The scene

A junior doctor contacted the MDU for advice. A complaint had been made by the mother of a four-year old child who had recently undergone a routine skin biopsy. The procedure itself had been uneventful but the child had developed an infection post-operatively and was left with a large scar.

The mother complained that she had not been warned about these potential complications prior to the procedure being done. The trust was concerned that she was intending to pursue a clinical negligence claim due to inadequate consent and was arguing that she would not have let the child have the biopsy done, had she been aware of the complication risk.

The junior doctor recalled speaking to a woman who had accompanied the child to the day patient clinic on the day the procedure was done. He recalled discussing the reasons for the biopsy, as was his normal practice, and the potential complications that could arise from it, including infection and scarring. He had documented this discussion in the records, where there was also a copy of the signed consent form.

During the complaint investigation, the trust established that the woman who had accompanied the child and signed the consent form was the child's aunt, and not the mother. Although the nursing staff had been aware of this it was not communicated to the junior doctor, who had assumed the woman was the child's mother.

The junior doctor was asked to provide a response to the complaint, reflect on his involvement in the patient's care and consider what lessons he had learnt.

MDU advice

The MDU adviser suggested that the junior doctor write a factual account of his involvement and acknowledge that he had assumed that it was the child's mother with whom he had discussed the procedure and from whom he had obtained consent.

The junior doctor was advised that consent should only be obtained from a person who has legal parental responsibility for the child. This would generally be the child's mother or their father, if they were married to the mother, or if their name was on the child's birth certificate. Where the father was not married to the mother, it may be necessary to seek proof of parental responsibility before consent is obtained.

Consent from a person who did not have parental responsibility for the child would not be valid. In the event of an emergency, where no appropriate consent could be obtained, medical staff could act in the best interests of the child.

 

Under the circumstances in this case, the junior doctor should have established whether or not the woman was the child's mother, and on finding that she was not, should have contacted the mother to discuss the procedure with her, including the potential complications, and seek her consent.

All discussions with the mother and aunt should be clearly documented in the child's records. It was acknowledged that this situation may have been avoided if the parents were made aware of the need for a person with parental responsibility to give consent before they attended hospital, and this was something that the junior doctor was going to discuss with his consultant.

As part of his reflections the junior doctor did some professional development on parental responsibility and consent and planned to discuss the incident at his annual appraisal. The trust was satisfied with the explanation the junior doctor had given and acknowledged that he had reflected on this and had proactively engaged with relevant professional development to ensure that this situation did not arise again.

The trust also put procedures in place to ensure that all parents were aware of the need for a person with parental responsibility to provide consent before a procedure could be undertaken.