The California Court of Appeal has reversed a jury's decision in a medical malpractice case involving Dr. Angela A. Chang and the late David Lindgren. The court ruled that the trial court failed to provide proper jury instructions regarding the informed refusal doctrine, which is crucial for patients to understand the risks of declining medical treatment. This ruling could have significant implications for medical malpractice cases in California.
The case centers around David Lindgren, who was diagnosed with tonsillar cancer in 2012. After successful treatment, he continued to undergo regular screenings. In 2018, Dr. Chang, an ear, nose, and throat specialist, began treating David. In June 2019, after David reported symptoms of a sore throat and weight loss, Dr. Chang ordered a PET-CT scan. The scan indicated no signs of cancer recurrence but showed areas of concern that required further evaluation.
During a phone call on June 5, 2019, Dr. Chang discussed the scan results with David. The details of this conversation are disputed. Dr. Chang claimed she recommended a follow-up with a gastroenterologist, while David believed she assured him he did not have cancer. David did not pursue further medical evaluation immediately and later discovered a cancerous tumor in January 2020, leading to extensive treatments and ultimately hospice care. He passed away in October 2025.
In 2021, Debra Lindgren, David's wife, filed a lawsuit against Dr. Chang for medical malpractice and loss of consortium. The Lindgrens argued that Dr. Chang failed to adequately inform David of the risks associated with not pursuing further evaluation, which they believed constituted a breach of her duty of care. At trial in 2024, the jury found in favor of Dr. Chang, concluding that she did not breach her duty of care. Debra appealed, claiming the trial court had erred by not instructing the jury on the informed refusal doctrine.
The court found that substantial evidence supported Debra's informed refusal theory. The court stated, "Substantial evidence supports Debra’s informed refusal theory, so the trial court erred in refusing to instruct the jury on that issue." The ruling emphasized that a physician has a duty to disclose all material information that would enable a patient to make an informed decision regarding medical treatment.
The court highlighted that Dr. Chang's communication with David was central to the case. The trial court's refusal to instruct the jury on informed refusal deprived the jury of the opportunity to consider whether David would have made different choices had he been fully informed of the risks of declining further evaluation. The court noted that the jury's decision was based solely on expert testimony regarding Dr. Chang's duty of care, without considering the informed refusal aspect.
As a result of these findings, the court reversed the judgment and remanded the case for a new trial. The court also vacated the cost award previously granted to Dr. Chang as the prevailing party, stating, "An order awarding costs falls with a reversal of the judgment on which it is based."
This ruling emphasizes the importance of clear communication between physicians and patients, particularly regarding the risks associated with medical decisions. The informed refusal doctrine ensures that patients are adequately informed about the potential consequences of declining recommended treatments.
The outcome of this case may set a precedent for future medical malpractice claims in California, particularly in how courts interpret the informed refusal doctrine. It underscores the necessity for medical professionals to provide comprehensive information to patients, allowing them to make informed decisions about their health care.
Looking ahead, the case is set for a new trial, where Debra Lindgren will have the opportunity to present her informed refusal claim to a jury. The court's decision to remand the case signals a significant moment for medical malpractice law in California, reinforcing the rights of patients to be fully informed about their medical options.