Informed Consent For Wrist Surgery

The Office of the Health and Disability Commissioner today released a report finding an orthopaedic surgeon in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to establish informed consent for a surgical procedure.

A woman had suffered injuries to her right wrist, and was undergoing hand therapy treatments. In her first visit to the orthopaedic surgeon, she saw the surgeon, a trainee, and a hand therapist. The plan was for the woman to continue with hand therapy treatments and then have another review in two months’ time to consider surgical intervention.

At the second review, the woman first saw the trainee, who did not document his conversation with the woman, but told HDC that the details of ulnar shortening osteotomy, including the use of plate and screws, were discussed. The woman then saw the orthopaedic surgeon, who advised HDC that the trainee told him that he had gone through the operation with the woman in great detail and that she was happy to proceed.

The orthopaedic surgeon signed the consent form with the woman. The form noted the operation to be performed, but the clinical notes and consent form did not document in detail what was communicated to the woman.

The woman told HDC that neither the trainee nor the orthopaedic surgeon informed her about the use of a plate and screws, or that her ulnar was to be cut in half and shortened with access through her forearm. The surgery was performed and proceeded uneventfully. However, the woman subsequently suffered further complications to her elbow and saw a new orthopaedic surgeon.

Former Commissioner Anthony Hill considered it unlikely that the woman was informed that her ulna bone would be cut in half, or that her surgery would involve the insertion of a plate and screws. He found that therefore the woman was not in a position to make an informed choice or give informed consent for the treatment provided, and, as a result, that the orthopaedic surgeon breached the Code.

The Commissioner also found that, by not documenting the information that was provided to and discussed with the woman, the orthopaedic surgeon failed to adhere to Medical Council of New Zealand standards.

"It was important for [the woman] to know that her surgery would involve cutting her bone in half at the forearm and then inserting a plate and screws," said Mr Hill. "The failure to provide this information meant that she did not receive the information that a reasonable consumer, in her circumstances, needed to make an informed choice."

The Commissioner recommended that the orthopaedic surgeon undertake further training on communication and informed consent, and provide HDC with evidence that the training has been completed. He also recommended that the surgeon apologise to the woman.

The full report for case 19HDC00455 is available on the HDC website.

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