MARIA GANOZA v. JAMES LABORDE AND INTERIM LSU PUBLIC HOSPITAL MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS (2026)

This is a medical malpractice case. Plaintiff, Maria Ganoza, appeals the July 11, 2025 judgment that dismissed her claims against defendants, State of Louisiana, through the Board of Supervisors of Louisiana State University and Agricultural and Mechanical College, on behalf of LSU Health Sciences Center, LSU Health Care Services Division, Interim LSU Public Hospital; and James M. Laborde, M.D. (collectively “Dr. Laborde”) with prejudice. For the reasons that follow, we affirm the judgment.

FACTS AND PROCEDURAL HISTORY

The background of this matter, as capsulized by this Court in Ganoza v. Laborde:

After treating with a podiatrist for a bilateral bunions ailment, Ms. Ganoza was referred to Dr. Laborde—an orthopedic surgeon at Interim LSU Public Hospital, in New Orleans, Louisiana—for bunions surgery. On April 4, 2011, Ms. Ganoza first presented to Dr. Laborde for a pre-operative clinic visit. After examining Ms. Ganoza, Dr. Laborde determined that she suffered not only from bilateral bunions, but also from other ailments—painful calluses and lower extremity tight tendons. Dr. Laborde further determined that the appropriate treatment for Ms. Ganoza's ailments included a bilateral bunionectomy and a tendon lengthening procedure.

At the same pre-operative clinic visit, Ms. Ganoza read and signed a consent form for the recommended surgical treatment. On the consent form, the surgical treatment was described as a bilateral bunionectomy with tendon lengthening calves and possible toes. Ms. Ganoza's condition was described as bunions, calluses and tight tendons bilateral. The purpose of the surgical treatment was described as improving alignment and pain. But the section of the consent form entitled “reasonable therapeutic alternatives and the risk association with such alternatives” was left blank.

About a week after Ms. Ganoza's pre-operative clinic visit, Dr. Laborde performed the surgery. According to Dr. Laborde, the surgery was without incident. According to Ms. Ganoza, she suffered from numerous complications following the surgery.

One year after the surgery, in April 2012, Ms. Ganoza filed a medical review panel (“MRP”) complaint, with the Louisiana Division of Administration, pursuant to the Malpractice Liability for State Services Act (“MLSSA”), La. R.S. 40:1237.1, et seq., against Dr. Laborde. In her MRP complaint, Ms. Ganoza asserted claims of medical malpractice associated with the surgical procedures that Dr. Laborde performed on her in April 2011. She averred that Dr. Laborde originally was authorized to treat only the bunions on her toes, but he chose instead during the procedure to sever her Achilles tendons in unnecessary surgery. Such unnecessary surgery, she averred, was performed to gain experimental data for a future publication on tendon-lengthening surgeries.

In August 2015, the MRP, composed of three orthopedic surgeons, rendered a unanimous opinion in Dr. Laborde's favor; the MRP's opinion was as follows:

1. The procedures were well described, not experimental, and based upon the provided medical records, the procedures were warranted based upon the operative surgeon's physical exam.

2. Consent was adequate including tendon lengthening and bilateral bunionectomy. Conservative methods had failed and she was referred from podiatry for a surgical consult. It was her choice to proceed with surgery or not.

3. An [Institutional Review Board's(“IRB”)] consent was not necessary as the procedure was not experimental and there was no evidence provided to indicate that she was a part of a study.

4. There is nothing in the record presented to the panel to review to indicate the hospital, and/or its employees, deviated from the standard of care.

2023-0392, pp. 1-3 (La. App. 4 Cir. 12/5/23), 380 So.3d 578, 581-82.

In 2015, Ms. Ganoza filed a petition for damages asserting the averments she made in her MRP complaint. Prior to trial, Dr. Laborde filed a motion in limine to exclude evidence 1) characterizing Dr. Laborde's treatment as experimental or human research, 2) evidence relating to Dr. Laborde's research applications and approvals, and 3) evidence concerning Dr. Laborde's treatment of other patients or other lawsuits. Following a hearing held on June 12, 2025, the trial court granted the motion in limine.

