A Clinical Risk Case Study- Failure to Obtain Adequate Consent for Surgery

A Clinical Risk Case Study- Failure to Obtain Adequate Consent for Surgery

The Scene

The Patient had a history of left medial knee pain and was listed for surgery after an MRI confirmed a significant posterior horn tear of the meniscus along with a small chondral defect.

The Patient consented for and underwent a left knee arthroscopy. However, during surgery the Orthopaedic Surgeon performed two procedures, the first a meniscal repair procedure, and secondly an articular cartilage repair to the medial femoral condyle. The Patient was only broadly consented for the meniscal repair procedure and did not consent to the chondral surgery.

Post-operatively the Patient continued to suffer from significant left medial knee pain, and a second opinion was sought.

Following a further MRI scan a failed meniscal repair was confirmed. The Patient therefore, underwent a second left knee arthroscopy.

Recommendations to Help Improve Healthcare Standards and Patient Safety

Improving the Standard of Consent

All surgery, especially complex surgery such as this needs thorough consenting. TMLEPs recommendations are that patients should be provided with an information leaflet detailing all the material risks and benefits of the procedure(s). For this case for example, the risks and benefits would be:

  • Failure to relieve pain and locking
  • Infection
  • DVT/PE
  • Failure of the meniscal repair and revision surgery
  • Extended period of non weight bearing

A further recommendation to satisfy the increasingly detailed consent requirments would be, to ensure that any alternative treatment options are discussed in detail with the Patient. In this case for example, alternatives would include:

  • Conservative treatment in the form of physiotherapy
  • Non steroidal anti-inflammatories
  • Activity modification

The final recommendation, in order to ensure any consent can be relied upon, is to ensure that surgeons document their discussions regarding the consent process in the patient’s notes, both at the clinic stage and on the consent form. It is simply not enough to write in the modern day that the ‘risks and benefits have been discussed with the Patient’, they must be more detailed so that they can be relied upon and referred to in the future as and when necessary.

To Conclude

Although surgery itself can be unsuccessful through no fault of the Surgeon, if the Surgeon does not discuss the risks and potential adverse outcomes (such as the meniscal repair failing and the possible need for further chondral surgery), the clinician and healthcare provider leave themselves vulnerable to litigation.

References

  • The TMLEP Clinical Risk and Patient Safety Publishing Group and Miss Diane Back BSc(Hons) MBBS FRCS Ed(Tr&Orth) Consultant Trauma and Orthopaedic Surgeon. (2018). A Clinical Risk Case Study- Failure to Obtain Adequate Consent for Surgery. TMLEP Clinical Risk Case Studies. 2 (1), 1.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable. To request an independent clinical review, please contact admin@tmlep.com or call +44 (0) 203 355 9796.