## Facts

- Kenyeda Taft received obstetrical care at a federally supported community health center from Dr. Louis Laz, a federal employee, making the United States the defendant under the FTCA.
- Taft previously delivered a large infant whose birth involved shoulder dystocia and resulted in Erb’s palsy.
- During Taft’s pregnancy with Melvin D. Harrison, Jr., Laz knew of her prior delivery history and reviewed records that characterized the prior delivery as “without complications,” despite the prior child’s Erb’s palsy.
- Laz did not discuss with Taft the alternative of elective cesarean section or its comparative risks and benefits versus vaginal delivery in light of her history.
- Harrison’s delivery was a difficult vaginal birth complicated by shoulder dystocia, and he sustained a brachial plexus injury (Erb’s palsy).
- Taft, on Harrison’s behalf, sued under the FTCA alleging (1) negligence (standard-of-care deviation) and (2) lack of informed consent based on nondisclosure of the elective C-section option and related comparative risks.

## Issues

1. Under Massachusetts informed-consent law, must a physician disclose the alternative of elective cesarean section and comparative risks/benefits to a patient with a known history of shoulder dystocia and resulting Erb’s palsy?
2. Did the district court apply the correct legal standard when it rejected the informed-consent claim by relying on physician/court risk-benefit balancing rather than a reasonable-patient materiality test?

## Decision

- The First Circuit vacated the judgment for the United States on the informed-consent claim and remanded.
- The court held the district court applied the wrong standard by substituting its own (and the physician’s) assessment that C-section risks outweighed vaginal-delivery risks.
- The court left undisturbed the district court’s disposition of the separate standard-of-care negligence claim, which was not appealed.

## Legal Principles

- Massachusetts uses a patient-oriented disclosure rule: a physician must disclose information a reasonable person in the patient’s position would consider material to deciding whether to undergo a procedure.
- Materiality asks whether a reasonable person in the patient’s position would have found the withheld information significant in making the decision.
- A physician’s judgment about what is medically preferable, and a court’s independent risk-benefit balancing, do not replace the reasonable-patient materiality inquiry.
- Patient-specific circumstances (including prior adverse outcomes) inform what a reasonable person in that patient’s position would consider material, even though the standard remains objective.

## Conclusion

The First Circuit required reconsideration of the informed-consent claim under Massachusetts’s reasonable-patient materiality test, focusing on whether a reasonable person with Taft’s prior experience would have viewed the comparative risks and benefits of elective C-section versus vaginal delivery as significant to the delivery-choice decision.


Harrison v. United States, 284 F.3d 293 (1st Cir. 2002)