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Information about and informed consent for anaesthesia (09HDC01691)

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(09HDC01691, 6 April 2011)

Anaesthetist ~ Abdominal surgery ~ Choice of anaesthesia ~ Informed consent ~ Rights 6(2), 7(1)

A woman complained that she was given morphine without her consent. The woman was admitted to a private hospital for abdominal surgery, for a suspected ovarian mass. She had previously completed preoperative documentation, noting allergies or sensitivities to codeine and cloth sticking plasters. Nursing staff completed a preoperative checklist, and placed allergy stickers on several pages in the clinical notes. These indicated that codeine caused the patient to feel "spaced out", plasters caused a rash, and also that morphine caused vomiting. "Codeine", "morphine" and "sticking plaster" were written on her patient wristband. During the pre-anaesthetic consultation with the anaesthetist, the patient said that she did not want morphine because it had previously caused her to vomit, and explained that she had tolerated pethidine and tramadol in the past.

Later that morning the woman underwent surgery. On arrival in the recovery ward, she was started on a morphine PCA and given Codalgin (paracetamol and codeine). The woman was reviewed by the anaesthetist that evening. At that time, her main complaint was a feeling of being "spaced out". A nurse reminded the anaesthetist of the woman's previous reactions to morphine and codeine, and noted that he was not concerned.

The woman's postoperative course was marred by episodes of nausea and vomiting, despite the use of antiemetics. Because of this, she declined analgesia other than paracetamol from the first postoperative day. Another doctor prescribed pethidine and tramadol on the afternoon of the second postoperative day. The woman was discharged home five days after her surgery.

The anaesthetist did not make it clear that he intended to prescribe morphine, in spite of the patient's express wish not to have morphine. Nor did he discuss her clinically feasible choices, including those not preferred in his judgment.

It was held that the anaesthetist failed to provide the woman with adequate information about her options for postoperative pain relief, or act appropriately to obtain her informed consent for the treatment he provided. Accordingly, he was found in breach of Rights 6(2) and 7(1).