A patient claiming that a physician's negligence caused severe emotional distress does not have to have suffered an accompanying physical injury to be eligible to recover monetary damages, according to a ruling by Alaska's highest court.

The case centers around the consequences a patient experienced after her physician informed her husband that tests indicated it was likely that the patient was HIV positive.

The dispute arose in 1989 when the physician of a woman hospitalized for severe pneumonia and gastritis ordered a laboratory test to screen for the presence of HIV, the virus that causes AIDS. The physician believed that since the patient had come from the Caribbean nation of Trinidad and Tobago, she was at high risk for contracting the disease, and that the pneumonia thus might be a sign of HIV infection.

The results of the ELISA screening test, which is routinely used to determine whether HIV is present, were not absolutely conclusive but pointed to the likelihood that the patient carried the virus. With this evidence in hand, the physician elected to tell the patient's husband of the test results rather than informing the patient directly.

Following the return of the test results, and while the patient was still hospitalized, a physician specializing in treating HIV-related illnesses evaluated her. He concluded, however, that her symptoms showed little evidence of HIV disease and that the laboratory test appeared to be a false positive.

When the husband's subsequent HIV test turned out to be negative, their marriage began to be beset by considerable strife, which the patient attributed to their discordant HIV serological statuses. It was not until three weeks after discharge that the patient and her husband learned that her medical chart included a notation that the ELISA results were, in fact, probably a false positive reading.

The abrupt shift from bad to good news on her HIV status did not alleviate the domestic problems between the patient and her husband, however, and he soon moved out of their home and filed for divorce.

Following the marriage breakup, the patient sued the physician for negligence, requesting damages based on the physician's failure to obtain her informed consent for the HIV test, his breach of confidentiality when he told the husband of her suspected HIV status, and the emotional distress she suffered as a consequence of believing she had contracted the AIDS virus.

The trial court judge granted a directed verdict in favor of the physician, ruling that there were no grounds for the patient to recover monetary damages for her emotional distress since no physical injury occurred as a result of treatment.

The Alaska Supreme Court disagreed, however, and reversed the trial court's ruling. The justices indicated that the lower court judge's ruling was too narrow in completely denying the option that emotional distress could be severe enough even in the absence of physical injury to warrant a monetary damage award.

The appellate court remanded the case to the lower court with the opinion that the jury should be responsible for deciding whether the physician's negligence caused the severe emotional distress and whether his actions merited a damage award to the patient.

The supreme court justices did, however, uphold two parts of the lower court ruling--that the patient was not eligible to recover monetary damages for distress attributable to the confidentiality breach or for economic losses consequent to her divorce.

(Chizmar v. Mackie, 896 P.2d 196, Alaska Supreme Court)

(Psychiatric News, September 6, 1996)