It's OK to repair damage without consent, say doctors

SINGAPORE - It is not uncommon to accidentally severe nerves during surgery.

When that happens, it is best to repair the damage in the same operation, even if the patient is sedated and no prior consent has been given, said doctors interviewed by The Sunday Times.

The surgeon's immediate concern should be to act in the patient's best interest, which is to repair the damage as quickly as possible to ensure the patient's best chance of recovery, said Dr Andrew Chin, head of the Hand Surgery department at the Singapore General Hospital (SGH).

However, surgeons should be prepared for such complications by providing patients with sufficient counselling and informing them beforehand of the possible outcomes and risks, the doctors said.

The consent form should also include clauses for the patient to be informed of additional procedures that may be performed should complications arise.

Last month, hand surgeon Looi Kok Poh made headlines when he severed the nerves of his patient during surgery and proceeded to repair them without the patient's consent.

He later had a nurse amend the patient's signed consent form to include the additional procedure.

For that misdemeanor, Dr Looi had his accreditation revoked by Parkway Holdings, barring him from performing surgery at three of Parkway's facilities: Gleneagles, Parkway East and Mount Elizabeth hospitals.

Dr Looi was also found liable for failing to protect the patient's medical records by the Singapore High Court, along with Gleneagles Hospital.

The damages to be awarded to the plaintiff - a property and stock trader from Hong Kong Mr Li Siu Lun - will be determined by the court at a later date.

Doctors interviewed by The Sunday Times also said consent forms should never be altered and stressed the importance of ensuring patients are fully aware of the complications that may arise during the surgery and what steps will be taken to rectify them.

However, surgeons also explained that there is a relatively high risk of nerves being accidentally cut in a complicated procedure, especially if there is already existing damage and scarring to the tissue.

Some hospitals here say they have measures in place to prevent such cases from happening.

At Tan Tock Seng Hospital (TTSH), forms are submitted electronically, and no cancellations or alterations are allowed once forms are submitted, said Dr Winston Chew, head of TTSH's Hand and Microsurgery section.

This system is being considered for implementation at SGH, Dr Chin said.