Prior to entering law, when I was employed for 15 years, for a wide variety of medical specialists in private practice, attached to various major hospitals in Sydney. I organised 1000’s of surgical procedures for patients and even spoke to specialists about how they ‘warned’ their patients of surgical ‘risks’. I also personally underwent four surgeries from June 2014 to September 2015, three of the four were major surgeries, so I have personal experience of the ‘warnings’ given by surgeons.
When a patient signs a consent/request for medical procedure of treatment form (‘admission form’) prior to surgery, there is a section (which varies slightly between hospitals) but basically says:
The doctor has told me that (amongst other things):
- the procedure/treatment carries some risks and that complications may occur
- an anaesthetic, medicines, or blood transfusion may be needed, and these may have some risk;
- I understand the nature of the procedure and that undergoing the procedure/treatment carries risks.
- I request and consent to the procedure/treatment described above (set out earlier on the form) for me
Then right at the bottom of the form, it says:
I consent/do not consent to a blood transfusion if needed and immediately below that the patient signs their consent.
Does a doctor have a duty to warn the patient only of the ‘material‘ risks associated with surgery or is there also a duty to warn of the ‘material‘ risks connected with administering blood transfusions, when a patient consents to a blood transfusion (by providing consent when signing the ‘admission form’?)
If a blood transfusion is ordered while the patient is ‘on the ward‘ and the nurse hangs the blood bag following a doctor ‘writing it up‘ (usual practice) without the doctor discussing any risks of transfusion with the patient, has the doctor breached his duty of care in failing to warn of the material risks of blood transfusions?
What are some of the adverse effects of blood transfusions:
- febrile reactions
Moderately Severe Reactions
- allergic reactions (may be associated with laryngeal oedema and/or bronchospasm)
Life Threatening Reactions
- severe anaphylactic reactions (signs of cardiovascular instability including hypotension, tachycardia, loss of consciousness, cardiac arrhythmia, shock and cardiac arrest)
- acute haemolytic reactions (Most haemolytic reactions are the result of human error such as the transfusion of properly labelled blood to the wrong patient, or improper identification of pretransfusion blood samples”)
- bacterial contamination ( from sources such as donor skin, donor bacteraemia or equipment used during blood collection or processing)
- transfusion related acute lung injury (pulmonary oedema with hyperaemia)
- citrate toxicity (may cause hypocalcaemia and hypomagnesaemia)
- fluid overload or circulatory overload
- transfusion related sepsis
Delayed and Long Term Adverse Effects
- delayed haemolysis
- transfusion associated graft versus host disease
- transfusion related immunomodulatory (TRIM) (The detrimental clinical impacts of TRIM are increased chances of post-operative infections and cancer recurrence and possibly a transfusion-related multiple organ dysfunction syndrome)
- iron accumulation
- infectious disease transmission (Hepatitis, HIV + more)
Does a doctor have a duty to warn a patient of the above risks? How many of these risks are you aware of when interviewing your clients or reading clinical notes?
Duty To Warn
“A doctor has to exercise reasonable care and skill to warn of any material risk of physical injury inherent in a proposed treatment” as stated by French CJ, Crennan, Kiefel, Gageler and Keane JJ in Wallace v Kam  HCA19 at .
The patient needs to perceive the existence of the danger and fully appreciate it and then freely and voluntarily agree to accept the risk [Carey v Lake Macquarie City Council  NSWCA 4] inherent ‘in any proposed treatment.”
Adverse reactions to blood transfusions are generally not discussed with patients prior to surgery or before hanging a ‘bag’ in a ward. It may be prudent to ask your clients if they have had a blood transfusion during surgery (and then check the clinical notes) and then seek further information about any adverse reactions or long term effects following transfusion? The warnings discussed with the patient prior to surgery, if discussed, would usually be listed in the doctors notes.
I highly recommended to you to watch the following video at :
www.blood.gov.au (go to “For Patients” tab, then “Patient Education Videos” then the video “What is the Evidence Telling Us”
If you are looking for a medical negligence barrister and mediator who has both practical medical knowledge combined with legal acumen, contact Louise at (02) 9336 5399 or firstname.lastname@example.org