Question

The patient was to undergo a fundoplication surgery to repair an esophageal hernia. The procedure involves the insertion of an esophageal dilator, which at this institution is performed by the anesthesia team. In this particular instance, the dilator was to be inserted by a nursing anesthesia student. The student introduced herself to the patient immediately before the procedure. She used her first name only and stated that she was a registered nurse who would be working with the nurse anesthetist and anesthesiologist. The student referred to the nurse anesthetist by first and last names and to the anesthesiologist using the term doctor and his last name.

During the insertion of the dilator, the student tore the lining of the esophagus. This required an open procedure to be performed which resulted in complications for the patient. The patient sued for lack of informed consent, inadequate supervision, and negligence. Specifically, the patient argued that he had the right to know if a student was to perform any part of the procedure and that he had the right to refuse such participation.

The court returned a verdict in favor of the patient on the part of inadequate supervision. As stated in the institutions written policies, the student was to be supervised by an anesthesiologist, not merely a nurse anesthetist.

Was the informed consent deficient to the degree that there was a lack of informed consent by the patient?

How would you decide this case?

Answer 1

The patient has a legal right for autonomy and self-determination. A doctor who treats the patient without valid consent from the patient will be under tort and criminal laws.

Also the nurse should introduce herself to the patient by using the full name, her position, what they are there and the Type of procedure they are going to perform and be sure that the patient completely understands the person and their job, that will consent to do it. Using the last and first name make confusion for the patient it can damage their therapeutic relationship. Informed consent should be stated clearly. Informed consent for nonemergency treatment when changes for an unauthorized procedure involving patients that makes the risk for the outcome, when the patient was complicated during that time and harmed by the negligence of students and anesthetist lead to medical malpractice. The anesthesiologist should give enough information about the procedure then only the patient can provide consent for their treatment. It should include risks, outcomes, alternates to the procedure, etc.