PATIENT consent must be beefed up beyond a "box-checking" exercise, Scotland’s health watchdog said as it revealed a series of breaches including the case of a woman traumatised when a consultant performed bowel surgery without an anaesthetic and “ignored her requests to stop”.
Last-minute changes to operations, patients being asked to sign consent forms en route to theatre and a failure to warn patients of potential life-changing side effects from surgery are among the blunders detailed in a report by the Scottish Public Services Ombudsman (SPSO) which will be discussed at the Scottish Parliament today. [thu]
The SPSO, which investigates patients' complaints once they have been rejected or exhausted at health board level, said failings around consent were a "recurring theme in the cases we investigate".
The report details the case of an anonymous female patient, known only as Mrs C, who was admitted to hospital to have a blockage in her bowel investigated.
It said: "This was examined in the operating theatre and the blockage was resolved there and then.
"However, Mrs C experienced excruciating pain and complained that she was not given an anaesthetic for the procedure. She said the consultant ignored her requests to stop.
"She also complained that she was asked to sign a consent form on her way to theatre."
The SPSO said the woman "could have been offered anaesthesia or sedation" and that the consent process had "not been handled reasonably".
In a similar case, another female patient - also known only as Mrs C - was left "severely traumatised" after undergoing a colonoscopy under conscious sedation, instead of general anaesthetic as planned, because the operating theatre allocated to her was "unexpectedly unavailable".
She went on to suffer "excessive pain and discomfort during the procedure" and was in pain for more than a month afterwards.
The report added: "Mrs C said that, during the colonoscopy, she asked many times for it to be stopped and the nursing staff also asked for the procedure to be stopped. However, the doctors (a senior staff grade surgeon and a consultant colorectal surgeon) continued nonetheless. Mrs C said she had been left severely traumatised by what occurred.
"Our investigation identified a number of serious failings including poor communication, poor record-keeping, poor understanding of the consent process, and a failure to stop the procedure when asked."
Other incidents detailed in the report include a woman who was not warned before undergoing a cardiac angiogram that there was a risk of internal bleeding or vascular damage which could trigger a stroke. A few days after the procedure she lost power in her legs, which was linked to a type of stroke within her spinal cord.
The report states: "Mrs A was transferred to a different hospital, where her scan was reviewed and found to show the appearance of a stroke on the surface of the brain. Mrs A did not recover
the use of her legs, and she complained that she had not been warned of the risks associated with an angiogram ... We found that the board’s consent forms and printed information were inadequate, and there was no evidence that all the relevant risks and benefits of an angiogram had been discussed with Mrs A."
The SPSO report said the examples highlight the need to ensure patients are "properly informed about what the consent process involves, why it is important, and what their rights are", adding: "Consent requires more than a ‘box-checking’ exercise, and it is not the case that ‘one size fits all’."
It comes amid a renewed focus around consent with the Scottish Government recently announcing that a review of the consent process will be carried out this year following the landmark Supreme Court ruling against NHS Lanarkshire in 2015 in a case brought by Nadine Montgomery, who was awarded £5.25 million compensation after successfully arguing that doctors had neglected to give her proper advice which may have led to her son, Sam, having a safer caesarean birth in 1999. He suffered brain damage during the delivery.
Scotland's chief medical officer, Dr Catherine Calderwood, also called this week for patients to have a greater role in determining their care.
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