LEGAL ISSUES
The guidance concludes that the Montgomery case has changed the focus of the consent process from one in which the surgeon would explain the procedure to the patient and obtain their consent to proceed, to one in which the surgeon sets out the treatment options and allows the patient to decide. The RCS points out that this change requires the surgeon to take time to explore the patient’s values and wishes about their care and to have sufficient experience to fully understand the risks and
benefits that are material to the patient. It follows therefore that the discussion about options lies with the surgeon responsible for the patient’s care or, if this is not practical, with an experienced member of the surgical team who has the time and skill to gain sufficient understanding of the patient’s views and wishes.
The RCS has produced a series of podcasts with a dramatised case study commentary by senior surgeons and a patient to support a cultural shift in the
The Montgomery case
In 1999, Nadine Montgomery gave birth by vaginal delivery to Sam. The birth was complicated by shoulder dystocia. Medical staff performed the appropriate manoeuvres to release Sam but, during the 12-minute delay, he was deprived of oxygen and subsequently diagnosed with cerebral palsy. Mrs Montgomery is diabetic and small in stature and the risk of shoulder dystocia was agreed to be 9-10%. Despite expressing concern to her consultant about whether she would be able to deliver her baby vaginally, the doctor failed to warn Mrs Montgomery of the risk of serious injury from shoulder dystocia or the possibility of an elective caesarean section. Mrs Montgomery brought a claim against Lanarkshire Health Board, alleging that she
should have been advised of the 9-10% risk of shoulder dystocia associated with vaginal delivery notwithstanding the risk of a grave outcome was small (less than 0.1% risk of cerebral palsy). It was also alleged that delivery by caesarean section ought to have been offered to Mrs Montgomery, and that this would have prevented the child’s injury. Lanarkshire Health Board argued that only the risk of a grave adverse outcome triggered the duty to warn of such risks and that, because the risk of such an outcome was so low and that an expression of concern was not the same as a direct question requiring a direct answer, no warning was required. The Supreme Court held that the question should have been about Mrs Montgomery’s likely reaction if told of the risk of shoulder
dystocia. The unequivocal position was that she would have chosen to give birth by caesarean section. The Bolam test was deemed unsuitable for cases regarding the discussion of risks with patients, as the extent to which a doctor may be inclined to discuss risks with patients is not determined by medical learning or experience. The court ruled that Mrs Montgomery should have been informed of the risk of shoulder dystocia and given the option of a caesarean section. Mrs Montgomery was awarded £5.25 million in damages.
Source:
www.medicalprotection.org/uk/ formembers/news/news/2015/03/20/ new-judgment-on-patient-consent
OFFERING A RANGE OF SERVICES THAT MEET CUSTOMER EXPECTATIONS
Full customisation of DIN containers. As well as supplying any type of basket from standard DINs to wire mesh trinket boxes, we can also supply them with silicone fittings and metal or silicone covered posts for added instrument protection. In some instances we can provide the fitting service on site.
way doctors think about consent and how they apply it in practice. To download the guidance and view the podcasts, visit:
https://www.rcseng.ac.uk/standards- and-research/standards-and-guidance/ good-practice-guides/consent/ To access the GMC’s guidance on consent and the law, a variety of learning materials, case studies, a mental capacity decision support tool, and other useful links, visit:
http://www.gmc-uk.org/guidance/ 27164.asp
CSJ
Our newly designed Endoscopy Tray Transport Trolley can fit all types of moulded endoscopy trays. Can be used both internally or externally as it is completely sealed when closed, we recommend that it is fitted with a cylinder lock also for extra security.
We provide a number of sterilisation packaging products, one being the coloured hang labels, which can be used to writing on or for simple colour coding. We can provide them in two sizes and a variety of different colours.
H4 MEDICAL HAS THE ANSWER Tel: +44 (0)161 743 9772 E-mail:
sales@h4medical.co.uk Web:
www.h4medical.co.uk Unit 21, Agecroft Enterprise Park, Shearer Way, Swinton, Manchester, M27 8WA United Kingdom FEBRUARY 2017
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