It is well established that a clinician has a duty to inform a patient about potential adverse effects from prescribed medications or continuing certain activities against medical advice. But what happens if a patient doesn’t follow advice? At what point does the patient become liable for their own injury? The Supreme Court of Georgia looked at this issue in this month’s case.

Medical Lawsuit Facts

The patient, Mr. B, went to a local medical clinic for chest pain and high blood pressure. The clinic doctor prescribed enalapril maleate/hydrochlorothiazide to lower the patient’s blood pressure, and referred him to Dr. C, a cardiologist. Dr. C performed a nuclear stress test that showed abnormal results and indicated that a large area of the patient’s heart was receiving low blood flow.

Dr. C instructed Mr. B to continue using the antihypertensive medication, and the physician prescribed clopidogrel to prevent blood clotting, rosuvastatin to help lower the patient’s cholesterol, and nebivolol to protect against a heart attack. The physician did not warn Mr. B about the medications’ possible side effects of dizziness or losing consciousness.

The following day Dr. C performed a cardiac catheter procedure on Mr. B, revealing a 99% blocked artery, and also performed a balloon angioplasty with a stent. After the procedures, Dr. C gave postsurgical instructions to Mr. B’s wife, including that Mr. B should not engage in any strenuous or risky activity or any lifting, bending, or stooping over for 1 week. The doctor also told Mr. B’s wife that Mr. B should be careful because he was on blood thinners.

Later, the physician went over the restrictions with Mr B himself, telling him that he could return to work in a week, but not to engage in any strenuous activity or lift objects weighing more than 10 pounds. Mr B spent a day in the hospital after his procedures. Prior to discharge, a cardiac nurse also discussed post-stent limitations, and Mr B confirmed that he understood and that he had the proper phone numbers to call with any questions.

Five days after having the procedures, Mr. B went hunting. He walked more than 200 yards through rough terrain while carrying his rifle, which weighed over 9 pounds, and climbed an 18-foot deer stand. Unfortunately, once he reached the top of the deer stand, Mr. B fainted and fell 18 feet, fracturing several vertebrae.

The Lower Court Decisions

Mr B sued the cardiologist and his practice, alleging that their negligence had caused his injury. Specifically, the plaintiff claimed that he had been prescribed too much blood pressure medication by the cardiologist and this had caused him to faint. The case went to trial.

At trial, the court gave the following instruction to the jury on assumption of risk: “When a person knowingly and voluntarily takes a risk of physical injury, the danger of which is so obvious that the act of taking such a risk in and of itself amounts to a failure to exercise ordinary care for his own safety, that person cannot hold another liable for injuries proximately caused by such action even though the injuries may be in part attributable to the negligence of the other person.

To establish that plaintiff assumed the risk of his injury,” continued the court, “the defendants must demonstrate that Mr. B had a subjective knowledge of a specific particular risk of harm associated with the activity or condition that proximately caused the injury yet proceeded with the activity anyway.” The court gave these instructions over the objection of the plaintiff. After deliberation, the jury returned a complete defense verdict, and the trial court denied plaintiff’s motion for a new trial.

The plaintiff appealed. The Court of Appeals reversed the lower court decision, holding that the trial court erred in giving the instruction on assumption of risk, because the evidence did not justify the instruction. Specifically, the Court of Appeals held “climbing into a deer stand was not a risk associated with Dr C’s duty to Mr B […] Rather, the risk of fainting as a side effect of the medication was the particular risk in question.”

The Court of Appeals believed that Dr. C’s telling the patient not to engage in strenuous activity did not establish that Mr. B knew that he risked losing consciousness if he chose to disregard the instructions, or that he knew dizziness or loss of consciousness were possible side effects of the blood pressure medication. The defendant appealed to the state’s Supreme Court.

State’s Supreme Court Decides

The Supreme Court reversed the Court of Appeals, holding that “there need only be slight evidence supporting the theory of the charge to authorize a requested jury instruction. For the purposes of this appeal, we need not decide as a matter of law whether Mr B assumed a risk that led to his injury; we must decide only whether there was slight evidence to support the jury instruction regarding assumption of the risk.

And if there was slight evidence supporting the instruction — and there was — it is irrelevant whether we find that slight evidence persuasive in the face of contrary evidence; that question was reserved exclusively for the jury.” The Court noted that “We have long held that a plaintiff who knowingly and voluntarily takes a risk of physical injury, the danger of which is so obvious that the act of taking such risk, in and of itself, amounts to a failure to exercise ordinary care and diligence for his own safety, cannot hold another liable for damages resulting from a hurt thus occasioned.” (As an example, the Court noted that a competent 20-year old university student was deemed to be “necessarily aware” of the risk of drowning when he voluntarily entered the ocean, even if he wasn’t aware of the presence of rip currents in the waters.)

Here, stated the court, there was evidence that Mr. B had been instructed not to engage in strenuous activity or lift more than 10 pounds, bend, or stoop over for at least 7 days after his procedures. Even though Dr. C did not explain all the specific risks that could have resulted from disregarding the instructions, a competent adult like Mr. B cannot blind himself to the obvious risk of a dangerous cardiovascular event that could result in unconsciousness if he disregards explicit physician instructions prohibiting strenuous activity immediately after heart surgery.

The Supreme Court concluded that there was at least slight evidence that Mr. B knew that going hunting and climbing a deer stand only 5 days after heart surgery posed a risk of serious physical injury and that he voluntarily exposed himself to that risk. The Supreme Court agreed with the trial court’s decision to give the jury instructions, and the trial court’s verdict for the cardiologist was upheld.

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Protecting Yourself

While it will never be possible to warn patients of every eventuality that could occur after surgery or being prescribed medication, this case is another reminder of how important communication with patients really is. Although Dr C did not specifically warn the patient of the danger of fainting, his other warnings, combined with common sense, were enough to protect him in this lawsuit.