A jury trial was held from June 16 through June 23, 2025. At the close of Ms. Ganoza's case, Dr. Laborde moved for a directed verdict to Ms. Ganoza's negligence, intentional misrepresentation, tarsal tunnel syndrome, plantar fasciitis and continued pain claims. The trial court granted the directed verdicts, dismissing Ms. Ganoza's claims for damages related to tarsal tunnel syndrome, plantar fasciitis, talofibular ligament injury, and ongoing pain. Dr. Laborde also moved for a directed verdict on Ms. Ganoza's informed consent claim to which the trial court denied Dr. Laborde's motion.

Thereafter, the informed consent claim was submitted to the jury. The first interrogatory on the verdict form asked whether Ms. Ganoza proved by a preponderance of the evidence the existence of a reasonable therapeutic alternative to the procedure that was unknown to her. The jury answered “No,” and, consistent with the verdict form, did not proceed to the remaining interrogatories.

On July 11, 2025, the trial court entered judgment in favor of Dr. Laborde and dismissed Ms. Ganoza's claims with prejudice. This timely appeal follows.

DISCUSSION

On appeal, Ms. Ganoza assigns six errors, however, we narrow our discussion to four issues: 1) whether the trial court's November 5, 2021 judgment properly dismissed Ms. Ganoza's claims for breach of standard of care; 2) whether the trial court properly granted the motion in limine, dismissing Ms. Ganoza's intentional tort claims; 3) whether the trial court applied the correct law and properly instructed the jury on Ms. Ganoza's informed consent claim; and 4) whether the trial court properly instructed the jury and permitted it to determine causation.¹

We first address the November 5, 2021 judgment.

Dismissal of Breach of Standard of Care

Ms. Ganoza argues that the trial court erred in dismissing her breach of standard of care claim. Ms. Ganoza challenges the trial court's judgment that granted in part Dr. Laborde's motion for summary judgment, arguing that the judgment lacked proper decretal language under La. C.C.P. art. 1918.

The trial court held a hearing on November 6, 2020 on Dr. Laborde's motion for summary judgment and the trial court signed a judgment on November 16, 2020:

IT IS HEREBY ORDERED that defendants’ Motion for Summary Judgment is GRANTED as to breach of the standard of care.

IT IS HEREBY ORDERED that defendants’ Motion for Summary Judgment is DENIED as to informed consent.

Thereafter, Dr. Laborde moved for clarification of judgment because of a contradiction between that judgment and the trial court's oral ruling at the summary judgment hearing. In June 2021, a hearing was held and the trial court granted the motion for clarification of judgment. On November 5, 2021, the trial court signed an amended judgment:

IT IS ORDERED, ADJUDGED AND DECREED that Defendant, State of Louisiana, through the Board of Supervisors of Louisiana State University and Agricultural and Mechanical College on behalf of LSU Health Sciences Center, LSU Health Care Services Division, Interim LSU Public Hospital, and James M. LaBorde, M.D.’s, Motion for Summary Judgment, is hereby GRANTED IN PART AND DENIED IN PART.

IT IS ORDERED, ADJUDGED AND DECREED that Defendant, State of Louisiana, through the Board of Supervisors of Louisiana State University and Agricultural and Mechanical College on behalf of LSU Health Sciences Center, LSU Health Care Services Division, Interim LSU Public Hospital, and James M. LaBorde, M.D.’s, Motion for Summary Judgment, is hereby GRANTED as it pertains to Plaintiff, Maria R. Ganoza's claim for breach of the Standard of care.

IT IS ORDERED, ADJUDGED AND DECREED that Defendant, State of Louisiana, through the Board of Supervisors of Louisiana State University and Agricultural and Mechanical College on behalf of LSU Health Sciences Center, LSU Health Care Services Division, Interim LSU Public Hospital, and James M. LaBorde, M.D.’s, Motion for Summary Judgment, is hereby DENIED as it pertains to Plaintiff, Maria R. Ganoza's claim for informed consent.

