Clinic consultation

Clinic and surgeon found in violation after procedure performed on child without consent

A child underwent nose surgery that his parents did not consent to. Photo/Picture 123rf

An 8-year-old boy had his nose operated on despite his parents’ refusal to consent to the operation.

It wasn’t until their son had to be discharged from the private clinic following further procedures that had been agreed to for his ongoing respiratory issues, that his parents noticed there was “a bit of oozing” coming from his nose.

At this point, a nurse noted another abnormality – the boy’s adenoids had not been removed despite this procedure being part of the operative plan.

A ‘chain of errors’ has since been identified by the Health and Disability Commissioner (HDC) in the boy’s case, after his parents complained to the watchdog.

As a result of the investigation into this matter, the clinic and the surgeon were found guilty of violating the Code of Rights for Consumers of Health and Disability Services (the Code).

The commissioner’s report, which does not name any of the parties, emphasizes the need to ensure respect for the patient’s right to decide to refuse treatment and the importance of providing appropriate information in order to obtain informed consent.

The report says the family first met with the otolaryngologist, referred to in the report as Dr A, in December 2019 to discuss treating the boy’s breathing and allergies.

The parents agreed and consented to the surgical treatment of their son, which was to take place in April 2020.

The consented and signed procedures included removal of the boy’s adenoids and tonsils, cleaning of his ears and imaging of his voice box, trachea and ears.

In February 2020, Dr. A wrote to the parents recommending that the boy undergo cauterization of his inferior turbinates (TIC) alongside the other scheduled procedures.

The CIT procedure involves making an incision or cauterizing the swellings on
the side walls of the nose (the turbinates).

The following month, the otolaryngologist’s clinic wrote to the mother to add the CIT procedure to the consent form and have it signed. However, the parents refused the CIT procedure and this was acknowledged by the clinic staff.

Despite the acknowledgment, the email in which the CIT procedure was refused was not placed in the boy’s electronic file, which means that Dr A was unaware that the boy’s parents had refused the procedure .

At the time of the boy’s surgery in July 2020, following a postponement due to Covid, Dr A consulted his records and recommendations in the boy’s file, which still included the CIT procedure.

Prior to the surgery, there was miscommunication between the mother and Dr. A regarding consent to the procedures to be performed. This resulted in the CIT procedure being written on the consent form and signed, contrary to what the parents understood they had not consented to.

The mum told HDC ‘we laughed and said we wouldn’t understand the medical jargon, and we repeated her fine as long as it was just an ear check, a vocal cord check , removal of adenoids and tonsils. [Dr A] confirmed that was what he wrote.”

The CIT procedure was performed, but the boy’s adenoids were not removed because only an insignificant amount of adenoid tissue was present.

After the operation, a brief discussion regarding the outcome took place between Dr A and the parents before the boy was transferred to another ward for recovery and monitoring.

About six hours later, the parents realized for the first time that, contrary to their expectations, their son’s adenoids had not been removed and the CIT procedure had been performed.

As a result of the investigation, the commissioner found that the clinic was responsible for ensuring that the parents’ decision to refuse the CIT procedure was acted upon and communicated to Dr A.

Because this “critical information” was withheld, the clinic violated the Code.

The clinic had informed the HDC that when new clinical information is received, the usual
The process was to email the information to Dr. A and file the email in the patient’s notes.

The clinic told HDC there was “no acceptable explanation” as to why the email was not saved in the boy’s electronic file, but said the timing of the first Covid lockdown had caused considerable stress to clinic staff.

“This is a very regrettable act of omission in a time of crisis.”

The clinic also said it was standard practice for staff to follow up verbally with Dr. A to confirm the email was received and acted upon.

He acknowledged that Dr A had “not been fully and clearly informed verbally of [the boy’s] parent’s decision

Dr. A had also violated the Code, the commissioner concluded, because, despite his ignorance of the family’s denial of consent due to an error in the clinic’s systems, he retained overall legal responsibility and duty to obtaining informed consent to procedures.

Additionally, the commissioner criticized the postoperative care of Dr. A.
communication with the family regarding their decision not to remove the boy’s adenoids.

He admitted he did not tell the boy’s parents during their post-surgery briefing that the adenoids had not been removed.

The otolaryngologist also acknowledged that he did not provide the family with enough information about the CIT procedure and that this was followed by miscommunication on the day of the surgery as to whether the procedure was to be included in the proposed procedures to be undertaken that day.

He acknowledged the seriousness of the parents’ concerns and told the HDC he was truly sorry they found his consent process lacked its “usual rigor” and that.

“Dr. A explained that as a result of this complaint, he made significant changes to his practice and that of the clinic,” the report states.

The boy’s parents told HDC they wanted accountability and recognition that things could have gone better for their son.

“They said there were ‘multiple opportunities’ to correct their understanding and that the informed consent process was ‘uneven at best,'” the report said.

“They hope the concern raised can lead to a review of the process and prevent something
the same thing happened to another young patient.”

The commissioner recommended that the clinic issue a written apology to the family and review the effectiveness of its new policy, which requires an additional consultation with a patient when there is a delay of more than three months between the initial consultation
and the day of surgery.