## Facts

- Pamela Rizzo was admitted to Fairfax Hospital in active labor on November 7, 1989, and signed a preprinted authorization form broadly permitting her physician to perform “diagnostic or therapeutic medical and surgical procedures.”
- The form did not identify obstetrical forceps or disclose procedure-specific risks, alternatives, or consequences.
- After many hours of labor, Pamela Rizzo began pushing but was unsuccessful.
- Dr. Maurice Schiller decided to use forceps to deliver the baby in circumstances described as nonemergent.
- Pamela Rizzo testified she was told forceps would be used, but before she could ask what they were for or why, the forceps were applied and the baby’s head was delivered.
- The child, Michael Sean Rizzo, Jr., was born around 10:30 p.m. and was later diagnosed with a subdural hematoma caused by head trauma, with resulting permanent disability including cerebral palsy.
- Plaintiffs’ experts attributed the injury to forceps and opined that, in a nonemergency delivery, the standard of care required disclosure of significant facts about the proposed use of forceps and an opportunity for the patient to participate in the decision.
- Plaintiffs also presented evidence that, if informed of the risks, Pamela Rizzo would have refused forceps delivery.

## Issues

1. Whether the plaintiffs presented sufficient evidence to establish a prima facie medical malpractice claim based on lack of informed consent, such that the informed-consent theory should have been submitted to the jury rather than struck.

## Decision

- The Supreme Court of Virginia held the evidence was sufficient to establish a prima facie informed-consent claim.
- The trial court erred by striking the informed-consent count at the close of plaintiffs’ evidence.
- The judgment was reversed and the case remanded for a new trial limited to the informed-consent claim.

## Legal Principles

- Informed consent in Virginia is measured by a professional standard: a physician must make reasonable disclosure of significant facts as a reasonably prudent practitioner in the same field and under similar circumstances would disclose.
- A patient’s signature on a general hospital authorization form, without procedure-specific disclosure, does not by itself satisfy a physician’s duty to obtain informed consent for a particular invasive procedure.
- To present a prima facie lack-of-informed-consent malpractice claim, a plaintiff must produce evidence of (1) the applicable disclosure standard of care, (2) breach by failure to disclose and obtain informed consent, and (3) proximate causation linking the nondisclosure to the injury.
- On a motion to strike, the evidence and reasonable inferences are viewed in the light most favorable to the plaintiff, and doubts about sufficiency are resolved in the plaintiff’s favor.

## Conclusion

The court required that informed consent be proven through procedure-specific physician disclosure consistent with professional standards, not merely through a generic consent form, and it held that plaintiffs’ expert and patient testimony supported jury consideration of breach and causation in a nonemergency forceps delivery.


Rizzo v. Schiller, 445 S.E.2d 153 (Va. 1994)