Shinal, M. v. Toms, S.
122 A.3d 1066
| Pa. Super. Ct. | 2015Background
- Megan Shinal underwent a January 31, 2008 open craniotomy by Dr. Steven Toms to resect a recurrent craniopharyngioma; intraoperatively the carotid artery was perforated, leaving her with visual and gait impairments.
- The central legal issue at trial was whether Dr. Toms obtained Megan Shinal’s informed consent for the surgery under the MCARE statutory standard.
- Plaintiffs originally sued Geisinger entities as well as Dr. Toms; the trial court granted partial summary judgment dismissing the Geisinger defendants because informed-consent duties are personal to the physician.
- During voir dire, several prospective jurors had employment or family connections to Geisinger affiliates; plaintiffs moved to strike four venirepersons for cause but the trial court denied those motions; plaintiffs used peremptory strikes to remove them.
- Plaintiffs also sought to exclude the signed standard surgical consent form and objected to jury instructions that physician assistants/qualified staff can relay information relevant to informed consent; the court admitted the form and gave the instruction. The jury found for the defense on informed consent.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether jurors with employment/family ties to Geisinger should be stricken for cause | Such indirect Geisinger ties create presumptive prejudice and required per se disqualification (relying on Cordes) | No direct close relationship to Dr. Toms; voir dire showed jurors could be impartial; indirect ties to a non-party do not mandate presumption of prejudice | Denied. No per se prejudice where ties were indirect/attenuated and jurors professed impartiality; Cordes plurality not controlling |
| Whether jury instruction allowing qualified staff (e.g., PA) to convey informed-consent information was erroneous | Only physician can obtain legal informed consent under MCARE; allowing non-physicians improperly expanded the duty | Law allows consideration of information actually communicated to patient, regardless of identity; precedent permits nurse/assistant testimony on what was conveyed | Denied. Instruction was proper; jury may consider information provided by qualified staff in assessing whether patient was informed |
| Whether the standard signed consent form should be excluded (motion in limine) | Form’s admission was unfairly prejudicial because Shinal claims consent was not informed; form is generic and non-specific | Form is relevant evidence of what was presented and signed; plaintiff can explain lack of recollection; limiting instruction suffices | Denied. Admission within trial court’s discretion; plaintiff could explain circumstances and jury was instructed on significance |
| Whether trial court erred in denying post-trial relief/new trial | Cumulative effect of the above errors deprived plaintiffs of fair trial | Defense: record supports rulings; plaintiffs failed to preserve and/or develop some claims | Denied. Appellate review found insufficient error; many claims waived or inadequately developed; verdict supported by evidence |
Key Cases Cited
- Cordes v. Assocs. of Internal Med., 87 A.3d 829 (Pa. Super. 2014) (en banc plurality decision addressing juror disqualification for employer ties; plurality reasoning not binding)
- McHugh v. Procter & Gamble Paper Prods. Co., 776 A.2d 266 (Pa. Super. 2001) (test for juror disqualification: close relationship warrants presumption of prejudice; two-situation framework)
- Colon, 299 A.2d 326 (Pa. Super. 1972) (limit categories of automatic juror removal; prefer diverse juries)
- Valles v. Albert Einstein Med. Ctr., 805 A.2d 1232 (Pa. 2002) (informed-consent duty is personal to physician; medical facility not vicariously liable for physician’s informed-consent duty)
- Foflygen v. Allegheny Gen. Hosp., 723 A.2d 705 (Pa. Super. 1999) (information relayed by surgeon’s nurse may be considered in informed-consent assessment)
- Bulman v. Myers, 467 A.2d 1353 (Pa. Super. 1983) (emphasis on ensuring patient is informed of material facts necessary for treatment choice)
- Montgomery v. Bazaz–Sehgal, 798 A.2d 742 (Pa. 2002) (medical battery/informed-consent principles distinguishing negligence)
- Quinby v. Plumsteadville Family Practice, Inc., 907 A.2d 1061 (Pa. 2006) (standard of review for jury instruction challenges)