Case 6895/2009

Plaintiff sued the Catalonian Institute of Health for alleged medical malpractice and lack of informed consent relating to an electrophysiological study that he underwent when he arrived at the hospital with severe arrhythmia and in an emergency condition. Plaintiff was a high-risk patient due to his past medical history, which included prior heart attacks and strokes. During the electrophysiological test, there was a complication and the patient’s aorta was punctured. The physicians were able to perform a procedure to fix the rupturing of the aorta, but after the procedures, the plaintiff was severely incapacitated and alleged the following: (1) That the doctors shouldn’t have performed the electrophysiological test because of the patient’s high-risk medical history, and (2) that the doctors failed to inform him of the dangers of the proceduret

The court held that the rupturing of the aorta was a known risk of the electrophysiological study and that the study was an adequate one for the physicians to have performed on the patient given his emergency condition when he arrived at the hospital. The court relied on the opinion of a court-appointed expert to conclude that the electrophysiological test was necessary to diagnose the patient’s condition and that the rupturing of the aorta was corrected through the subsequent surgery.

The court held that the patient’s claim failed on the causation element. Although there was a complication during the electrophysiological study, the complication was corrected and plaintiff was stable after the second surgery. The injuries plaintiff experienced after being discharged from the hospital were a result of the natural progression of his condition and not the medical procedures that were performed.

However, the court held that lex artis required the physicians to inform the patient of the risks of the medical procedure and receive his consent. The plaintiff arrived in an emergency condition, but the court reasoned that the physicians could have given his family members information regarding the electrophysiological study and its risks. The Court rejected the health institute’s view that the “objective urgency” of the situation negated the need for informing the patient or his family. Although the lack of informed consent did not cause the plaintiff’s injuries, the court upheld part of the damages the plaintiff received in the lower court proceeding because the plaintiff was deprived of an opportunity to make an informed decision.

“There was no malpractice but an urgent medical decision due to the seriousness of the patient’s condition, which implied the most accurate surgical intervention, indicated definitively at the moment, and not later, considered as vital to save the patient’s life, as it actually happened. For this reason, and even though the legal relevance of the arguments of the claim, valued herein fairly, we cannot share the deduction made about the effects of the lack of information and the damages caused.” (Page 7).

“…[B]etween that health care performance and the status of the patient before and after the events there is no relation of causality attributable to the administration. None of the alleged aftermath effects suffered by the patient are a consequence of those interventions, but a result of the general status of the patient and the evolution of the disease he is suffering.” (Page 22)

“As we know, eluding the duty of obtaining the patient’s informed consent constitutes an infraction of the lex artis ad hoc and reveals an abnormal functioning of the health services, as stated before…this Chamber considered that does not gives per se place for awarding damages if there is no damage to be repaired as a consequence of the transgression of the lex artis…But is also stated by the Chamber that in special circumstances that patent infraction produces on the victim of it pain and suffering economically repairable, since its capacity to decide was obstructed without any reason.” (Page 23)