Ms. Ganoza sought this Court's supervisory jurisdiction and the writ application was denied. Ganoza v. State of La., 2021-0688 (La. App. 4 Cir. 12/20/21) (unpub.). Ms. Ganoza is echoing the same argument as her writ application. Ms. Ganoza fails to articulate a valid argument as to the error made by the trial court in its November 5, 2021 amended judgment. This argument is without merit.

Next, we address whether the trial court properly granted the motion in limine, dismissing Ms. Ganoza's intentional tort and fraud claims.

Motion in Limine

Ms. Ganoza contends that the trial court erred in granting Dr. Laborde's motion in limine, effectively removing her intentional tort claims for fraud and human experimentation from the jury's consideration.

“In ruling on evidentiary matters, including motions in limine, a trial court is afforded broad discretion; and its determination is not to be disturbed on appeal absent a clear abuse of that discretion.” Pierre v. Myriad Genetics, Inc., 2024-0236, p. 13 (La. App. 4 Cir. 9/16/24), 400 So.3d 223, 232, writ denied, 2024-01277 (La. 1/14/25), 398 So.3d 1168 (quoting George v. Progressive Waste Sols. of La, Inc., 2022-1068, p. 5 (La. 12/9/22), 355 So.3d 583, 587). Louisiana Code of Evidence article 403 states “[a]lthough relevant, evidence may be excluded if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury, or by considerations of undue delay, or waste of time.”

Appellate courts employ a two-part test in reviewing a trial court's evidentiary ruling by 1) determining whether the evidentiary ruling was erroneous; and 2) if the ruling was erroneous, then determining whether the error affected a party's substantial right; if not, reversal is not warranted. Pierre, 2024-0236, p. 13-14, 400 So.3d at 232 (citation omitted). “The determination is whether the error, when compared to the record in its totality, has a substantial effect on the outcome of the case.” Id. (quoting Palmer v. UV Ins. Risk Retention Grp., Inc., 2018-404, p. 12 (La. App. 5 Cir. 12/19/18), 262 So.3d 1006, 1015).

Here, citing La. C.E. arts. 402 and 403, Dr. Laborde argued that the anticipated testimony of Ms. Ganoza's witnesses would likely characterize the procedures as “experimental” or “human research” and would confuse and mislead the jury, and would unfairly prejudice Dr. Laborde. Additionally, Dr. Laborde argued that Ms. Ganoza should be prohibited from introducing evidence or testimony concerning the Institutional Review Board (“IRB”) applications because there were no IRB applications submitted by Dr. Laborde for the combination of procedures performed on Ms. Ganoza. Dr. Laborde asserted that the IRB applications are related to Achilles tendon lengthening surgery for foot conditions other than bunions, such as neuropathic plantar forefoot ulcers, Achilles tendon pain and midfoot Charcot Arthropathy. Dr. Laborde further asserted that he did not intend to study or research bunions and Achilles tendon lengthening, no such study was performed, and no research was published on the issue. Lastly, Dr. Laborde sought to prohibit the introduction of evidence or testimony concerning other patients’ claims or lawsuits against him on the grounds that such evidence was irrelevant to the present case and that, to the extent any such evidence was relevant, it was inadmissible because its probative value was substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury.

Our review of the record reveals that Ms. Ganoza did not proffer any expert testimony that identified Dr. Laborde's procedures as experimental. The trial court found that there was no evidence that Ms. Ganoza had been included in any study. The trial court also found that testimony and evidence of another patient's claim against Dr. Laborde were not identical to the present matter, as the other patient was not diabetic.

This Court has recognized, “[a]part from cross-examination, Louisiana law does not permit the independent introduction into evidence of a defendant-physician's similar medical treatment of other patients.” Joseph v. Williams, 2012-0675, p. 19 (La. App. 4 Cir. 11/14/12), 105 So.3d 207, 219 (quoting Beaucoudray v. Walsh, 2007-0818, p. 27 (La. App. 4 Cir. 3/12/09) 9 So.3d 916, 931). We do not find that the trial court abused its broad discretion in granting the motion in limine. The prejudicial effect of presenting the jury with evidence characterizing Dr. Laborde's procedure as “experimental” or “human research,” as well as evidence of IRB applications and testimony and evidence of other patients’ claims against Dr. Laborde outweighs the probative value of such evidence. See La. C.E. art. 403.

