Case Law Update: The Iowa Supreme Court Extends Iowa’s Informed Consent Doctrine
On June 15, 2018, the Iowa Supreme Court, in Andersen v. Khanna1, broadened the scope of Iowa’s informed consent doctrine by requiring physicians to disclose their personal information if such information would be material in a reasonable patient’s decision whether or not to undergo a proposed procedure.
In 2004, Dr. Sohit Khanna, an employee of Iowa Heart Center, P.C., performed a Bentall heart procedure on Alan Anderson without any prior experience or training in the specific procedure. There were several complications with the procedure that left the patient in a coma, required a second heart surgery, and ultimately a heart transplant. The patient and his family sued physician and employer for medical negligence, alleging physician failed to obtain informed consent by: (1) not advising the patient that he had limited training and no experience in performing the procedure, and (2) physician failed to advise the patient of the increased risk and dangers of the procedure based on the patient’s bad heart. The first trial court granted partial summary judgment in favor of the physician and employer as to the patient’s first theory, finding that under Iowa’s informed consent law, “a physician does not have a duty to disclose physician-specific characteristics or experience in obtaining informed consent.” After a series of mistrials, the third trial court did not allow the patient to present his second informed consent theory to the jury. Ultimately, the jury concluded that the physician and employer were not negligent in performing the procedure. The Iowa Court of Appeals affirmed the district court and the patient applied for, and was granted, review by the Iowa Supreme Court.
The Iowa Supreme Court addressed several issues, including an important question related to informed consent. The Court held that a physician has a duty to disclose information about his or her inexperience or lack of training as a part of the informed consent process if a reasonable patient would consider such information material in deciding whether or not to undergo a procedure. The Court began its analysis by restating that Iowa informed-consent law followed the “patient rule” that applies to both elective and non-elective medical procedures. The Court noted that, under the patient rule, “the physician’s duty to disclose is measured by the patient’s need to have access to all information material to making a truly informed and intelligent decision concerning the proposed medical procedure.” As such, one of the key questions facing the Court was the materiality of a physician’s experience and training, or the lack thereof. The Court disagreed with the lower court’s ruling that, as a matter of law, “a physician’s lack of experience or training [was] never material to a patient’s decision to submit to a medical procedure.” In doing so, the Court explained that: (1) materiality of information turns on whether a reasonable person in the patient’s position would consider the information at issue to be material to the decision of whether to undergo the proposed procedure, and (2) Iowa law has never categorically excluded a particular type of information from the reasonable person analysis.
The physician raised multiple arguments in favor of a bright line rule that excluded physicians’ personal information from the scope of information required for informed consent: (1) reversing the lower court means imposing a duty on physicians to disclose personal information, including irrelevant peer review, licensure, and probation information; (2) Iowa’s statute governing informed consent establishes an exhaustive list of disclosures and physicians’ personal information is not listed; and (3) several jurisdictions have determined the scope of required disclosures is governed by the language of the jurisdictions’ informed-consent statutes. The Court addressed and dismissed these arguments, finding: (1) a physician is only required to disclose personal information that is material, nothing more; (2) the Iowa statute is not an exhaustive list of required disclosures; and (3) unlike other jurisdictions, Iowa’s informed-consent statute does not preempt common law. The Court held that “a physician’s experience or training with the proposed treatment can be information material to the decision of a reasonable person in the patient’s position to or not to undergo the proposed treatment,” and the materiality of such information “will depend on the facts and circumstances of each case.”
The Iowa Supreme Court’s decision in Andersen clarifies and puts Iowa health care providers on notice that, as pertinent, they might be required to disclose personal information (e.g., training, knowledge, disciplinary history, general practice history) to their patients in order to obtain valid informed consent. This means that Iowa health care providers need to carefully consider the relevant disclosures for the treatment or procedure that is subject to the informed consent disclosure, including personal competencies that could be material to the patient’s decision.
1 Andersen v. Khanna, ___ N.W.2d ___, No. 14-1682, 2018 WL 2999519 (Iowa June 15, 2018).