The Pandemic, Elective Surgical Care and Informed Consent

Posted By Mike Meyer, Thursday, March 19, 2020

empty hospital beds

By Jeff Segal, MD, JD, ByrdAdatto and Medical Justice

As I write this, we are reading in the news about potential quarantines and lockdowns. In addition, there's talk about canceling all elective surgical cases, leaving hospital operating rooms empty so beds will be available to take care of those affected by COVID-19.

Have all elective cases been canceled across the US? No. Weirdly enough, while most people are hunkered down, there is a sizeable cohort who are capitalizing on their time off. Business is slowing, and they'e been told to work remotely from home. Now they have a window of time to undergo that procedure they have been putting off.

Does the fact that there is a background pandemic change anything? Yes. Any surgery is an insult to the body. It is stressful. It affects the immune response. You know that. Most of the time, the body heals as expected.

What if the patient gets COVID-19 while convalescing? Perhaps nothing would change, and it would be no different than if they got the flu. But if the patient gets extremely sick, do not be shocked if a plaintiff's attorney argues that the patient was not reasonably informed about the increased risk of COVID-19 while the body was in a weakened state. I'm not suggesting a patient's post-surgical state may cause exacerbation of COVID-19—I'm just prognosticating the legal argument.

So, what to do? If your practice stays open and you are performing elective surgical cases, make sure the patient understands that any surgery increases their susceptibility to an infection, including the coronavirus. It's unlikely to move the needle much. It will depend upon the patient's underlying health, the body's reaction and the viral load, and these variables are not entirely predictable. As long as the patient is reasonably informed and the procedure is not unnecessarily risky relative to the background viral activity, the legal argument should be neutralized.

Use good judgment and stay healthy!

Jeffrey J. Segal, MD, JD, is a neurosurgeon turned serial entrepreneur turned attorney at ByrdAdatto who has literally been in both business and medicine. Segal was a neurosurgeon in private practice before beginning the second phase of his career as a serial entrepreneur in the health care field. He then founded or co-founded four separate health care startups. Segal lives and breathes health care and understands it viscerally.

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