Question

A 64-year-old woman by the name of Rhoda Dendrum was admitted to the Caruana hospital. She was hospitalized with complications of MS. The patient’s vital signs were marginal, low pulse, dilated pupils and moderate temperature. The admitting team felt that she needed to be placed in ICU and that a feeding tube was recommended to assure adequate nourishment. They asked the patient about this and she agreed. However, later in the day, actually, early evening, the patient became disoriented (prior to the tube being placed). She seemed confused about her decision to have the feeding tube placed. She claimed that she had no recall of the events. She told the surgical and medical staff that she doesn’t want it in her. They let her go to sleep. The next morning the medical team revisited the question when they felt that the patient was lucid. Rhoda was unable to recall her state of mind from the previous evening and she again agreed to do the procedure. She was told about the procedure by Dr. Francis (Frank) N Stine when he said, we are considering a cardio inversion…. Would you be interested in that? She nodded yes. Please assume that this procedure was not covered by her private insurance and was very expensive. As a result of the intubation, she began to experience a rapid and irregular heartbeat. She has a history of A-FIB. Her condition was deteriorating but she was clear-headed. She was told that she needed a recommended procedure called a cardio inversion, (stopping and restarting a heart to stabilize the heart). The arrhythmia was solved but the total billing is in the amount of $38,234.83. The hospital is demanding payment for the services and the patient is denying responsibility because there was no agreement to perform these services. Do not consider any issues of malpractice and assume that everything that happened related to the issues of offer and acceptance and consent.

In your opinion, was this patient competent to make this decision? What would be the factors which would be looked at and what would be some of the issues with respect to informed consent in this case? Was there and offer and acceptance? Please explain what informed consent is and please explain which preference (tube or not) should be honored.

Answer 1

The patient was competent at the beginning yo make a decision. Both at the time of asking for a NG tube insertion and for cardio-version.The patient responded by saying yes made the team to go ahead for the procedure.

The factors which could have a looked at

• The psychological status of the patient
• Getting a professional support and advice from ethics committee
• Informed consent when patient was conscious

The informed concent plays a key role whether it was in a written form or a printed form signed by the patient could have avoided the legal consequences when a patient claims against them

The providers offered the care by informing to the patient and there was also acceptance from the patient

Informed consent refers the detailed explanations of a treatment process,care,procedure,etc.,by a healthcare provider to a patient or relative and getting it signed off aftr the patient or patient party completely understands and accepts it

It is always honour to get an informed consent on a patient without tube who is in a sound mind.