Healthcare-acquired infection (HAI) rates at Dartmouth-Hitchcock Medical Center (DHMC) were below national averages, according to a New Hampshire Department of Health & Human Services report. How did it do it? Through a statewide patient safety checklist!

http://www.fiercehealthcare.com/story/checklist-prompts-low-infection-rates-dartmouth-hitchcock/2011-08-09?utm_medium=nl&utm_source=internal

Ann Miller RN MHA

Good informed consent is not just presentation of a form that demands the patient’s signature on the bottom. The process is dependent on all aspects of a good doctor-patient interaction, i.e. positive and empathetic communication, good bedside manner, open and frank discussion of alternatives and costs, opportunity to ask questions, to seek independent advice, and to make decisions based on full disclosure of relevant facts. The result can however be a valuable clinical record of benefit to all role-players in the process of having a surgical procedure.

The demands of taking fully informed consent are considerable. No patient is the same, and a standard ‘one size fits all’ approach cannot take this into consideration. The same can be said for the doctor taking the consent. All have individual approaches and styles that should facilitated by the consent process.

Again, ‘one size fits all’ is as inappropriate for doctors as it is for patients. The challenge for doctors is in documenting the process for both their patients’ and their own benefit. Without technological [customizable e-templates] assistance this is impossible to do, for example, to the satisfaction of a medical malpractice lawyer hell-bent on proving medical negligence.

Martin Young MD

So, presence of a detailed consent, while perhaps not specifying an obscure complication, makes it just that. No consent, or inadequate consent = mistake in my book.

Dr. Martin Young

The plaintiff, who was a healthy woman and an avid jogger and race walker, was a female in her mid-50′s at the time she visited the two defendant podiatrists. She contended that she had two office visits prior to surgery. She maintained that the defendants advised her that she needed an in-office surgical repair of her feet due to all the years of jogging, which had caused bursitis on the balls of her feet, as well as, hammertoes.

The procedure, called Arthrodesis, is usually reserved for more rigid toes or severe cases, such as when there are multiple joints or toes involved. It is a procedure that involves a fusing of a small joint or joining in the toes to straighten them. A pin or other small fixation device is typically used to hold the toe in position while the bones are healing. She alleged that she signed a pre-operative consent form. However, she claimed that during the procedure, the doctors failed to advise her that they would be performing additional invasive surgery, which involved the fracturing of her toes on both feet. As a result, she has been diagnosed with ataxic gait and experiences continual pain in both feet and toes and can no longer enjoy jogging.

The plaintiff testified that if she had been made aware of the extensiveness and invasiveness of the procedure, she would not have consented to it. She also produced testimony that the defendants failed to obtain consent for the additional surgery. As a result, the plaintiff claimed she has difficulty walking, is no longer able to jog and experiences pain in both feet and all of her toes. The plaintiff’s expert podiatrist testified that the plaintiff has since been diagnosed with ataxic gait, and will have pre-mature arthritis as a result of the surgery. In addition, he testified that the extensive procedure was unnecessary and that she would someday be a candidate for “salvage” surgery. Plaintiff’s counsel also testified that the plaintiff’s insurance company was overcharged.

The defendants testified that they did, in fact, inform the plaintiff of the surgical procedure, both before and during the surgery. They maintained that the phalanges and metatarsal surgical repair was necessary. In addition, they testified that the additional surgery was necessary in order to properly correct the plaintiff’s abnormalities in her toes. They maintained that the patient signed a consent form and they produced what they claimed was the plaintiff’s signature on a consent form. The defendant surgeons maintained that the procedure was minimally invasive. Counsel for the defense argued that the surgery did not worsen her condition.

Source: Podiatry Malpractice Blog
http://www.podiatrymalpracticeblog.com/2008/10/articles/another-category/750000-verdict-failure-to-obtain-informed-consent-for-foot-surgery-ny/

In two separate state rulings, in both Maryland and Wisconsin State Supreme Courts, the requirement that doctors provide “every” alternative treatment and risk was made. But these rulings go even further. Plaintiffs now have the ability to sue for “informed consent” claims even in the ABSENCE of proof of negligence. This is a new high water mark against healthcare providers. Unfortunately, without tort reform, it is unlikely that these issues will be solved. At this time, tort reform is absolutely off the table.

Podiatrists now (already) try to seriously provide extensive information and obtain informed consent for procedures. But with the bar higher now, it will probably mean that podiatric physicians inform their patients about attendant risks of many non-surgical treatment choices, like injection and drug therapies. Remember, it will no longer be necessary for your patient to prove “negligence” if you practice in either of these states.

Since I am not an attorney, I cannot provide legal advice. However, I would suggest that carriers that presently insure podiatrists take heed of the new rulings, and try to prepare their insured against this new threat. This might start out with patients’ signing informed consent for injection therapy and various drug therapies, including potent antibiotics that podiatric physicians routinely order.

Source: Michael M. Rosenblatt, DPM, San Jose , CA
[Podiatry Management August 31, 2009]

I just called to order Version I; and hope to order Version II in the future.

Charles Kelman; DPM
[West Lake Village, CA]

At e Podiatry Consent Forms™, we include basic skeletal illustrations and diagrams for your consideration; at no additional charge! We’ve placed them in a separate file for your convenience, too. Incorporate them into your informed-consent process and paperwork whenever you wish; or not!

Use our illustrations and diagrams, or substitute your own. It’s another value-added Content Management feature, for your consideration.

The Management