A thirty-two year-old mother delivered her third child by cesarean section. After the delivery, her obstetrician tied her tubes. The plaintiff complained the sterilization was done without her knowledge or consent. During a routine prenatal visit the plaintiff claimed that she had stated she did not want her tubes tied after the cesarean section, which was written in the obstetrician’s records. There was no written consent form for the sterilization. The obstetrician claimed that the nurse at the delivery approached him before the delivery and said that the patient had informed her that she wanted to have her tubes tied. The nurse had no recollection of the conversation. The cesarean section was the only consent in the records. The patient’s chart showed that the nurse had prepared the sutures for the tubal ligation and had taken the removed portions of the tubes to the lab. She had no memory of doing this.
The case was settled against the nurse. The defendant obstetrician claimed the patient could have reversal of the tubal ligation or could have more children with in vitro fertilization. A $490,000 settlement was reached in this Virginia case.
Source: Lewis Laska, Editor, Medical Malpractice Verdicts, Settlements and Experts, November 2010, page 27
Comments: Nurses are well informed that surgical procedures require consents. It is common practice to add a tubal ligation to a cesarean section consent form when the woman desires sterilization. The surgical nurses verifies that the consent is signed and witnessed. Witnessing the signature means that the patient appears to understand what she is signing. Nurses can perform this function. Surgeons also commonly obtain informed consent and witness the form.
This interesting Virginia case hinged on the fleeting memories of healthcare workers involved in one surgical procedure among hundreds or thousands performed annually. The absence of the informed consent made it impossible for the nurse to prove the patient requested a sterilization. The obstetrician relied on the nurse to make sure that the consent was signed. However, the obstetrician’s office records showed the patient did not want a tubal ligation and yet he or she went ahead in a rote way and performed the unwanted surgery. Reversal of tubal ligation is not often successful, and in vitro fertilization is a complicated undertaking that is often not covered by insurance policies. Both the nurse and the obstetrician fell through the holes in the safety net of health care.
Patricia Iyer MSN RN LNCC is a former medical surgical nurse who witnessed many consents of patients over the years.