An 5-week old infant presents with a fever. The mother refuses the standard lumbar puncture to rule out meningitis. The ER doc called Child Protective Services, who took custody of the child, and the LP was performed. The physician was subsequently sued:
A recent Idaho federal court ruling shows doctors should tread carefully when considering whether to get the state involved to ensure that a child gets critical treatment despite the parent’s objections.
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{ 11 comments }
If the concept of informed consent means anything, then in virtually all circumstances we have to respect patient/parent choices. Even if those appear to be poor choices, we have to allow people to exercise their autonomy. In reality, poor choices are still frequently followed by adequate results (even Russian Roulette works out OK 83% of the time). Making a big deal about poor choices has the perverse effect of reinforcing poor choices. There is the human tendancy to confuse luck for wisdom, and the fool who wins the gamble will be even more likely to gamble in the future.
I completely agree with gasman. In this case, I would have someone in the room to witness my discussion of the risks/benefits of proceeding (or not) with the LP as part of a full septic work-up, and if the family still refused, I’d document the hell out of it in the chart (name of witness, direct quotes from parents regarding their reasons why to not LP, details of discussion and facts you provided, etc.).
I wonder if we’re moving to a point where physicians will begin asking patients to document their choices that run counter to standard of care (e.g., having parents who choose not to vaccinate sign a statement acknowledging the risks). The AAP has such a form for parents who refuse to vaccinate.
Please explain why if the parent thought that a child’s fever was serious enough to take the child to the emergency room–where presumably qualified expertise is available– why the parents felt qualified to second guess the treating physician. Exactly what were the criteria these parents used to decide they didn’t want to give consent to the LP?
I have been in the position where I have had to threaten the same kind of action (in my case in a suspected Tylenol poisining), and I completely agree that the ER doctor
should at least have been given the benefit of the doubt. If the federal court can’t establish the facts against the doctor are present, how then should they find against him? And just how much information should the parent be given, if they do not show an adequate capacity to understand even an elementary amount of reasoning? It isn’t the doctor’s responsibility to compensate for every parent’s deficiency in reasoning or education, especially in an emergency setting. The patient is the child, not the parent. Suing because 1. the parent doesn’t like the idea of an LP and 2. the LP might appear to have been “unnecessary” because it was “normal” is still a frivolous action. Was harm done? Doubtful. Was informed consent given? The patient is incompeternt by minority, and the parent is not reasonable. Show me how the action of the doctor is still in the wrong. You can bet if the kid wasn’t tapped at the request of the parent and there was a bad outcome, the family would be suing because, you guessed it, the doctor failed to provide the right kind of pre-procedural consent.
“She concluded from her own research that the procedure’s risks outweighed the chances that her daughter had meningitis, records show.”
Published and peer reviewed, we may presumed. Most of the time when my patients tell me about their “research” it means that two other people at the beauty parlor told them something.
The internet does us no favors with parents for medical procedures. I often find they’ve stumbled upon a forum or discussion board or relying on faux-science.
I’m also with gasman. This doc did no service to informed consent. If we do our job as docs and explain the choice, most times parents have a right to opt in or out.
Sam raises an interesting point. I can only imagine what our medical records being to look like if we have to have parents literally document their choice legally. Not sure there is enough RAM on most computers for what will occur.
Who was there to act in the child’s best interests? A 5 week old cannot give consent at all, much less informed consent. Given the risk both medically and medicolegally, this physicians bent over (forwards, unfortunately) to do what he deemed best for the patient. I hope he is able to recover in a countersuit, but my guess is that this is just the usual extortion act, without any harm done, looking for a quick settlement.
Parents have NO right in ANY country to “opt out” of care deemed potentially lifesaving by a physician – what utter nonsense.
Parental rights are superceded by the duty of physicians to treat children appropriately nad protect their welfare despite parental objections.
This kind of verdict is complete rubbish and gives a big boost to the rabid anti (insert lifesaving , evidence based Rx of choice here) lunatics.
Glad I don’t work in the US!
I am allergic to the paint needed to paint the target insignia on my forehead!
Well once again the lawyers/courts f@#$ed up again. Are you surprised. This is what happens when the judiciary which has a total lack of understanding of potential medical emergencies is making 20/20 hindsight decisions.
PS: I personally saw someone DIE of meningitis/septic shock over the course of six hours so that JD IDIOT who stated there was plenty of time HAS NO GODDAMN CLUE WHAT HE IS TALKING ABOUT.
“A recent Idaho federal court ruling shows doctors should tread carefully when considering whether to get the state involved”
The legal system keeps the final authority, but dumps the responsibility back on the doctor.
This topic is covered (on the adult side) in a nice piece in today’s NY Times. Click here.
Interesting issue with adult consent on behalf of minors.The law permits the latitude of surrogacy automatically to the parent, even if the parent might not be the most qualified person to judge the best interests of the child. Yet while the consent is given by the surrogate, the liability does not follow the same course. The liability still remains open until the child reaches legal majority and then usually for a prescribed time after. That seems unreasonable, given that the right to decide is awarded to a person presumed to be a competent adult at the time consent is given. Laws that permit liability in pediatric medical encounters to extend as they do appear to stand that notion on its head, suggesting perhaps that right to consent isn’t really being given to the adult after all.
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