Jury Instructions

Next, Ms. Ganoza argues that the trial court applied the wrong law instructing the jury on medical malpractice standard of care principles in an informed consent case. Ms. Ganoza further argues that the trial court failed to properly instruct the jury on informed consent causation under the objective reasonable patient standard and failed to instruct the jury on the statutory presumption of breach arising from noncompliance with the Louisiana Medical Disclosure Panel.

“In addressing jury instructions, the gravity of the error dictates the applicable standard of review.” Hero Lands Co., L.L.C. v. Chevron U.S.A. Inc., 2022-0224, p. 31 (La. App. 4 Cir. 3/7/23), 359 So.3d 130, 149 (quoting PVCA, Inc. v. Pac. W. TD Fund LP, 2020-0327, p. 7 (La. App. 4 Cir. 1/20/21), 313 So.3d 320, 327). Appellate courts review jury instructions under manifest error standard of review. PVCA, Inc., 2020-0327, p. 7, 313 So.3d at 327 (citation omitted). This Court has explained, “[i]n considering an argument of improper jury instruction, the [C]ourt should consider the entirety of the charges and determine if they adequately provide[d] the correct principles of law applicable to the issues as framed by the pleadings and the evidence, and whether they provide[d] adequate guidelines for the jury.” Hero Lands Co., 2022-0224, p. 31, 359 So.3d at 149 (quoting Seal v. State Farm Fire & Cas. Co., 2000-2375, p. 4 (La. App. 4 Cir. 3/20/02), 816 So.2d 868, 872). “A de novo standard of review is warranted only ‘when the charges are so incorrect or so inadequate as to preclude a verdict based on the law and the facts.’ ” Id. at p. 31, 359 So.3d 130, 149 (quoting Clark v. Jesuit High Sch. of New Orleans, 96-1307, p. 7 (La. App. 4 Cir. 12/27/96), 686 So.2d 998, 1003). “The trial court does not have ‘to give the precise instructions submitted by either party, but must give instructions which properly reflect the law applicable in light of the facts of the particular case.’ ” Carrero v. Mandina's, Inc., 2025-0254, p. 13 (La. App. 4 Cir. 1/28/26), ---So.3d ----,----, 2026 WL 221096, writ denied, 2026-00278 (La. 5/19/26), 431 So.3d 1197 (quoting Goodman v. Allstate Ins. Co., 1998-732, p. 3 (La. App. 5 Cir. 5/19/99), 736 So.2d 310, 312).

Informed Consent

Ms. Ganoza argues that the trial court applied the wrong law by instructing the jury on medical malpractice standard of care principles in an informed consent case. It is well established that informed consent is analyzed under negligence principles and is governed by the provisions of the Medical Malpractice Act. In re Med. Rev. Panel For Claim of Larche, 97-2397, pp. 6-7 (La. App. 4 Cir. 4/15/98), 714 So.2d 56, 59 (citing Lugenbuhl v. Dowling, 96–1575 (La.10/10/97), 701 So.2d 447).

The trial court instructed the jury, in relevant part ² :

In a mal practice [sic] action based on the negligence of a physician licensed under [R]evised [S]tatute 37:1261. et seq, which means there's category of statutes behind there. The plaintiff shall have the burden of proving, number one, the degree of knowledge or skill possessed, or the degree of care ordinarily exercised by physicians, dentists, or chiropractic physicians licensed to practice in the State of Louisiana and actively practicing in a similar community or locale and under similar circumstances, and where the defendant practices in a particular specialty, and where the alleged acts of medical negligence raise issues peculiar to the particular medical specialty involved, then the plaintiff has the burden of proving the degree of care ordinarily practiced by physicians, dentists, optometrists, or chiropractic physicians within the involved medical specialty that the defendant either lacked this degree of knowledge and skill, or failed to use reasonable care and diligence, along with his best judgment in the application of this, that as a proximate result of this lack of knowledge skill or the failure to exercise this degree or of care, the plaintiff suffered injuries that would not otherwise have been incurred.

