Source: Health and Disability Commissioner
The importance of obtaining a consumer’s informed consent before administering medicine was highlighted in a decision published by Deputy Health and Disability Commissioner, Deborah James.
In her decision, Ms James noted this was particularly important where a patient has previously expressed concerns about the medication and there is documented evidence of the patient’s past adverse reactions to it in the clinical notes. She found an anaesthetist in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to obtain a patient’s informed consent for the administration of morphine prior to surgery.
In this case, a woman underwent a hysterectomy. Prior to the surgery, the woman made her concerns regarding morphine administration known to Te Whatu Ora (previously DHB) staff and the anaesthetist, including her understanding that morphine could cause her heart rate to slow to an abnormally low rate.
During surgery, the anaesthetist gave the woman 3mg of morphine. He thought this would give her better pain control after the surgery, and that giving a small dose in theatre under anaesthetic with continuous monitoring would allow him to establish if it was a safe drug for the woman. However, the anaesthetist had not obtained the woman’s informed consent for this prior to surgery. To her surprise, the woman was informed post-surgery that morphine had been administered to her.
Informed consent is at the heart of the Code and services may be provided to a consumer only if the consumer makes an informed choice and gives informed consent.
Ms James noted if a consumer will be under general anaesthetic, the Code provides an additional safeguard that consent must be in writing.
“It is unacceptable the anaesthetist did not discuss with the woman, the possibility of a trial of morphine during surgery, or obtain her consent to this.
“The woman was particularly vulnerable, as she was under anaesthetic. I am critical of the actions by the anaesthetist to give the woman morphine when she had not agreed to the trial. The woman had also stated on multiple occasions she is allergic to morphine, and there was documented evidence of adverse reactions in her notes and on her medical alert bracelet,” says Ms James.
Ms James found Te Whatu Ora did not breach the Code, as the errors that occurred did not indicate broader systems issues, and appropriate policies had been in place. However, she considered Te Whatu Ora staff could have done more to advocate on behalf of the woman to prevent the use of morphine during surgery.
Ms James recommended the anaesthetist undertake further education and training on informed consent, and report back to HDC on completion of the training. She also recommended Te Whatu Ora use an anonymised version of this case for wider education of its staff; consider streamlining its process of pre-operation checks; and take steps to ensure its staff are able to advocate for patients in theatre when and as required.
Following the events of this case, the anaesthetist has made appropriate changes to his practice.
The full report of this case will be available on HDC’s website. Names have been removed from the report to protect privacy of the individuals involved in this case. The DHB (now Te Whatu Ora), has not been named in this decision as they were not found to be in breach of the Code.
The Commissioner will usually name providers found in breach of the Code, unless it would not be in the public interest, or would unfairly compromise the privacy interests of an individual provider or a consumer.
More information for the media and HDC’s naming policy can be found on our website here.
