Failure to discuss medical treatment options creates liability
August 21, 2009
Posted by:Suzanne Trask
The importance of discussing true alternative treatment options with the patient has been emphasised in the case of Janet Birch and University College Hospitals NHS Foundation Trust. Ms Birch was 55 years old and had a history of diabetes. She was admitted to Watford General hospital with suspected third nerve palsy due to the occlusion of a small blood vessel supplying the third nerve, which controls most of the eye's movement. However, she had symptoms that were atypical of this condition, including swelling around the eye, nausea and possible infection. An urgent MRI was recommended, however no slots were available at Watford, so she was referred to the National Hospital for Neurology, Queen's Square. Ms Birch was admitted and the neurosurgeons decided to do a catheter angiogram rather than an MRI. The risks of the angiogram were explained to her, including the 1% risk of stroke. Unfortunately, the catheter angigram did result in a stroke, leaving her with left sided weakness and lack of function in her left arm. J Cranston held that there was a failure to provide Ms Birch with the full information and risk analysis of performing a catheter angiogram rather than an MRI, and that had this occurred, she would have most likely opted for the MRI scan and avoided her injury. This again emphasises the judiciary's movement away from supporting medical paternalism towards upholding patient autonomy.