Observed an Unconsented surgery performed

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I'm new to OR and is currently undergoing periop101 training at a teaching hospital.

This week during my first clinical rotation, I observed a surgery being performed on a patient without consent (pt was consented for R side ovarian cyst removal and surgeon removed Right ovarian cyst but also proceeded to remove the Left one)!

My preceptor (who's a highly experienced and respected preceptor) reminded the surgeon that we do not have consent on the other side but surgeons did not stop the surgery due to "medical necessity". My preceptor then called the charge nurse and asked her to report up the chain of command and inform that we would filed an incident report (which we did).

I wasn't with the pt in preop so I don't know if the possibility of bilateral removal were even discussed but it was definitely not written on consent. And I honestly did not know what/or if anything happened in the surgery that led to "medical necessity" of the other side removal (I was charting behind computer and grabbing supplies so I didn't really see what's going on when it happened). When I called the family for update, my preceptor said to inform family surgery is still going but do not mention anything about another side being performed...it's surgeon's responsibility to speak with the family and patient afterward.

However, I have an uneasy feeling all weekend thinking about this...how else things could be done differently? Why didn't my preceptor or anesthesia or scrub tech or charge nurse do anything to halt the surgery? Or does this happen more often in OR than I think? Should i have stopped the surgeon and have him scrub out to speak with the family? Also, Should I be freaking out about liability and losing my job/license? I know I'm technically in training but I do have an RN license and my name was on the OR documentation...

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Specializes in OR, Nursing Professional Development.

Sounds like you did everything you should have. However, I bet if you read the fine print of the surgical consent, you will find language similar to "and any other procedures deemed necessary". My facility has this line in each procedural consent. In my specialty, patients who do not do well coming off cardiopulmonary bypass may end up needing an intraaortic balloon pump or ECMO support. It's not listed specifically on the consent, the surgeon doesn't break scrub to go talk to the family, we just do it because it's necessary to prevent death. In your situation, I don't know that the surgeon would be covered by any such language in the consent, but that may be how it ends up. This is why every patient should read each and every word on any consent they sign.

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Specializes in critical care.

Are you saying the ovaries were removed? Or cysts?

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Specializes in Healthcare risk management and liability.

Rose Queen has said pretty much what I would have said, and the consent forms I write have language permitting that other procedures can be done as necessary in the clinical judgment of the surgeon. A good example is you clip the common bile duct during a lap chole and you have to convert to an open procedure. You would not break scrub or go get additional permission to perform this. In this particular case, the patient was having an ovarian cyst removed, and the surgeon found similar pathology on the other ovary. I would expect the surgeon to take care of that additional pathology right then and there, as opposed to having to do another procedure later with the attendant potential morbidity and mortality of another procedure.

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Are you saying the ovaries were removed? Or cysts?

Yep. Good question. Sounds like it might of been another cyst on left side possibly. If that was the case, I think its fine. I consented for ex lap and got a partial salphinectomy(sp) with lysis of adhesions. Sometimes the surgeons find something else they need to fix.

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Specializes in critical care.
Yep. Good question. Sounds like it might of been another cyst on left side possibly. If that was the case, I think its fine. I consented for ex lap and got a partial salphinectomy(sp) with lysis of adhesions. Sometimes the surgeons find something else they need to fix.

See, if the cysts were removed, then regardless, that's really not that big of a deal. If both ovaries were removed, that's definitely huge.

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I agree with above posters, not as an OR nurse, but as a patient who has had this procedure done several times. Basically, the agreement I have with my doctor is to do what it takes to make me feel better without removing any organs. I have endometriosis and get cysts often so whatever my doctor finds that he deems necessary at the time is okay with me. I would probably be pissed if he woke me up to tell me he was going to go back in to remove a cyst on the other side. Removing organs are a whole different issue altogether, I would definitely not be okay waking up without ovaries.

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Thank you all for your responses! You have no idea how much relief this has brought me! I kept thinking what if the pt sues and this would be the end of my nursing career...😱

The surgery were for cysts removal, no ovary was being removed. Now let's say the surgeon was actually removing ovary, how should it be handled? Would he then need to break scrub or call to speak with family and obtain verbal consent? And as far as family update goes, how much information should the nurse give on the phone?

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Specializes in Nurse Leader specializing in Labor & Delivery.
See, if the cysts were removed, then regardless, that's really not that big of a deal. If both ovaries were removed, that's definitely huge.

Unless the patient was post-menopausal.

Ah, it was cyst removal. No biggie.

On a pre-menopausal woman, I don't believe any sound surgeon would go in and remove a viable ovary without a long discussion beforehand with the patient.

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Specializes in Healthcare risk management and liability.

Speaking as the person who handles these types of claims, there is very little chance indeed that the nursing staff would be involved in this case and it would have no impact on your career. It would most likely be a case pursued against the surgeon only.

Now, if this was a case of the incorrect surgical site due to your error in marking the site, or you knew the site was incorrect and said nothing or otherwise failed to act, the hospital as your employer would have a share of the liability. And some nice person like me would invite you the root cause analysis where we could all have a lovely chat about what happened and how we could prevent something like this from happening in the future.

From the OR nursing perspective, the majority of the cases I see are related to patient identification (the wrong patient, the wrong procedure or the wrong site) or surgical counts (needles, sponges, or instruments) with the occasional surgical fire or patient positioning issue thrown in for variety.

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As a legal nurse, I'm curious about a few things. If the preceptor is a highly experienced and respected OR nurse, she knows about that "... and anything else that's medically necessary" clause and has seen it a million times. If she didn't think something was odd about this procedure she wouldn't have reported it to the charge and sent the incident report to RM. I'd be interested in hearing the final outcome, including the path report.

Perhaps it's that this particular surgeon is a jerk and didn't feel he needed to explain to some nurse why he was dong what he was doing, or had some other reason not to communicate more clearly. Maybe he took the whole ovary. Maybe he was working on the wrong one to start. Perhaps it's just a big misunderstanding. Curious, though. Not OP's problem, though, I do agree about that.

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Ovarian cyst removal is necessary and it depends on what kind of cyst it was. There is a risk in anesthesia. I worked for a surgeon and procedure like that is routine among other things and yes it is medically necessary. The incident was overboard and I can assure you it will go nowhere.

How would you like it if at your follow up appointment the surgeon said, "Oh.... By the way, we saw another cyst that didn't appear on ultrasound and we didn't have a consent to remove it. So we are going to schedule you for another surgery. Gotta get the paper work!"

He was not removing an ovary he was removing a cyst. It is minor. See how ridiculous it sounds when you read above?

Surgeons are required to obtain a consent in good faith. Everything doesn't show up on imaging or in labs. As long as he can justify it he's covered.

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