Consent not implied

...Dr P, aware that Mrs K is “exhausted and traumatised” by the birth, decides it would be unreasonable to disturb her in the middle of night...

BACKGROUND: Dr P is a registrar in neonatal medicine and is working on-call. A newborn infant – Jack K – is admitted to the unit with fever and breathing/feeding difficulties. Mrs K had been induced and the birth was difficult. She was keen to be discharged and has returned home to rest.

Jack is started on first-line antibiotics, and bloods results in the early hours of the following day are strongly indicative of neonatal sepsis. Lumbar puncture is indicated to investigate the underlying cause. Dr P, aware that Mrs K is "exhausted and traumatised" by the birth, decides it would be unreasonable to disturb her in the middle of night.

Dr P carries out the lumbar puncture and plans to discuss the results and any necessary changes in treatment with Mrs K in the morning. She is concerned that any delay in determining the cause of his sepsis might result in Jack not receiving the correct treatment early enough to prevent a deterioration in his condition.

The next day Mrs K is informed of the results, which rule out the possibility of meningitis. Although relieved, Mrs K is angry that she was not contacted by Dr P to discuss the need for a lumbar puncture – and remains upset following discussion with the on-call consultant, who explained the urgent indication for the procedure.

No formal complaint has yet been made by Jack’s parents but they are now insisting that Dr P no longer be involved in their child’s care. Dr P contacts MDDUS for advice in the matter.

ANALYSIS/OUTCOME: An MDDUS adviser emails in response. She recommends that Dr P’s line manager or clinical director would need to consider the request that Dr P has no further contact with Jack and decide whether this was feasible and would not compromise his clinical care. They would need to consider whether a sufficiently experienced colleague would always be available, for example in an emergency. She advises Dr P that, in any event, should Jack need urgent care and no other appropriate clinician was available, she should assist until a colleague could take over.

In relation to being able to justify that the lumbar puncture was warranted, the adviser suggests Dr P review the relevant national or local guidance on early-onset sepsis in neonates. Dr P is however advised that she should have discussed the need for lumbar puncture with the parents and secured their consent before proceeding – and an acknowledgement of this and an apology would be appropriate.

Dr P is advised to contact MDDUS again should the matter escalate into a formal complaint.

KEY POINTS

  • Always ensure you have appropriate consent before undertaking a procedure or treatment.
  • Proceeding with an intervention without consent would only be justified where immediately necessary to save the patient’s life or prevent a serious deterioration in their condition.
  • An apology and sincere expression of regret can often stop a complaint escalating further.

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