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  • Taking Chances2:24

The ruling, by U.S. District Court for the District of Columbia, said a physician bas a duty to tell patients the extent of their condition, the risks associated with it, and the varying courses of treatment available.


In Randall v. United States, Jacqueline Randall received both her pre- and post-natal care at the Walter Reed Anny Hospital. She was seen by more than 10 different doctors in her visits to the obstetrics and gynecology clinics. Tests revealed that Ms. Randall had cervical intraepithelial neoplasia-1 and condyloma acunminatum, conditions that can result from human papilloma virus infection, or HPV. Although this condition is noted in Ms. Randall's medical records, she was told only that she had "mole-like growths" in her birth canal and that she should return for a follow-up exam three months after giving birth.


The baby was delivered vaginally. Three months later, the parents learned about the mother’s condyloma and HPV for the first time during a follow-up exam, which confirmed the earlier tests. The baby suffered from juvenile onset recurrent respiratory papillomatosis. It was caused by a subtype of the HPV associated with the mother's genital condyloma.


Ms. Randall then brought a claim of medical malpractice against the physicians and Walter Reed Hospital. A lower court agreed with the plaintiff that the daughter contracted this disease when she passed through the mother's infected birth canal. The court also found that, had the baby been delivered by Caesarian section, she might not have become infected. But the court then ruled that the plaintiff failed to meet her burden of proving that a national standard of care existed that required a Caesarian section to be performed in cases involving similar circumstances.


            On appeal, however, the U.S. District Court found just because the physician did not breach any standard of care, that did not relieve him of a duty to inform a patient of the extent of her condition, the risks associated with it, and the various alternative treatments. The D.C. Circuit Court described a test for deciding whether a particular peril must be divulged: Is the information “material” to the patient’s decision whether to forgo a proposed treatment? Material information is defined as information that a reasonable person, in what the physician knows or should have known is the patient's position, would consider significant to the decision.


            Based on this legal foundation, the court held that Ms. Randall probably would have opted for Caesarian over vaginal delivery if she had had adequate information about her condition and the risks to her unborn child. The court found that Walter Reed Hospital knew or should have known that Jacqueline Randall suffered from HPV before her daughter's.  


            This decision underscores the value of informed consent. It confirms the notion that, even in the absence of a standard of care for the treatment involved, failure to fully inform patients of their condition, the treatment, its risks and alternatives can lead to medical malpractice liability. The physician's best defense in such cases is simply to be sure to keep his or her patients as fully informed as possible and to document their discussions in the medical records. Such documentation will also help facilitate future care of a patient where, as in this case, multiple health care professionals may become involved in the patient's treatment.


Duty Beyond the Standard of Care

by Attorney Frank E. Reardon

December 1995