Expert: Man Did Not Properly Consent to Fatal Heart Procedure

Joseph O'Neill

Written by
— Updated on October 23, 2017

Informed ConsentDecedent underwent a coronary angiography, and he died during the procedure. His estate sued the defendant doctor in Pennsylvania Court of Common Pleas under the Pennsylvania wrongful death statute. Plaintiffs allege the doctor breached the standard of care during the procedure and that decedent did not even need to have it because he did not have significant symptoms of myocardial ischemia. Further, they assert that other, less dangerous treatment options were available and that the defendant did not adequately explain them to the decedent. The defendant also failed to provide sufficient information for the decedent to give informed consent.

Question(s) For Expert Witness

  • 1.) What is the accepted standard for obtaining informed consent?
  • 2.) Was it breached?
  • 3.) Was the decedent of sound mind when he consented to the angiography?

Expert Witness Response

As an anesthesiologist, I commonly encounter patients who are presented with informed consent documents that are requisite in order to undergo a wide range of procedures requiring my services, either as a provider of sedation and/or general anesthesia. Informed consent regulations require that the patient has consent capacity at the time consent is obtained. This means that the individual has the ability to understand information relevant to making a voluntary decision and must be able to understand the nature and risk of the proposed treatment as well as alternatives to it. There are circumstances which impair or diminish a patient’s capacity to understand, including mental or emotional conditions, language barriers, and medications or concomitant drug use.

The standard of care in medical practice is to preclude the use of sedative medications in preparation for surgery until informed consent is obtained. The patient needs to have the capacity to understand and reason about his condition and proposed intervention so as to be able to appreciate the risks, benefits, indications and alternatives. If the patient lacks capacity, consent is invalid and commonly used medications in the realm of anesthesiology alter ones capacity. That is why it is mandated that such medications be withheld until consent is obtained.

In this circumstance, decedent was administered benzodiazepine, which is a psychoactive medication used to provide sedation. It possesses sedative, hypnotic, amnesiac and anxiolytic actions, which, though desirable for undergoing a procedure, also interfere with cognition, decrease alertness and concentration and impair information processing. As such, it would be expected to have altered decedent’s baseline abilities of providing the elemental contingent aspects of informed consent, that is, to have the capacity to render decisions relevant to his care. Shortly after 9:00am during the course of the coronary angiography, and while decedent was sedated with benzodiazepine, as well as fentanyl, a synthetic opioid, specific findings of the catheterization were reviewed with him and an intervention (stenting) was performed. It would be expected at this particular time, which was approximately 1/2 hour after the administration of the anesthetic agents, that decedent would still be under the effect of such medications, including their synergistic capacity to affect baseline cognition.

The expert is a board-certified anesthesiologist and pediatrician.

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