Consent Required??

[Proserpina]

I can assure you that it will now become standard practice to discuss this at one of the country's most highly respected hospitals --- or at least the cardiac department at this hospital. The department head has already said as much. I cannot give you all the specific quotes but two themes were:

1. If the medical community has become so complacent that inserting a tube into a man's penis is not worthy of a at least a quick discussion with that patient, it is time we re-evaluate ourselves. We have to be better than this.
2. To not learn and adjust from the horrible, and avoidable, situation that occurred in this case would be a complete failure of this institution.

And I don't suppose the patient actually asked the question himself?

Also, beware of administrators giving you lip service just to get you out of their hospital.

 

[tranquility]

What people get shoved in them is not the law. Those who disagree with anything I have written in this thread need to review their legal and ethical responsibilities if they are working in the medical field. Rather than tell me how it is done, please specifically describe the legal error.

I am not way out here. I can provide case law and official ethics/legal journal support for everything I've written. Please provide ANY support for what those who disagree with what I wrote beyond your own opinion of what the law is.

 

[ivanl3]

[/quote] And I don't suppose the patient actually asked the question himself? [/quote]

As previously stated, no he did not. He had no reason to suspect this would be occuring. He had an ablation at the same facility with the same Dr a few years earlier and no urinary cath was used so there was no reason for him to suspect that one would be used this time. In fact, during the conversation with the Dr about this ablation, the focus of the conversation was on any differences between this one and the last one. Several differences were highlighted, but the urinary cath issue was never mentioned. And from what I understand, the Doc has conceded that in hindisght this should have been covered and will be in the future.

 

[ivanl3]

BTW, nothing anyone has said in this thread has changed the conclusions I reached at the beginning of this thread:

1) Although there is clearly an argument that can be made for failure to properly obtain informed cosent here, the chance of receiving a material settlement is quite low unless the patient's complications don't clear up. It will likely be months before that is known -- if not longer.

2.) B/c of #1, the chances of getting a good lawyer to take the case (at least right now) is very low as well.

And as an aside, the patient in question has a strong distaste for lawsuits (either side), so the chances of him filing a suit are extremely low to beging with. Plus there is a psychological affect at play here, IMO -- similar to that of a rape victim. He feels compltely humiliated and violated by the experience -- in addition to all the physical problems. Re-living that in a public setting is not something that appeals to him --- even if he could make a few bucks of it. Compound that with items #1 and #2 and it makes the chances practically non-existent.

 

[Proserpina]

BTW, nothing anyone has said in this thread has changed the conclusions I reached at the beginning of this thread:

1) Although there is clearly an argument that can be made for failure to properly obtain informed cosent here, the chance of receiving a material settlement is quite low unless the patient's complications don't clear up. It will likely be months before that is known -- if not longer.

2.) B/c of #1, the chances of getting a good lawyer to take the case (at least right now) is very low as well.

And as an aside, the patient in question has a strong distaste for lawsuits (either side), so the chances of him filing a suit are extremely low to beging with. Plus there is a psychological affect at play here, IMO -- similar to that of a rape victim. He feels compltely humiliated and violated by the experience -- in addition to all the physical problems. Re-living that in a public setting is not something that appeals to him --- even if he could make a few bucks of it. Compound that with items #1 and #2 and it makes the chances practically non-existent.

I'm deeply disturbed by this post.

Deeply.

He was given a urinary catheter for heaven's sake - that's not EVEN CLOSE to rape.

He needs therapy.

 

[ivanl3]

That's not how he feels. And he does intend to seek out professional psychological help once his physcial conditions allow for it. As things stand right now, that is not really possible. Remember that there are (HORRIBLE) details about what occurred after the catheter was inserted that have not (AND WILL NOT) be posted here. None, IMO, were medically inappropriate, but very much contribute to the patients physical and mental condition.

I am very hopeful that he recovers physically from what occurred. Time will tell. But I have no doubt that this man is forever psycholigcally scarred from the events.

I respectfully ask that all refrain from judging his psychological response. None of you know all the details and even if you did, it's none of our places to judge how one reacts to personal trauma. We all process it differently. And there currently is no legal question about the psychological impact on the table. So let's please leave it alone.

Thanks in advance.

 

[Zigner]

None, IMO, were medically inappropriate...

Well, there you go!

 

[ivanl3]

Right, but none would have occured had the cath not been inserted in the first place....which brings us back to doe.

 

[Zigner]

Right, but none would have occured had the cath not been inserted in the first place....which brings us back to doe.

 

[tranquility]

The OP from the start has felt that once there were complications due to the insertion, the problems were timely identified and properly treated. He has said it at least twice previously.

