Obstetrician accused of failing to obtain informed consent before dilation and curettage procedure
The Health Professions Appeal and Review Board of Ontario recently confirmed a decision to issue advice to an obstetrician/gynecologist on alleged deficiencies in his conduct relating to a dilation and curettage (D&C) procedure performed after a miscarriage.
The patient in this case was referred to the doctor for a D&C after experiencing a miscarriage. Following her surgery in November 2021, the patient filed with the College of Physicians and Surgeons of Ontario a complaint expressing concerns about aspects of the care that she received.
Specifically, the patient alleged that the doctor:
- failed to introduce himself or speak directly to her
- failed to obtain informed consent before the D&C and a subsequent pelvic examination after she experienced postoperative bleeding
- displayed poor bedside manner, including by failing to show empathy or sensitivity
- provided inadequate postoperative care, including by prematurely discharging her and by failing ensure that she was ready to leave
The Inquiries, Complaints and Reports Committee of the College investigated the matter and determined that the doctor’s actions did not amount to professional misconduct. However, the committee held that certain aspects of his practice fell short of professional expectations.
The committee noted that the doctor relied on other surgical team members to introduce him and that, while a resident obtained consent for the D&C, the doctor failed to explicitly obtain consent for the postoperative pelvic examination after the patient started bleeding.
The committee found that the doctor failed to adequately document the postoperative bleeding incident and his response to it and failed to show sensitivity to the patient during a potentially frightening time.
The committee advised the doctor to:
- introduce himself to patients before starting surgery
- obtain consent for postoperative pelvic examinations
- contemporaneously document events requiring intervention
- communicate professionally with patients
- understand the importance of being sensitive to the patients’ experience during internal examinations and to react accordingly
Advice confirmed
The patient requested a review of the committee’s decision. She wanted the review board to issue a professional reprimand and to order increased supervision for the doctor. She claimed that the advice given did not reflect the seriousness of his actions.
In Mckenna v Giannoulias, 2024 CanLII 79505 (ON HPARB), the Ontario Health Professions Appeal and Review Board refused to impose more severe disciplinary measures and instead confirmed the committee's decision to provide the doctor with advice, which was aimed at improving his professional conduct and safeguarding future patient care.
The review board found that the committee conducted a thorough investigation and gathered relevant information, including medical records and responses from both parties.
The review board also deemed the committee’s decision reasonable. The review board noted that the committee applied its knowledge in assessing the doctor’s conduct against the expected professional standards.
Lastly, the review board found the advice provided to the doctor appropriate. The advice would serve to address the deficiencies identified in his practice, the review board said. The complaint and resulting advice would remain on the doctor’s record and would be available for consideration in any future complaints, the review board noted.
