Pauscher v. Iowa Methodist Medical Center

408 N.W.2d 355 (1987)

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Nature of the Case

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Facts

Becky, age twenty-six, entered D to deliver her first child. Brad, was born the next day and Becky was scheduled to be released on August 6. Becky developed a fever and pain in her right side. She also discharged large amounts of blood in her urine. Dr. Mark delayed her release and prescribed Macrodantin, a bacteriostatic drug. Because the symptoms continued into the next day, Dr. Bardole, a urology specialist, feared a potentially life-threatening obstruction might be present in Becky's urinary tract. Bardole ordered a more aggressive bacterial drug, Mandol. Blood tests were instituted. Bardole ordered an intravenous pyelogram (IVP) to be run the next morning to determine whether Becky's urinary tract was obstructed. A relatively small percentage of individuals will suffer some discomfort, including flushing, hives, and nausea. More serious reactions include significant trouble breathing and a severe drop in blood pressure. One person in 100,000 to 1 person in 150,000 will die as a result of an IVP. Two of the shift nurses told Becky she was to have an IVP and one told Becky she could get a mild reaction, like hives, or a severe reaction, like difficulty breathing. The other nurse described only the possibility of a mild reaction, 'just the warmth of the dye, that sort of thing.' Neither nurse was acting at the direction of a doctor and neither told her a severe reaction could include anaphylactic shock and death, and neither asked Becky if she consented to the procedure. A radiology technician testified she asked Becky some questions about allergies (apparently of some significance in reactions) and noted her responses on a 'requisition slip,' which later could not be found. Becky denied any allergies, although it ultimately appeared from her medical chart she had a bee sting allergy and there was evidence she had suffered from asthma as a child. The technician did not tell Becky she could die as a result. Nor did the technician ask Becky if she consented to the procedure. Becky complained of significant chest pains. Despite substantial lifesaving measures, Becky soon died. An autopsy disclosed the cause of death to be anaphylactic shock directly induced by injection of the contrast material during the IVP. There was no obstruction in the urinary tract and the infection had been on the left side, not the right. P sued Ds claiming they failed to get informed consent. P presented no expert testimony on the professional standards involved. Ds moved for a directed verdict. It was granted. P appealed claiming the standard should have been whether Ds disclosed all material risks instead of whether the doctors followed the professional standards of informed consent.