 

[Zigner]

The OP from the start has felt that once there were complications due to the insertion, the problems were timely identified and properly treated. He has said it at least twice previously.

OP is claiming that those complications and the treatment thereof are having a negative impact on the physical and emotional well-being of the patient.

This is all irrelevant, as the OP has already told us that the patient isn't going to pursue legal remedies (if any.)

 

[tranquility]

OP is claiming that those complications and the treatment thereof are having a negative impact on the physical and emotional well-being of the patient.

This is all irrelevant, as the OP has already told us that the patient isn't going to pursue legal remedies (if any.)

Yes, complications that derived from treatment that was not properly consented to. (Allegedly.) Once the damage occurred, it was treated properly. As to if the original treatment was proper or not is irrelevant to the question as to if there is liability for the injuries for failure to obtain informed consent. The OP has NOT already told us the patient isn't going to pursue legal remedies, he said that because of the current amount of damages, the remedies will not be pursued at this time. However, the attorney he contacted seemed to indicate if conditions changed and the injuries where more serious then they should recontact the attorney. Psychological help may be part of those injuries. Full physical recovery has not happened yet.

 

[ecmst12]

So you believe that if the situation arose during surgery where the cath was needed to prevent injury to the bladder, they should have stopped the procedure and woken him up to make sure it was ok with him? Makes no sense at all.

 

[Proserpina]

So you believe that if the situation arose during surgery where the cath was needed to prevent injury to the bladder, they should have stopped the procedure and woken him up to make sure it was ok with him? Makes no sense at all.

In complete agreement here.

 

[tranquility]

So you believe that if the situation arose during surgery where the cath was needed to prevent injury to the bladder, they should have stopped the procedure and woken him up to make sure it was ok with him? Makes no sense at all.

Um...no. I believe:

I think we'd all agree that in certain emergency medical situations, patient consent is presumed to exist for medical treatment that addresses the emergency.

and then divided it into the three main areas of discussion when dealing with medical ethics and the law in an emergency situations:

Unconscious? That's one thing. But a conscious and aware patient? A physician must respect the refusal of treatment by a patient who is capable of providing consent. Admittedly, an informed consent situation is more difficult if the patient is conscious but incapable of accurately comprehending his own medical condition.

But, everyone here is claiming the use is routine in such matters. Would that change things? Once again, sheesh.

See also:
http://www.uic.edu/depts/mcam/ethics/ic.htm

Many otherwise competent individuals are unable to participate in decisions about their medical care when they are temporarily incapacited by injuries and illness. Both ethics and the law permit physicians to treat these individuals without consent to the extent treatment is necessary to save their lives or protect them from identifiable harm or death. To the extent possible, consent for treatment should be sought from spouses, relatives, or close friends should there be someone available. In the absence of these parties, however, life-saving treatment can be administered.

This entitlement to carry out emergency treatment prevails only so long as the patient is unable to participate meaningfully in decision-making about his or her condition. When, an adult regains consciousness he or she should be respected in his or her decision-making. If an individual does not recover from unconsciousness or is cognitively impaired by injury or illness, then the standards for treatment of the non-competent or surrogate decision-making apply. (See “Surrogate Decision-Making.”) In general, people who serve as surrogate decision-makers are entitled to the same degree of disclosure that would be appropriate with a patient who is not disabled by disease or disorder.

http://www.turner-white.com/pdf/hp_mar99_emergmed.pdf
Exceptions to Informed Consent in Emergency Medicine

The doctrine of informed consent is a legal concept that applies to all physicians in every field of medicine. This doctrine is premised on the notion that “[e]very human being of adult years and sound mind has a right to determine what shall be done with his own body . . .”

The principle of bodily self-determination, even in emergency care situations, permeates through all cases involving informed consent and may only be set aside by legally recognized exceptions.
Limitations to the doctrine of informed consent do exist, and physicians do not have a duty to disclose every remote risk associated with a medical procedure. For example, the physician does not need to disclose the chance that a spinal anesthetic may be contaminated and may therefore cause neurologic damage if the chance of contamination is no longer considered a current risk. Nor do physicians have a duty to disclose risks that are considered common knowledge or already obvious to the patient, such as the risk of infection following a surgical operation.

However, physicians should note that “[r]isks of drug side-effects . . .are singled out for disclosure by some courts, even if the risk of side effect is small.” Fundamentally, the law only requires disclosure of risks that are defined as material, as judged by the seriousness or chance of occurrence. Material information is that which the physician knows or should know would be regarded as significant by a reasonable person in the patient’s position when deciding to accept or reject the recommended medical procedure. To be material, a fact must also be one which is not commonly appreciated. If the physician knows or should know of a patient’s unique concerns or lack of familiarity with medical procedures, this may expand the scope of required disclosure.