* * *

Under the law, a patient is presumed to have consented to the material risk communicated adequately within the written consent form when the consent form outlines, one, the nature and purpose of the medical procedure, two, the material risk associated with the procedure, three, the patient's acknowledgment of the disclosure of the information and an opportunity to ask questions and receive answers and, four, contains the signature of the patient. Thus, such a written consent shall be presumed to be valid and effective in the absence of proof that the execution of the consent was induced by misrepresentation of material facts. In a suit against a health care provider, which is based in part on the allegation on the failure of the health care provider to disclose or adequately to disclose the risks and hazards involved in the medical care or surgical procedure rendered by the health care provider, the only theory on which recovery may be obtained is that of negligence in failing to disclose the risk or hazards that could have influenced a reasonable person in making a decision to give or withhold consent.

Consent to treatment may not be written. It may be verbal if necessary information is conveyed to the patient, and the patient is given an opportunity to ask questions which are answered satisfactorily. The applicable substantive law here is the law governing informed consent claims which is both statutory and jurisprudential. Louisiana courts have developed the following four-pronged test for establishing an informed consent claim. One, the existence of a material risk or reasonable therapeutic alternative unknown to the patient, two, a failure to disclose a risk or reasonable therapeutic alternative on the part of the physician, three, that the disclosure of the risk or reasonable therapeutic alternative would have led a reasonable patient in the patient's position to reject the medical procedure or choose another course of treatment and, four, injury. When considering the significance and materiality of any potential risk or reasonable therapeutic alternative associated with the proposed treatment, the probability and gravity of harm are the primary factors to assess. These factors must be established through competent expert physician testimony.

Here, we find that the trial court properly instructed the jury on the standard of care for informed consent. We do not find it to be harmful or prejudicial to Ms. Ganoza's case that the trial court provided jury instructions on the general medical malpractice burden of proof when an informed consent claim is at issue. The trial court delineated the applicable principles of informed consent. See Descant v. Adm'rs of Tulane Educ. Fund, 95-2127 (La. App. 4 Cir. 1/21/98), 706 So. 2d 618, 630 (holding that although the trial court's instructions were unnecessarily repetitive, the instructions accurately reflect the law applicable to this medical malpractice case, including plaintiffs’ burden of proof).

Causation under the Objective Reasonable Patient Standard

Ms. Ganoza argues that the trial court's jury instructions improperly altered the informed consent standard by requiring expert physician testimony to establish the materiality of risks and alternatives and by emphasizing a presumption favoring the validity of a signed consent form, thereby shifting the inquiry from the reasonable patient to the physician. Ms. Ganoza further contends that the causation instruction improperly limited the inquiry to whether disclosure of the risk that resulted in the injury would have caused a reasonable person to decline treatment, omitting whether the procedure aggravated or activated a pre-existing condition, and that the verdict form prematurely terminated deliberations upon the jury's finding that no reasonable therapeutic alternative existed.

There are four elements a plaintiff must prove to prevail in an action based on a failure to obtain informed consent: “(1) a material risk existed that was unknown to the patient; (2) the physician failed to disclose the risk; (3) the disclosure of the risk would have led a reasonable patient in the patient's position to reject the medical procedure or choose another course of treatment; and (4) the patient suffered injury.” Snider v. La. Med. Mut. Ins. Co., 2013-0579, p. 8 (La. 12/10/13), 130 So.3d 922, 929-30.

This Court has previously explained the definition of material risks are encompassed “ ‘in the concept that in order for a patient to make an informed, intelligent decision, he [or she] must be advised of any alternatives to the proposed procedure.’ ” Ganoza, 2023-0392, p. 11, 380 So.3d at 587 (quoting Kennedy v. St. Charles Gen. Hosp. Auxiliary, 630 So.2d 888, 892 (La. App. 4th Cir. 1993)). The requirement to disclose alternatives to the proposed procedure is limited to feasible alternatives. Id. at p. 11, 380 So.3d at 587. Generally, expert testimony is required to establish the “aspect of materiality because only an expert is capable of judging what risk exists and the likelihood of occurrence.” Martin v. Berthier, 2009-1360, p. 7 (La. App. 4 Cir. 5/19/10), 39 So.3d 774, 780.

