Unforeseen complications

The patient with severe endometriosis

39-year-old patient diagnosed with severe endometriosis attends a specialist Obstetrician and Gynaecologist who recommends the patient undergo a hysterectomy. The patient has been referred to that specialist because the specialist is highly experienced. The specialist appropriately takes the patient’s consent and the patient signs a consent form verifying consent to a “hysterectomy plus any other procedure deemed necessary”

The specialist has admitting rights at Best Private Hospital (BPH) and schedules the procedure to take place in four weeks’ time; the specialist is away during weeks one and two of that four-week period. The specialist sends the signed consent from to BPH with other relevant paperwork. 

Seven days after the consultation the patient has an episode of extreme pain and attends BPH Emergency Department (ED). Through an arrangement betweenBPH and a company named Emergency Department Doctors Pty Ltd (EDD P/L), EDD P/L provides the medical personnel working in the ED and BPH provides the nursing personnel, premises and equipment. The attending ED physician assesses the patient and recommends that the patient be admitted having the hysterectomy ASAP. Because her specialist is away, the BPH contacts Specialist B who is the specialist next on the rotating roster for referral. The patient is informed that the referring specialist is away, but that Specialist B is available to do the procedure the next day. The patient agrees and is admitted to BPH.  

The next morning specialist B attends the hospital, reviews the patient record, attends the patient and informs the patient that in the specialist’s opinion it would be best for the patient to have the procedure that day to which the patient agrees. 

During the procedure there were unforeseen complications caused by scarring from previous surgery. Specialist B determined that in addition to the hysterectomy it is in the patient’s best interests to also perform a bilateral salpingo-oophorectomy and proceeds accordingly. 

Reason for complaint, claim or investigation 

The patient subsequently ascertained that Specialist B, has only recently gained their fellowship and has done that particular procedure only 15 times. This was compared to the initial specialist who was highly experienced and has performed the procedure about 1000 times. Had she known that; she would not have agreed to Specialist B performing the procedure. 

Clinico-legal knowledge 

  • Informed consent.
  • Material risks
  • Appropriate material risk communication and assessment 

Questions to ponder 

  1. Has the hospital and/or EDD P/L and /or Specialist B obtained valid informed consent to Specialist B performing the procedure?  
  2. Specialist B didn’t re-consent the patient for the surgery instead relying on the consent form witnessed by the initial specialist and which appeared on the patient record. Was Specialist B entitled to rely on the consent form taken and witnessed by the initial specialist? 
  3. Was there valid informed consent from the patient in respect of the bilateral salpingo-oophorectomy? 

Key learning points

Comprehension and application of informed consent legal principles. In particular: 

  • What are materials risks? 
  • Why they are important? 
  • How are they approached in informed consent conversations? 
  • How should they be recorded in the health records? 

Relevant board’s code of conduct skills and competencies

4.5 Informed Consent