Gomez v. Sauerwein

331 P.3d 19, 180 Wash. 2d 610
Washington Supreme Court·Decided June 19, 2014·No. No. 88307-6·Published·Cited by 25 cases

Opinions

J.M. Johnson, J.*

¶1 This case asks whether Washington’s informed consent statute, RCW 7.70.050, applies when a health care provider misdiagnoses the patient’s condition. We must decide whether the legislature intended to provide recovery to plaintiffs who allege both negligence and informed consent violations based on the same set of facts.

¶2 We hold that when a health care provider rules out a particular diagnosis based on the patient’s clinical condition — including test results, medical history, presentation upon physical examination, and any other circumstances surrounding the patient’s condition that are available to the provider — the provider may not be liable for informed consent claims arising from the ruled out diagnosis under RCW 7.70.050. We affirm the Court of Appeals.

Facts and Procedural History

¶3 Christina Palma Anaya (Mrs. Anaya) suffered from uncontrolled diabetes, leaving her immunocompromised and susceptible to serious infections. On August 20, 2006, Mrs. Anaya went to the Toppenish Community Hospital complaining of urinary tract infection (UTI) symptoms. Urine and blood samples were taken and sent to the [614] laboratory at Yakima Regional Medical Center for analysis. She went home the next day. On August 23, Mrs. Anaya returned to the Toppenish emergency room still feeling ill from UTI symptoms and she could not empty her bladder. After her bladder was drained, she felt better and so was sent home. On August 24, the lab preliminarily determined that one of Mrs. Anaya’s blood cultures was positive for yeast. Following protocol, the lab called Mrs. Anaya’s primary care facility, the Yakima Valley Farm Workers Clinic (Clinic), where Dr. Sauerwein was covering for Mrs. Anaya’s usual primary care provider.

¶4 Dr. Sauerwein was concerned about the test result. He conferred with Dr. Moran, one of Mrs. Anaya’s treating physicians at Toppenish on August 20 and 21. Dr. Moran, an internal medicine specialist, suggested contacting Mrs. Anaya to obtain a fuller clinical picture of Mrs. Anaya’s condition. Due to the serious nature of a blood infection, the two physicians decided that if Mrs. Anaya was feeling ill, she should come in immediately for treatment. If Mrs. Anaya was feeling better, they determined that it was more likely that the test result was a false positive, a common occurrence in microbiology labs.1 A nurse from the Clinic called Mrs. Anaya, who said she had been feeling much better since her second visit to Toppenish. Dr. Sauerwein used the complete clinical picture available to him to conclude that the lab result was a false positive resulting from contamination but had the nurse contact Mrs. Anaya to move her next appointment up to the following week. Dr. Sauerwein did not tell Mrs. Anaya about the test result.

[615] ¶5 On August 26, the lab positively identified candida glabrata as the yeast in Mrs. Anaya’s blood. An infection of glabrata in the blood is serious and can even be deadly. Lab microbiologists entered this information into Mrs. Anaya’s medical record but did not notify Dr. Sauerwein, the Clinic, or anyone else about the positive test result.

¶6 Before Mrs. Anaya’s next visit to the Clinic occurred, her condition worsened. On August 29, Mrs. Anaya went to Yakima Memorial Hospital. There she was prescribed a general antifungal called fluconazol. Fluconazol is effective against most strains of yeast, but it is ineffective against glabrata. When the hospital positively identified glabrata, they discontinued using fluconazol and started using amphotericin B. While amphotericin B is effective against glabrata, it is highly toxic to the kidneys. Given the compromised state of Mrs. Anaya’s kidneys from her diabetes, a health care provider would not normally prescribe amphotericin B until positively identifying glabrata.

¶7 Unfortunately, the amphotericin B treatment came too late to stop the glabrata infection from spreading to the internal organs. Mrs. Anaya died at age 32 on November 17, 2006, of cardiac arrest, deprivation of oxygen to the brain, and fungal sepsis; all stemming from type II diabetes mellitus.

¶8 Mr. Anaya Gomez (Mr. Anaya), as personal representative of Mrs. Anaya’s estate, brought an action in Yakima County Superior Court against Dr. Sauerwein and the Clinic for malpractice. Three weeks before the jury trial, the estate moved to add a claim for failure to obtain informed consent. The trial judge took the motion under advisement. At the close of Mr. Anaya’s case, the defense moved for judgment as a matter of law on the informed consent claim.

¶9 The judge granted the motion and dismissed the informed consent claim, concluding that Backlund v. University of Washington, 137 Wn.2d 651, 975 P.2d 950 (1999), precluded an informed consent claim in misdiagnosis cases. The defense then presented its case in chief, and the jury [616] found that Dr. Sauerwein did not breach any duty owed to Mrs. Anaya. Finding that Dr. Sauerwein did not deviate from the standard of care, the jury did not reach the issues of proximate cause or damages.

¶10 On appeal, the Court of Appeals, Division Three, affirmed the trial court, holding that this case was indistinguishable from Gates v. Jensen, 92 Wn.2d 246, 595 P.2d 919 (1979), but that Gates was either overruled sub silentio by Backlund or abrogated or limited to its facts by Keogan v. Holy Family Hospital, 95 Wn.2d 306, 312-14, 622 P.2d 1246 (1980). Anaya Gomez v. Sauerwein, 172 Wn. App. 370, 385 289 P.3d 755 (2012). The case was appealed to this court for discretionary review, which was accepted. Anaya Gomez v. Sauerwein, 177 Wn.2d 1008, 302 P.3d 180 (2013).

Issues

¶11 1. Whether Mr. Anaya could bring an informed consent claim based on the same facts giving rise to a medical negligence claim for misdiagnosis.

¶12 2. Whether any reasonable finder of fact could, on the facts in this case taken in a light most favorable to Mr. Anaya, conclude that Dr. Sauerwein’s failure to obtain informed consent proximately caused Mrs. Anaya’s death.

Analysis

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Gomez v. Sauerwein, 331 P.3d 19, 180 Wash. 2d 610 (Wash. 2014).

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