Facts
- Robin Carr and his wife, Donna Sorrell, decided they did not want more children after the birth of their second child due to financial and educational concerns.
- Sorrell planned to have a tubal ligation, but scheduling difficulties arose; Carr offered to undergo a vasectomy instead because Sorrell had recently been pregnant for nine months.
- Carr consulted Dr. Walter S. Strode at Straub Clinic & Hospital, Inc. (the clinic) twice about the vasectomy.
- Strode performed the vasectomy, and a post-operative semen analysis indicated Carr was sterile.
- About three months later, Sorrell became pregnant, and a later analysis showed Carr was no longer sterile, indicating the vasectomy failed.
- After the third child’s birth, Sorrell again planned a tubal ligation, but the birth occurred around the Thanksgiving holiday and no physician could be scheduled for the procedure.
- Carr underwent a second vasectomy, performed by Dr. Robert Simich.
- Carr and Sorrell sued Strode and the clinic on multiple theories, including lack of informed consent, alleging Strode failed to disclose that a vasectomy could fail and failed to disclose the rate of such failures.
- A jury returned a verdict for Carr and Sorrell on the informed-consent claim.
- The trial court granted defendants’ motion for judgment notwithstanding the verdict (JNOV) and conditionally granted a new trial if the JNOV were reversed.
- Carr and Sorrell appealed; Strode and the clinic cross-appealed various pretrial rulings and the giving of a plaintiffs’ jury instruction.
Issues
- Whether Hawaiʻi informed-consent law applies a patient-oriented materiality standard (what a reasonable patient would want to know) rather than a physician-custom standard.
- Whether plaintiffs presented sufficient evidence of causation under Hawaiʻi’s informed-consent standard to support the jury’s verdict and defeat JNOV.
- Whether expert medical testimony was required to prove that the undisclosed risk (vasectomy failure and failure rate) was material and that nondisclosure caused the plaintiffs’ harm.
- Whether the trial court properly instructed the jury on informed consent and properly ruled on defendants’ summary-judgment motions and motions in limine.
- Whether the trial court’s conditional order granting a new trial could stand after reversal of the JNOV, and whether any additional trial-court orders related to informed consent required reversal.
Decision
- The Supreme Court of Hawaiʻi affirmed the order denying defendants’ motion for summary judgment (including alternative requests for partial summary judgment).
- The court affirmed the denial of defendants’ motions in limine.
- The court affirmed the trial court’s decision to give plaintiffs’ jury instruction no. 11 on informed consent.
- The court reversed the judgment for defendants entered after the JNOV, holding the case should not have been taken from the jury on the informed-consent claim.
- The court reversed the trial court’s conditional grant of a new trial.
- The court reversed an order granting plaintiffs’ motion for partial summary judgment and reversed an order denying defendants’ motion for reconsideration.
- The court remanded for a new trial limited to the issue of informed consent.
Legal Principles
- A court may grant JNOV only when, viewing the evidence and reasonable inferences in the light most favorable to the nonmoving party, reasonable jurors could reach only one result; the judge cannot reweigh evidence or decide credibility.
- Hawaiʻi applies a patient-oriented standard for informed consent: the duty to disclose turns on what a reasonable patient would consider material to the decision whether to undergo the proposed treatment.
- Materiality focuses on the significance of the risk to a reasonable patient’s decision; evidence of customary physician disclosure practices may be considered but does not control the legal duty.
- Informed-consent causation is evaluated using an objective test: whether a reasonably prudent person in the patient’s position would have declined the procedure if adequately informed of the material risk.
- Expert testimony is not automatically required to establish materiality or causation when the risk and decision-making consequences are within ordinary juror understanding; lay testimony about the patient’s situation and choices may be enough to submit the claim to the jury.
- Evidence that the patient later underwent a similar procedure may be relevant to causation, but it does not resolve causation as a matter of law where the circumstances and adequacy of later disclosures are disputed.
- A conditional new-trial order tied to an erroneous JNOV cannot stand when the record shows the jury’s verdict had evidentiary support and the claim should remain for jury resolution.
Conclusion
The Hawaiʻi Supreme Court held that Hawaiʻi informed-consent law uses a reasonable-patient, material-risk disclosure standard and an objective causation test, and that the plaintiffs’ evidence was sufficient for the jury to decide whether nondisclosure of vasectomy failure risk and failure rate caused their harm; it therefore reversed the JNOV and conditional new-trial order and remanded for a new trial limited to informed consent.