## Facts

- Megan Shinal had a recurrent, nonmalignant brain tumor that threatened her life if untreated.
- She met with neurosurgeon Steven Toms, M.D., for an initial consultation and agreed to surgery, but she did not then decide between a more aggressive total resection and a more conservative approach.
- Subsequent preoperative communications and the pre-surgery clinic visit were largely handled by Toms’s physician assistant (PA), who provided information and obtained Shinal’s signature on a written consent form for an aggressive approach while Toms was not present.
- During surgery, Toms perforated Shinal’s carotid artery, causing hemorrhage, stroke, brain injury, and partial blindness.
- Shinal sued for medical malpractice based on lack of informed consent, alleging Toms did not personally provide the required information or personally obtain her consent for the aggressive procedure.

## Issues

1. Whether the trial court abused its discretion by refusing to strike for cause prospective jurors with employment ties (directly or through family) to entities within the health system employing the defendant.
2. Whether Pennsylvania’s informed-consent statute permits a physician to satisfy the duty to obtain informed consent through disclosures made by “qualified staff” such as a PA, or instead requires the physician’s direct disclosure and consent discussion.

## Decision

- The Supreme Court of Pennsylvania held the trial court did not abuse its discretion in denying the for-cause juror challenges.
- The Court held the trial court erred by instructing the jury that it could consider information provided by the surgeon’s “qualified staff” when determining whether informed consent was obtained.
- The Court reversed the judgment for the defendant and remanded for a new trial limited to the informed-consent claim.

## Legal Principles

- Under 40 P.S. § 1303.504, the duty to provide the information necessary to obtain informed consent for covered procedures rests with “the physician” and is nondelegable.
- Valid informed consent requires direct communication between the treating physician and the patient regarding material risks, benefits, and alternatives.
- A jury instruction that allows staff-provided disclosures to satisfy the physician’s informed-consent duty misstates Pennsylvania law and, when central to the defense, is not harmless.

## Conclusion

Pennsylvania law requires the treating physician personally to conduct the informed-consent discussion for covered procedures; reliance on subordinate staff to provide substantive disclosures cannot satisfy the physician’s statutory duty, and a contrary jury instruction warrants a new trial on informed consent.


Shinal v. Toms, 162 A.3d 429 (Pa. 2017)