RISK REVEALED Mr. Canterbury's suffering protecting countless patients from potential harm.

The next time you confirm that a patient has signed and understands the informed consent, think of Jerry Canterbury, whose paralysis after routine back surgery nearly 60 years ago led to the creation of laws that require surgeons to disclose the risks and benefits of surgery as well as alternative treatment options.

Mr. Canterbury died last March in Hartville, Ohio, at the age of 78 from complications of pulmonary disease. That news of his death didn't reach the mainstream media until now is somewhat fitting. His brief obituary, which he wrote several years ago, made no mention of his role in arguably the most influential malpractice case ever tried.

In December 1958, Mr. Canterbury, who was a 19-year-old FBI employee at the time, went to famed neurosurgeon William T. Spence, MD, to seek relief from severe neck and back pain. He was diagnosed with a ruptured disk and underwent a laminectomy to relieve pressure on the spinal cord. A day after the operation, he fell out of his hospital bed while trying to urinate. His legs went numb and he had difficulty breathing. Mr. Canterbury underwent a second emergency laminectomy. Nearly 4 months later, he was discharged from the hospital with partial paralysis in his legs. He also reportedly suffered a lifetime of urinary incontinence.

His malpractice case hit the courts 5 years after his hospitalization as lawyers argued about what caused his paralysis and whether Dr. Spence's treatment deviated from the standard of care at the time. The trial court ruled that Mr. Canterbury lacked the evidence to prove surgical negligence, but an appeals court later asked the question that would forever change the course of medical care: Should Dr. Spence, who apparently referred to laminectomy as routine surgery, have informed Mr. Canterbury that 1% of the surgeries result in paralysis?

During the appellate court trial, Dr. Spence acknowledged that he warned Mr. Canterbury that the surgery might cause weakness, but stopped short of discussing the possibility of paralysis, because he did not want to deter him from undergoing the needed surgery. Although the jury in the second trial ruled against Mr. Canterbury — claiming he undermined his credibility about being entitled to understand the risks of laminectomy by agreeing to a second procedure after being partially paralyzed from the first — legal experts say the case ultimately shifted malpractice culture from physician-based standards to the care a "reasonable person" should expect to receive. They say it also served no small part in the large number of malpractice cases brought to trial today.

Daniel Cook