Jeff Segal, MD, JD, FACS

Have you ever had a patient who, in the middle of a procedure, said “Please stop. It hurts.” Never? Almost every doctor has heard these words once.

One doctor apparently did not heed these words quickly enough. He was sued for battery. Battery is an “intentional tort.” It is different than negligence. Many professional liability policies exclude coverage of intentional torts – such as battery.

Here’s what happened. It’s an old case, but it’s instructive. Shirley Coulter underwent outpatient surgery to remove a mass on her lower eyelid. An automated blood pressure cuff was placed on the patient’s arm – to monitor her blood pressure. The first time it inflated, Coulter testified she felt extreme pain, began to sweat and tremble, and demanded the cuff be removed.

She claimed the cuff inflated a second time. She again cried for someone to remove the cuff.

The patient said it was not until several minutes later that her demands were heeded. The cuff was removed. Surgery continued uneventfully. (By the way, the doctor and nursing staff testified that the cuff only inflated a total of two times).

Coulter sued the doctor for battery. Battery is an offensive “touching” of another person’s body without her consent. The patient argued she gave consent for the procedure. Then she withdrew consent for one part of the procedure – in the middle.

This case percolated to the Kentucky Supreme Court (Coulter v. Thomas, 33 S.W.3d 522 (2000)), and its decision was rendered 8 years after the cuff’s inflation / deflation cycle.

The patient argued that a subsequent surgery on her pronator teres (releasing the median nerve) demonstrated damage to the nerve. Never mind the pronator teres is well distal to the typical location of a blood pressure cuff. Perhaps at this surgicenter, the doctor places BP cuffs around the forearm. I don’t want to judge.

The Court ruled that a patient can revoke consent – (a) if the revocation is clear and can evoke no doubt in the minds of reasonable men that consent was revoked; and (b) “it must be medically feasible for the doctor to desist in treatment or examination without the cassation being detrimental to the patient’s health or life from a medical viewpoint.”

Apparently the patient’s demand to remove the cuff qualified for the first prong. And the procedure was indeed completed safely without the cuff. Once consent was revoked, battery occurred.

Who would guess a blood pressure cuff could create such drama?