neurosurgery recommended by Dr. Steven Toms and later sued, alleging lack of informed consent and issues with jury selection; appeal reached the Pennsylvania Supreme Court.
- Dr. Toms testified he discussed risks, benefits, and alternatives (total vs subtotal resection) with Mrs. Shinal; afterward, Mrs. Shinal called Dr. Toms’ physician assistant (PA) with follow-up questions that the PA answered.
- Trial court instructed the jury that, in assessing whether Dr. Toms obtained informed consent, the jury could consider information given to the patient by any qualified person assisting the physician.
- Plaintiffs sought to strike four prospective jurors for cause based on alleged relationships with Geisinger entities; the trial court denied the challenges after finding relationships too attenuated and jurors credible.
- Superior Court affirmed; the Supreme Court majority issued an opinion from which Justice Baer (joined by Chief Justice Saylor and in part by Justice Mundy) dissented on two points: (1) whether qualified staff may assist physicians in fulfilling the duty of informed consent, and (2) the proper appellate standard of review for juror-for-cause rulings.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a physician may rely on qualified staff to aid in obtaining informed consent | Shinal: Physician must personally provide requisite information; staff communications should not substitute | Toms: Physician may use qualified staff to assist; physician remains liable for any negligent communication | Dissent (Baer): Trial court properly allowed jury to consider information from qualified assistants; law does not prohibit staff assistance. Majority disagreed on scope (see opinion). |
| Whether the duty to obtain informed consent is delegable | Shinal: Duty is the physician’s and cannot be delegated to avoid liability | Toms: Duty attaches to physician but allowing staff to assist does not amount to improper delegation; physician remains responsible | All agree duty is physician’s (nondelegable), but dissent emphasizes assistance by qualified staff is permissible and juries can consider such communications. |
| Whether the jury could consider answers the PA gave to plaintiff after the physician visit | Shinal: Post-visit staff communications should not be treated as fulfilling physician’s duty | Toms: Those communications are relevant evidence that may inform whether the patient was adequately informed | Dissent: Trial court did not abuse discretion in permitting the jury to consider PA communications as relevant to informed consent. |
| Proper appellate standard for reviewing trial court refusal to strike jurors for cause; whether trial court erred in this case | Shinal: Trial court erred; refusing to strike forced exhaustion of peremptory challenges and prejudiced plaintiffs | Toms: Trial court’s denial of challenges was within discretion; relationships were too attenuated | Dissent: Standard should be abuse-of-discretion for juror-for-cause rulings; here the trial court did not abuse its discretion in refusing to strike the jurors. The Majority proposed a mixed de novo/abuse-of-discretion approach. |
Key Cases Cited
- Commonwealth v. Briggs, 12 A.3d 291 (Pa. 2011) (trial court's juror-disqualification decisions generally reviewed for abuse of discretion)
- Commonwealth v. Safka, 141 A.3d 1239 (Pa. 2016) (definition of abuse of discretion includes misapplication or overriding of law)
- Commonwealth v. Stevens, 739 A.2d 507 (Pa. 1999) (trial court discretion on juror qualification not easily disturbed on appeal)
- Shinal v. Toms, 122 A.3d 1066 (Pa. Super. 2015) (Superior Court opinion affirming trial court and addressing preservation/waiver of exhaustion-of-challenges claim)