## Facts

- Karen Gemme sought orthodontic treatment for an overbite; her orthodontist extracted two teeth and later referred her to oral and maxillofacial surgeon Morton H. Goldberg.
- Goldberg examined Gemme, reviewed diagnostic materials, diagnosed a jaw deformity, and recommended segmental osteotomy to realign her jaws and close extraction spaces.
- Goldberg discussed the surgery and disclosed some risks, but did not disclose (1) the risk of significant gum and bone loss and (2) a nonsurgical alternative, restorative bridgework, that could provide a less-than-ideal correction with less risk.
- Gemme consented to surgery and later experienced complications including bone and gum loss, requiring additional dental and surgical treatment.
- Gemme sued for malpractice, alleging lack of informed consent based on nondisclosure of material risks and a viable, less risky alternative.
- At trial, Goldberg admitted he did not inform Gemme that bridgework was an available alternative.
- A jury found for Gemme and awarded damages; Goldberg appealed, arguing insufficient evidence of causation and error in denying a directed verdict.

## Issues

1. Whether sufficient evidence supported a finding that nondisclosure of material risks and the bridgework alternative was a proximate cause of Gemme’s injuries under an objective “reasonable patient” standard.
2. Whether the trial court erred in denying Goldberg’s motion for a directed verdict on the informed-consent claim for lack of proof of causation.

## Decision

- The appellate court affirmed the judgment for Gemme.
- The court held that the evidence permitted a reasonable jury to find a breach of the duty of informed consent based on nondisclosure of material information, including a feasible alternative.
- The court held that causation could be found under the objective standard without requiring definitive subjective testimony that Gemme personally would have refused surgery.
- The trial court properly denied the directed verdict because causation and materiality were questions for the jury on this record.

## Legal Principles

- In informed-consent cases, causation is evaluated objectively: the plaintiff must prove that a reasonable person in the patient’s position, if fully informed of material risks and feasible alternatives, would have declined the treatment.
- A risk or alternative is material if a reasonable patient would consider it significant in deciding whether to undergo the procedure.
- A physician’s duty of disclosure includes feasible alternatives, particularly when an alternative is significantly less risky and clinically viable.
- Causation may be inferred from circumstantial and expert evidence regarding the nature of the procedure, the seriousness of undisclosed risks, and the availability and risk profile of alternatives.
- On review of a denied directed verdict, evidence is viewed in the light most favorable to the verdict, and a verdict stands if reasonable jurors could reach it.

## Conclusion

The court upheld a jury verdict for the patient, ruling that nondisclosure of material surgical risks and a feasible, less risky alternative supported liability for lack of informed consent and that the jury could infer objective causation from the evidence, making a directed verdict improper.


Gemme v. Goldberg, 31 Conn. App. 527, 626 A.2d 318 (Conn. App. Ct. 1993)