User:Adam sk/Canterbury v. Spence

Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972). The case is frequently used first year Torts courses taught in American law schools to teach students about the law of informed consent.

Background
In December 1958, Jerry W. Canterbury, a nineteen-year-old clerk-typist working at the Federal Bureau of Investigation in Washington, D.C., began experiencing severe back pain between his shoulder blades. He consulted with two general practitioners, but the medication they prescribed failed to relieve his pain. He then consulted Dr. William T. Spence, a neurosurgeon. Dr. Spence took X-rays of Canterbury's back, but these did not reveal the source of the problem, so Dr. Spence recommended a myelogram, a procedure in which dye is inserted into the spinal cord and traced to find evidence of the disease.

Canterbury entered Washington Hospital Center on February 4, 1959 for his myelogram. This myelogram revealed that there was a filling defect in the region of Canterbury's fourth thoracic vertebra. Dr. Spence told Canterbury that he suspected this was a sign of a ruptured disc and that Canterbury would have to undergo a laminectomy. Canterbury did not object to the procedure or ask any questions about the risks involved.

Canterbury told Dr. Spence that his mother was a widow of slender financial means living in Cyclone, West Virginia. Dr. Spence called Mrs. Canterbury and informed her of the recommended surgery. She asked Dr. Spence if the recommended operation was serious and Dr. Spence told her "not anymore than any other operation." Given her limited financial circumstances, Dr. Spence told Mrs. Canterbury that she did not need to travel to Washington, D.C. for the surgery.

Dr. Spence performed the laminectomy on February 11, 1959. This surgery revealed that Canterbury's spinal cord was swollen and unable to pulsate; that the veins in this region of the back were twisted and dilated; and that there was an almost total lack of epidural fat, which normally surrounds the spine. Dr. Spence inserted a long hypodermic needle into Canterbury's spine to attempt to rupture any cysts, but no fluid emerged. When Dr. Spence sutured the wound, he attempted to enlarge the dura at the site of the pain in order to relieve pressure on the spinal cord.

Mrs. Canterbury arrived in Washington, D.C. later on February 11, 1959 and, when she arrived at the hospital, signed a consent form agreeing to the surgery. (Since Canterbury was a minor, his mother's consent was required.)

After the surgery, Dr. Spence gave orders that Canterbury should remain in bed while voiding. The day after the surgery, however, hospital personnel gave Canterbury a receptacle in which to void and then left him unattended. In the course of voiding, Canterbury slipped off the side of the bed and fell on the floor. Later that evening, he began complaining of inability to move his legs and he was having trouble breathing; he was totally paralyzed from the waist down. Dr. Spence was summoned and he recommended an immediate second surgery. Mrs. Canterbury signed a consent form and Dr. Spence then operated on Canterbury a second time, reopening the surgical wound and creating a gusset to allow the spinal cord greater room to pulsate.

Canterbury's ability to control his muscles somewhat improved after the second surgery, but he continued to suffer from urinal incontinence and paralysis of the bowels. For years afterward, Canterbury continued to require the care of a urologist. On Dr. Spence's recommendation, Canterbury requested that the F.B.I. transfer him to Miami so he could get more exercise and swimming, and Canterbury subsequently worked for the F.B.I. in Miami, Los Angeles, and Houston. Finally, in June 1962, he resigned from the F.B.I. for health reasons. He found difficulty finding another job because he needed to remain seated and close to a bathroom at all times.

On March 7, 1963, Canterbury filed a lawsuit against Dr. Spence and Washington Hospital Center in the United States District Court for the District of Columbia. The lawsuit alleged that Dr. Spence had been negligent in the performance of Canterbury's laminectomy and in failing to fully inform him of the risks of surgery. The lawsuit also alleged that the hospital had acted negligently by allowing Canterbury to remain unattended after his surgery; by failing to provide a nurse or orderly at the time of his fall; and for failing to have a rail on the side of his bed. The damages claimed in the lawsuit included extensive pain and suffering, medical expenses, and loss of earnings.

After years of discovery and pretrial motions, a trial was held in April 1968. After Canterbury's lawyers had presented their evidence, the defendants moved for a directed verdict. The trial judge granted these motions, holding that Canterbury had failed to produce any medical evidence indicating negligence on Dr. Spence's part in diagnosing Canterbury's malady or in performing the laminectomy; that there was no proof that Dr. Spence's treatment was responsible for Canterbury's disabilities; and that notwithstanding some evidence to show negligent post-operative care, an absence of medical testimony to show causality precluded submission of the case against the hospital to the jury. The judge did not consider whether Dr. Spence had had a duty to disclose the possible risks of surgery to Canterbury or his mother prior to the surgery.

Canterbury then appealed this decision to the United States Court of Appeals for the District of Columbia Circuit.