Surgical consent altered at UW after case involving hysterectomy
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MADISON, Wisconsin (madison.com/Wisconsin State Journal) — UW-Madison’s obstetrics and gynecology department changed its surgical consent process to ask patients to sign consent forms on the day of surgery, not before, after a case in which a patient’s ovaries were not removed as desired during a hysterectomy.
“This reduces the possibility of conflicting information and offers another opportunity on the day of the surgery to verify the intended procedure,” Dr. Laurel Rice, department chair, said in a statement.
The policy change in 2018 came after a patient’s ovaries were not taken out as requested during a 2015 surgery at Meriter Hospital to remove her uterus, cervix and fallopian tubes. Details of the case became public this month in a Wisconsin Medical Examining Board order against the OB-GYN provider involved, Dr. Jay Lick.
After the patient discovered her ovaries had not been removed, Lick removed them during a second surgery the same day with no complications, according to the medical board order.
No lawsuit has been filed in the case. The medical board accepted continuing education that Lick completed in 2017 involving risk management as what the board would have ordered, after a hearing scheduled for last June was delayed indefinitely because of the COVID-19 pandemic. No action was taken against his license.
“Dr. Lick remains a valuable member of our faculty,” Rice said. “We are confident in the treatment he provides to patients.”
The unidentified patient, born in 1965, initially agreed to have her uterus, cervix and fallopian tubes removed, and the procedure was scheduled. During a subsequent clinic visit with Lick, the patient said she also wanted her ovaries removed. Lick suggested she keep them to reduce risk of osteoporosis and heart disease, and she agreed not to have them taken out. She signed a consent form to have just the uterus, cervix and fallopian tubes removed.
Shortly after the visit, she called the clinic and said she wanted her ovaries removed. Lick made a handwritten change to the consent form but didn’t change the procedure in the woman’s electronic medical record. A nurse made a “telephone note” in the electronic record indicating the change.
On the day of the operation, the orders in place called for removing the uterus, cervix and fallopian tubes. Lick checked part of the electronic record but not the parts indicating the change requesting removal of the ovaries.
Twice before surgery in front of the patient, Lick stated the procedure he planned to perform, using the medical terms “total vaginal hysterectomy, bilateral salpingectomy.” If the procedure included removal of the ovaries, it would be called “bilateral salpingoophorectomy.”
According to the medical board order, Lick “has implemented changes in his personal practice to avoid a similar future event including speaking in plain language during a preoperative discussion with a patient and reviewing the most recent clinic notes prior to a procedure.”
The order says the OB-GYN department now has patients sign the consent form on the day of surgery, “with the stated procedures listed in plain language.”
However, Rice said the form doesn’t have to use plain language. “We have long encouraged providers in our department to use plain language in all communications with patients but there is no departmental requirement to use plain language in consent forms,” she said.
Lick was involved in another case in which a Dane County jury in 2019 awarded an Oregon woman and her husband $435,000 — reduced to $300,000 because of a state cap — after finding Lick failed to disclose information about a procedure after the birth of the couple’s son, causing injuries that led to a hysterectomy and loss of fertility.
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