TAKE CONSENT. YOU CAN BE SUED.
DON’T TAKE CONSENT. YOU CAN BE SUED.
WAIT FOR CONSENT. YOU CAN STILL BE SUED.
Welcome to being a Doctor.
A 30-year-old PhD scholar was found unconscious in his hostel in Hyderabad, India.
He had suffered a massive stroke.
MRI reportedly showed a massive hyperacute infarct involving the right middle cerebral artery territory with complete occlusion.
The doctors considered mechanical thrombectomy.
There was one problem.
The patient was unconscious.
His family was not there.
His friends had brought him to hospital, but according to the hospital, they were not authorised to make the decision.
So what would YOU do?
WAIT? Or ACT?
Remember:
TIME IS BRAIN.
The hospital waited.
Conservative treatment continued.
Consent was an issue.
Then COVID became an issue.
This was August 2020, in the middle of the pandemic.
The RT-PCR eventually came positive and the patient was transferred to a COVID-designated hospital.
His condition deteriorated.
He died four days after the stroke.
Six years later, the Hyderabad District Consumer Commission has ordered the first hospital and its consultant neurologist to jointly pay:
₹1 CRORE.
Plus legal costs.
One of the Commission’s central questions was devastatingly simple:
Why did you WAIT?
The Commission held that where an unconscious patient requires an urgent intervention and relatives are unavailable, emergency treatment can proceed on implied or presumed consent.
In other words:
YOU SHOULD HAVE ACTED.
Now every surgeon reading this knows what comes next.
Because we have also been taught:
NEVER perform an invasive procedure without informed consent.
And Indian medico-legal history contains cases punishing doctors for exactly that.
In Samira Kohli’s landmark case, the Supreme Court dealt with a patient who had consented to diagnostic laparoscopy.
While she was under anaesthesia, substantially more surgery was performed.
Consent had reportedly been obtained from her mother while the patient herself was unconscious.
The Supreme Court made the principle clear:
Consent for one procedure is not automatically consent for another.
Doctors cannot simply decide that because the patient is already anaesthetised, they know what is best and proceed.
Unless there is a genuine emergency where delaying treatment would endanger life or health.
So imagine being the doctor at 2 AM.
An unconscious patient lies in front of you.
Family unreachable.
The clock is ticking.
You have minutes.
Option A:
WAIT FOR CONSENT.
Years later someone may ask:
“Doctor, this was an emergency. Why did you WAIT?”
Option B:
PROCEED WITHOUT CONSENT.
The patient develops a catastrophic complication.
Years later the family may ask:
“Who gave you permission to do this?”
Option C:
TRANSFER.
“Why did you transfer an unstable patient?”
Option D:
DO NOT TRANSFER.
“Why did you retain a patient your facility was not equipped or authorised to manage?”
And there is another trap.
DOCUMENTATION.
In the Hyderabad case, the hospital later argued that the patient was not clinically suitable for thrombectomy.
There was a problem.
The Commission noted that this explanation was not reflected in the contemporaneous doctor’s notes/case sheets.
Think about that.
A doctor may make dozens of calculations in minutes.
Clinical condition.
Imaging.
Time of onset.
Risk.
Benefit.
Family availability.
Hospital capability.
COVID protocol.
Transfer risk.
And six years later, the decision may be reconstructed from what was written on a piece of paper during those few minutes.
If your reasoning is not documented…
did it legally exist?
This is where doctors need to stop reading this as another story about “courts troubling doctors.”
There is a much bigger lesson.
CONSENT IS NOT A FORM.
Consent is a clinical process.
And emergency consent is not permission to do whatever you want.
The law does not actually say:
“Take consent and you are wrong.”
“Do not take consent and you are wrong.”
It asks something far more difficult:
WHAT WOULD A REASONABLE DOCTOR HAVE DONE IN THOSE EXACT CIRCUMSTANCES?
That sounds beautifully simple six years later.
It can be terrifying at 2 AM.
Because the doctor gets minutes to decide.
Everybody else may get years to examine the decision.
And this is why documentation may be almost as important as the decision itself.
If you act without consent:
WHY was this immediately necessary?
Why could consent not reasonably be obtained?
What would delay have risked?
What alternatives existed?
If you wait:
WHY was waiting clinically acceptable?
Who was contacted?
At what time?
What was explained?
What treatment continued while you waited?
If the family refused:
DOCUMENT THE REFUSAL.
If the patient was outside the therapeutic window:
DOCUMENT WHY.
If you transfer:
DOCUMENT WHY THE BENEFIT OF TRANSFER OUTWEIGHED THE RISK.
Because six years from now nobody will remember the chaos of that night.
THE CASE SHEET WILL.
And perhaps this is the frightening reality of modern medicine.
We tell doctors:
Respect autonomy.
Do not touch a patient without consent.
We also tell them:
In an emergency, do not let consent delay life-saving treatment.
Both principles are correct.
The nightmare is deciding precisely when one gives way to the other.
And that decision may eventually carry a ₹1 crore consequence.
So I want every doctor reading this to answer one question.
You are standing in that emergency room.
30 years old.
Unconscious.
Massive stroke.
Potentially time-sensitive intervention.
Family unreachable.
The clock is running.
DO YOU PROCEED?
Now make it harder.
You proceed without consent.
The procedure causes a catastrophic complication.
The patient dies.
The family looks at you and asks:
“WHO GAVE YOU THE RIGHT TO OPERATE?”
Would the same society that condemned you for waiting, defend you for acting?
I genuinely do not know.
But I know this:
There are decisions doctors make in ten minutes that other people may spend ten YEARS judging.
Because six years later, nobody remembers the chaos.
THE CASE SHEET DOES.
Doctors get ten minutes.
Everyone else may get ten years.
So here is the question:
30 years old. Massive stroke. Unconscious. Family unreachable.
DO YOU PROCEED?
And if you do, the patient dies from a complication and the family asks:
“WHO GAVE YOU THE RIGHT?”
Would the same world that condemned you for waiting defend you for acting?
That is the nightmare.
And that is something every patient, every doctor, every lawyer and every judge should occasionally remember.
And what you do as a Doctor may be a contemporaneous record for a jury, many years later.
What do you think about these trends in healthcare? Leave a comment.
- Dr. Debraj Shome,
Author of
‘DOCTORS ARE NOT MURDERERS’
&
‘DEAR PEOPLE, WITH LOVE AND CARE, YOUR DOCTORS’.
deemagclinic
