A matter of consent

...afterwards the patient complained that she had not agreed to undergo the type of procedure the doctor had carried out...

BACKGROUND: Mrs J has a long history of abdominal and pelvic pain and is referred by her GP to a private specialist. The 42-year-old is seen by a consultant gynaecologist, Dr S, who after numerous diagnostic tests discusses the possibility of performing a total hysterectomy. Mrs J agrees on the understanding that her ovaries – which she has been told appear healthy – will be conserved if possible.

While performing the hysterectomy, Dr S identifies signs of endometriosis and thickening of the fallopian tubes and decides to remove both ovaries. Subsequent tests reveal the ovaries and tubes are both normal and Mrs J continues to suffer pain. She also now requires HRT for early onset menopause and this leads to depression.

Mrs J lodges a complaint against Dr S alleging clinical negligence and a failure to obtain informed consent for the removal of her ovaries. It is alleged that Dr S should not have removed the ovaries without a more thorough assessment of their condition. It is also argued that Mrs J only consented to a hysterectomy on the basis that her ovaries would not be removed unless there was an urgent need to do so during surgery and this should have involved further discussion of the matter with her. A copy of the consent form signed by Mrs J cannot be located and only the medical note written before the operation is available for reference.

ANALYSIS/OUTCOME: MDDUS, acting on behalf of Dr S, commissions an expert report from a consultant gynaecologist. The report concludes that Dr S was not justified in removing the ovaries, particularly as the pre-operative medical note suggests Mrs J thought they would be conserved unless absolutely necessary. The member accepts that the case is indefensible and MDDUS negotiates a settlement with Mrs J.

KEY POINTS

  • Always fully explain the risks and benefits for each treatment option, including potential lifestyle changes.
  • Be clear about the circumstances under which you might decide to proceed to more radical treatment when carrying out surgical procedures, i.e. to save life or avoid significant deterioration such as in cases of uncontrollable bleeding or malignancy.
  • Make a clear and comprehensive note of discussions you have had with the patient about consent before any procedure.