Here, Ms. Ganoza fails to consider that the existence of a reasonable therapeutic alternative is a prerequisite element to her case. See Taylor v. Louisiana Mut. Med. Ins. Co., 2014-0727 (La. App. 4 Cir. 1/14/15), 158 So.3d 900 (the Court affirming the judgment in favor of the physician after finding that the plaintiff failed to prove that the proposed alternative therapy was a reasonable alternative in her case). The record is devoid of expert testimony to rebut Dr. Laborde's position that there was no other reasonable therapeutic alternative. Accordingly, the jury was presented with the threshold question of whether a reasonable therapeutic alternative existed that was unknown to Ms. Ganoza. The jury answered the question in the negative and, consistent with the verdict form, did not proceed to the remaining interrogatories.

Because the jury found that Ms. Ganoza failed to establish the existence of a reasonable therapeutic alternative, an essential element of her informed consent claim, it was not necessary for the jury to reach the remaining elements, including whether disclosure of alternative would have caused a reasonable patient in Ms. Ganoza's position to reject the procedure. Thus, even assuming Ms. Ganoza's challenge to the causation instruction has merit, she has not demonstrated that the instruction affected the verdict. Because jury did not get past the threshold issue of material risks, we therefore find no reversible error in the trial court's instructions.

Statutory Presumption of Breach

Ms. Ganoza argues that the trial court should have instructed the jury of the statutory presumption of breach because Dr. Laborde failed to comply with La. R.S. 40:1299.40(E).³ Ms. Ganoza asserts that Louisiana Medical Disclosure Panel's list required disclosure of “limitation of motion”; however, Dr. Laborde substituted the term “stiffness” for that disclosure, and such alternative terminology does not satisfy the statutory requirement.

Prior to its repeal, effective June 6, 2012, La. R.S. 40:1299.40(E), provided that failure to disclose risks and hazards involved in any medical care or surgical procedure required to be disclosed shall be admissible evidence and shall create a rebuttable presumption of a negligent failure to conform to the duty of disclosure. The statute further provided that disclosures be given in such terms and language that a layman would be expected to understand. A “physician is required to disclose material risks in such terms that a reasonable person in the patient's position would understand. Cascio v. Downing, 2006-0570, p. 8 (La. App. 4 Cir. 4/4/07), 957 So.2d 795, 801. Here, Dr. Laborde testified at trial that he used the word “stiffness” instead of “loss of motion” because he thought that would be more understandable to Ms. Ganoza. In light of the aforementioned, we do not find that the trial court erred in not instructing the jury on the statutory presumption of breach pursuant to La. R.S. 40:1299.40(E).

CONCLUSION

For the foregoing reasons, we affirm the July 11, 2025 judgment.

AFFIRMED

FOOTNOTES

1.   Ms. Ganoza lists six assignments of error: 1) The trial court erred by instructing the jury on medical malpractice “standard of care” principles in an informed consent case; 2) The trial court erred by refusing to instruct the jury that failure to disclose a reasonable alternative with a high probability of avoiding surgery constitutes a material omission as a matter of law; 3) The trial court erred by failing to instruct the jury on the statutory presumption of breach arising from noncompliance with the Louisiana Medical Disclosure Panel requirements; 4) The trial court denied Ms. Ganoza a properly instructed jury determination of informed-consent causation under the objective reasonable-patient standard mandated by Louisiana law, and in failing to allow causation of exacerbation of pre-existing condition; 5) The trial court erred by treating Ms. Ganoza's medical malpractice claims as dismissed where the purported summary judgment lacked proper decretal language and therefore was not a valid final judgment capable of removing claims from trial; and 6) The trial court erred by granting a motion in limine that removed Ms. Ganoza's intentional tort claims for fraud and human experimentation from the jury, thereby using an evidentiary motion as a dispositive ruling without the procedural protections of summary judgment or trial.

2.   This excerpt is from the June 23, 2025 trial transcript of the trial court reading the jury instructions.

3.   The law in effect at the time of Ms. Ganoza's surgery was former La. R.S. 40:1299.40 (now La. R.S. 40:1157.2).

JUDGE SANDRA CABRINA JENKINS