Consent in patient’s / attendant’s handwriting? Yes, why not!

Informing patients and attendants about procedure’s known complications and taking an informed consent in their own handwriting is one of the healthiest practice doctors can follow. This case is an excellent example of this fact.

The patient, a teenage girl, suffered from progressive congenital spinal deformity which was diagnosed as Congenital Kyphoscoliosis. She was admitted to a reputed hospital where the orthopaedic surgeon performed a surgery.

Soon after the procedure, misplacement of screw was identified and an emergency surgery was performed. The patient was discharged after some days with an advice to come for follow up. However, the patient’s father consulted other hospitals where the young girl underwent physiotherapy and received treatment. Unfortunately, her lower limbs were paralysed.

The hospital and orthopaedic surgeon were sued by patient’s irate father. It was alleged that spinal surgery necessitated presence of a neurosurgeon, however it was performed by an orthopaedic surgeon who was not entirely competent. It was further alleged that the surgery was performed without the C-arm which led to misplacement of screw.

The Commission rejected these allegations as it was observed from records that the hospital had two fully functional C-arm machines and the surgery was performed with one of those. It was also observed that an orthopaedic surgeon can treat spinal injuries and perform the procedure which the patient underwent. Presence of a neurosurgeon was not mandatory.

More importantly, for the hospital and orthopaedic surgeon, the Commission observed that an informed consent was taken, as it stated the following: “It is an admitted fact that the patient’s father and one other relative are doctors. They were aware about congenital spinal defects and the available treatment options and their risks. Post-operative paralysis is a well-documented complication of spinal deformity due to anatomical malpositioning of spine. It is pertinent to note that the patient’s father gave two informed consents, in his own handwriting after accepting all these complications and as possible consequences of the surgery. Parents / relatives were duly explained more than once and consented for the surgery”.

The hospital and orthopaedic surgeon were not held negligent and the case against them was dismissed.