The rules governing informed consent given by patients need to be clarified to provide more guidance for doctors, a Medical Council disciplinary hearing has been told.
Waiting lists will grow and patients will have to undergo multiple operations in place of one if a narrow interpretation of the consent provided to doctors carrying out investigatory procedures prevails, obstetrician Dr Mary Wingfield told the inquiry.
Doctors will increasingly choose to “walk away” from dealing with issues they uncover when carrying out investigations if the view is that this work is not covered by the principle of informed consent, she said.
Dr Wingfield, from the National Maternity Hospital, is giving evidence in the case of Dr Declan Egan, a Galway fertility doctor who clipped both of a woman's fallopian tubes when he had consent to clip one.
This is the fifth day of the hearing into Dr Egan, a consultant obstetrician/gynaecologist who practised until recently at University Hospital Galway and runs the private Galway Fertility Unit in Rahoon. He faces a single allegation of poor professional performance.
Medically justified
He acknowledges he should have sought the consent of Lorna McKeogh before he clipped both her fallopian tubes but argues his action was medically justified.
Ms McKeogh, a sales executive from Mountbellew, Co Galway, says the decision by Dr Egan to clip both of the tubes, rather than just one, has rendered her infertile.
As a result of Dr Egan’s actions, she has been deprived of the opportunity to bear children naturally and may only be able to conceive using IVF, an option that involves a great deal of stress and expense.
The allegation against Dr Egan is that he performed a clipping of both left and right hydrosalpinges (fallopian tubes) “in circumstances where this was not consistent with the consent form dated June 2nd, 2010”.
Dr Wingfield said Dr Egan did what he thought was best for the patient and would help improve her fertility. It was very difficult to put every detail into a consent form when you were doing a laparoscopy.
On occasion a doctor would find something they hadn’t discussed with the patient and had to make a choice, whether to do what the doctor thought the patient would want to happen, or whether to walk away.
If the latter happens, waiting lists would get longer and longer and patients would end up needing two or three operations rather than one.
She told JP McDowell, for the council, she “possibly” wouldn’t have done what Dr Egan did if she hadn’t spoken to the patient about it beforehand.
‘Not poor performance’
Her view was that Dr Egan’s action did not amount to poor professional performance. Neither was there any evidence of professional misconduct.
It was unfortunate there hadn’t been any prior discussion between Ms McKeogh and her doctors about clipping both tubes but given this didn’t happen, Dr Egan had to make his best judgement call, as he did on the day of the operation.
She said it was unlikely that Ms McKeogh, for a variety of medical factors, would be able to conceive naturally in the future. She also believed Dr Egan’s actions were covered by the consent form signed by Ms McKeogh, though she added that view had changed in recent years about the general nature of some of the clauses in this form.
Dr Wingfield said it was relatively easy to ask a woman with blockage in her fallopian tubes to agree to the removal of one tube, where she believed the other tube to be normal. However, it was very upsetting, though necessary, for patients to discuss a bilateral tubal ligation.
If the woman was prepared to undergo IVF treatment, this would be considered, but where the woman was not going for IVF, a doctor would not put her through such an operation.
Dr Egan performed a bilateral tubal ligation on Ms McKeogh, who was 32 at the time, at the Galway Fertility Unit on June 2nd, 2010.
She had been referred by her GP for gynaecological treatment after suffering a number of miscarriages. Dr Egan, who met her for the first time in theatre, told her after the procedure that he had clipped her left fallopian tube in addition to the right one, though the consent form mentioned only the right tube.
In previous evidence, he told the hearing the clipping of both tubes, rather than just one, represented the least threat to her “life and limb” by preventing fluid from blocked tubes going into the uterus and causing damage.
Mr Egan maintained the clipping of the tubes was not a sterilisation procedure as infection had blocked both tubes before he operated. He said there was very little chance of Ms McKeogh and her husband Darragh conceiving after tubal surgery and she would require IVF to get pregnant.
Clipping the tubes left open the possibility of further tubal surgery to reverse the procedure. Ms McKeogh later pursued this option, he pointed out.
