High Court Case Emphasizes Importance of Informed Consent in Medical Procedures

Citation: [2023] EWHC 3115 (KB)
Judgment on

Introduction

In the High Court of Justice case “Michelle Parsons v Isle of Wight NHS Trust”, presided over by Mr Justice Ritchie, the court examined a clinical negligence claim involving failure of obtaining informed consent for post-operative pain relief (POPR), the excessive number of attempts for epidural anesthesia, and subsequent spinal cord injury caused during these procedures. The case analyzed key legal principles such as the standard of care in negligence and the doctrine of informed consent, reflecting their application within the realm of medical law.

Key Facts

Michelle Parsons, the claimant, was diagnosed with bowel cancer and underwent a right hemi-colectomy operation in 2018. During attempts to administer epidural anesthesia for POPR, the Trocar needle caused direct trauma to her spinal cord, leading to long-term neurological damage. A central dispute concerned whether the claimant consented to the subsequent unconscious epidural attempts (UEPIs), following three initial failed attempts while she was conscious.

The claim involved assessing whether the defendant, Isle of Wight NHS Trust, breached their duty of care by failing to:

  1. Obtain informed consent from the claimant regarding the risks associated with the epidural anesthesia and alternatives such as patient controlled analgesia (PCA).
  2. Cease epidural attempts after multiple failures, purportedly leading to the claimant’s spinal injury.

Drawing from “Montgomery v Lanarkshire [2015] AC 143”, informed consent necessitates that doctors provide patients with knowledge of all material risks and reasonable alternatives to the recommended treatment. The test of materiality considers what a reasonable person in the patient’s position would deem significant, or what the doctor has reason to believe the specific patient might consider important.

Standard of Care

The “Bolam v Frien Hospital [1957] 1 WLR 582” test defines the standard of care as the practice accepted as proper by a responsible body of medical professionals. The “Bolitho v City and Hackney HA [1998] AC 232” refinement requires that the professional opinion has a logical basis, considering the comparison of risks and benefits.

Documentation and Duty of Candour

Professional guidance and duty of candour necessitate accurate and thorough documentation of the consent process and clinical decisions, as an integral part of clinical care standards.

Outcomes

Mr Justice Ritchie determined that the claimant was not given informed consent for the epidural attempts while unconscious. The absence of medical record evidence underpinning the defendant’s assertions significantly weakened their case. Conversely, the claimant’s evidence remained consistent and was supported by the lack of documented consent. The decision to proceed with multiple epidural attempts was viewed as at the upper limit of acceptable professional practice but not negligent per se. However, the clinical decision did not respect the claimant’s legal right to informed consent.

Conclusion

The Michelle Parsons v Isle of Wight NHS Trust case underscores the judiciary’s continuing commitment to patient autonomy and informed consent in medical procedures. Notably, it strengthens the legal precedent that material risks and alternative treatment options must be conveyed to patients to make informed choices about their medical care. It also affirms the importance of meticulous record-keeping in reflecting such discussions and clinician decisions. Consequently, Mr Justice Ritchie’s judgment in favor of the claimant for £1.3 million in damages highlights the legal consequences of failing to meet the established standards of care, particularly in the context of informed consent.