Improper Informed Consent Leads to Allegation of Negligent Supervision In this i

Improper Informed Consent Leads to Allegation of Negligent Supervision
In this interaction, the involved physicians avoided disclosing important information to the patient during the informed consent process. An informed consent exchange that is not truthful and complete violates standards of medical ethics.
Allegation
Improper performance of a procedure; negligent supervision; improper informed consent
Case File
A 59-year-old female patient was scheduled for burr-hole drainage of a subdural hematoma she had sustained in a fall. The night before the surgery, the patient was evaluated by a neurosurgeon and a third-year neurosurgery resident. The burr-hole procedure was agreed upon, the risks and benefits were discussed with the patient and her husband, and the patient signed an informed consent form.
The next morning the resident brought the patient to the operating room and performed burr-hole drainage of a right subdural hematoma with placement of two subdural drainage catheters. The resident’s supervising neurosurgeon was not in the operating room during the surgery, although he had reviewed the procedure with the resident before the surgery. Postoperatively, the patient had left hemiparesis. A CT scan revealed that the right frontal catheter had entered the right frontal cortex. The attending physician met with the patient and her husband and explained the nature of the complication. The catheters were subsequently removed, and the patient was discharged to a rehabilitation center. She continued to have left-sided weakness, paralysis and pain.
The patient and her husband sued the attending neurosurgeon and the resident, alleging improper performance of the procedure, negligent supervision of a physician in training and improper informed consent. They testified that their understanding was that the attending physician — not the resident — would perform the surgery. Complicating this situation were the facts that the attending physician was listed as the primary surgeon on the operative report, and the resident had never before performed the procedure independently.
Expert reviewers thought that while the decision to perform the burr-hole drainage of the hematoma was proper, the attending physician should have been present during surgery to supervise and assist. They believed the resident’s placement of the drainage catheter into brain tissue caused significant, permanent paralysis. In addition, experts asserted that if the resident had been directly observed and supervised during the procedure, the complication would likely have been prevented. Further, experts believed the informed consent process was flawed because the attending physician’s name, not the resident’s, appeared on the consent form and the patient and her husband testified in depositions that they had expected the attending neurosurgeon to perform the surgery. Because expert reviewers thought the care and informed consent process did not meet the standard and more likely than not caused harm to the patient, the case was settled.
Four Basic Principles of Medical Ethics2
Beneficence — acting for the patient’s good
Nonmaleficence — doing no harm
Autonomy — recognizing the patient’s values and choices
Justice — treating patients fairly
QUESTIONS FOR POST
1. Nonmaleficence is the key ethical principle in this case. Why?
2. What is the definition of INFORMED CONSENT?
3. Based on the consent obtained during this case, why did the informed consent process not meet medical standard?