## Facts

- Terri Blakesley, a Pennsylvania resident, suffered lingual nerve damage during a wisdom-tooth extraction in Pennsylvania, causing tongue numbness and painful sensations.
- In 1982, she consulted Dr. Larry M. Wolford, a Texas oral and maxillofacial surgeon, during his examination at a Pennsylvania clinic.
- Wolford recommended nerve graft surgery and described using a section of the greater auricular nerve as the donor nerve, with limited resulting numbness.
- Wolford told Blakesley he could perform the surgery only in Texas; she traveled there for treatment.
- In Texas, Wolford performed the operation but used a different donor nerve than the one described in the Pennsylvania consultation.
- After surgery, Blakesley’s original symptoms persisted and she experienced additional adverse symptoms.
- Blakesley brought a diversity action alleging lack of informed consent, contending Wolford did not disclose the possibility of using an alternative donor nerve or its associated risks.
- The applicable law mattered because Pennsylvania imposed a broader, patient-focused disclosure duty and had no comparable malpractice damages cap, while Texas required less disclosure and limited malpractice damages by statute.

## Issues

1. Under Pennsylvania choice-of-law rules applicable in diversity, whether Pennsylvania or Texas substantive law governed (a) the informed-consent standard and (b) damages, including any statutory cap.
2. Whether the trial court erred in allowing the jury to use a damages summary chart during deliberations.

## Decision

- The Third Circuit held the district court erred by applying Pennsylvania substantive law.
- Applying Pennsylvania’s interest-analysis/most-significant-relationship approach, the court concluded Texas had the more significant relationship to the alleged tort and the parties on informed consent and damages.
- The court reversed the judgment for Blakesley and remanded for a new trial applying Texas law.
- Because the case was remanded for a new trial based on the choice-of-law error, the evidentiary dispute over the damages chart did not control the disposition.

## Legal Principles

- In diversity cases, federal courts apply the forum state’s choice-of-law rules.
- Pennsylvania’s conflicts methodology uses interest analysis and the Restatement (Second) “most significant relationship” framework rather than a strict place-of-injury rule.
- For medical treatment occurring in another state, the state where the procedure and alleged malpractice occurred has a strong regulatory interest in defining physicians’ disclosure duties and liability exposure.
- Damages limitations, including statutory caps, are substantive for conflicts purposes and apply when the governing state’s substantive law applies.
- A preliminary consultation in the forum state and a plaintiff’s domicile may be outweighed by the treatment state’s direct connection to the conduct at issue and its policy choices regulating in-state medical practice.

## Conclusion

The Third Circuit ruled that Pennsylvania’s choice-of-law rules required application of Texas substantive law to both informed consent and damages for surgery performed in Texas by Texas physicians, reversed the Pennsylvania-law verdict, and remanded for a new trial under Texas law.


Blakesley v. Wolford, 789 F.2d 236 (3d Cir. 1986)