Facts
- Doreen Shorter, a Jehovah’s Witness, became pregnant and was diagnosed by Dr. Robert E. Drury with a missed abortion requiring uterine evacuation to prevent infection.
- A dilation and curettage (D&C) could be performed by curette, suction, or prostaglandin-induced labor; Drury selected the curette method, which carried the highest puncture-related bleeding risk.
- Drury explained the D&C and warned of possible bleeding and uterine perforation but did not discuss alternative D&C methods.
- The Shorters repeatedly communicated that Doreen would not accept blood transfusions for religious reasons and signed a hospital form refusing blood and releasing providers from responsibility for adverse results due to that refusal.
- During the D&C, Drury severely lacerated Doreen’s uterus, causing internal bleeding; despite repeated requests, Doreen (and Elmer) refused transfusion, and Doreen died from blood loss.
- Elmer Shorter, as personal representative, sued for wrongful death based on medical negligence.
- The jury found Drury negligent and a proximate cause of death, set gross damages at $412,000, and found the Shorters knowingly and voluntarily assumed the risk of death from refusing blood; it reduced damages by 75% to $103,000.
- The trial court denied both sides’ post-trial motions; the plaintiff appealed the assumption-of-risk reduction, and Drury cross-appealed, arguing the release barred the claim.
Issues
- Whether the blood-refusal/release document was valid and enforceable, and whether it barred the wrongful-death claim or instead affected damages.
- Whether express assumption of risk remains a viable doctrine after adoption of comparative negligence, and how it applies when a patient refuses recommended treatment.
- Whether enforcing the release and permitting a damages reduction violates public policy limiting medical exculpatory agreements or infringes religious freedom.
Decision
- The court affirmed the judgment finding negligence but reducing damages by 75%.
- The blood-refusal/release form was enforceable as evidence of express assumption of risk as to the consequences of refusing transfusion, but it did not bar the malpractice-based wrongful-death action.
- Express assumption of risk survived comparative negligence and could support a damages reduction where the plaintiff knowingly and voluntarily accepted a specific risk.
- Enforcing the form and applying assumption of risk did not violate public policy governing medical services because it did not immunize negligent care generally, and it did not violate religious freedom because it gave effect to a voluntary choice without state coercion.
Legal Principles
- Exculpatory clauses in matters of public interest, including medical services, are generally unenforceable to the extent they purport to release providers from liability for negligent care.
- A narrowly limited agreement allocating the consequences of a competent patient’s informed refusal of specific treatment may be enforced as express assumption of risk rather than as a general waiver of malpractice liability.
- Under comparative negligence, express assumption of risk based on knowing and voluntary consent to a specific danger remains a viable defense and may reduce recoverable damages.
- When negligent treatment creates a condition requiring a refused intervention, liability for negligence may remain, but damages may be reduced to reflect the patient’s voluntary refusal as a substantial cause of the fatal outcome.
Conclusion
The court held that a signed blood-refusal release did not eliminate liability for negligent medical care but validly showed express assumption of the risk that refusal of transfusion could result in death, permitting a substantial reduction of wrongful-death damages under comparative negligence.