This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the 2017 ruling by the Supreme Court of Pennsylvania regarding whether a physician can delegate informed consent
2. List which features constitute informed consent
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 03/01/23 through 03/01/25, participants must read the learning objectives and faculty disclosures and study the educational activity.
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In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
In June 2017, the Supreme Court of Pennsylvania determined that “A physician may not delegate to others his or her obligation to provide sufficient information in order to obtain a patient’s informed consent. Informed consent requires direct communication between physician and patient, and contemplates a back-and-forth, face-to-face exchange, which might include questions that the patient feels the physician must answer personally before the patient feels informed and becomes willing to consent” (emphasis added).
This shocking decision now requires physicians across the Commonwealth of Pennsylvania to change their practice for obtaining informed consent from patients. Physicians now must personally obtain informed consent as well as personally answer their patients’ questions. Physician assistants, nurses, and other medical personnel can no longer obtain informed consent.
As the dissenting opinion stated, “Today’s decision will have a far-reaching, negative impact on the manner in which physicians serve their patients. For fear of legal liability, physicians now must be involved with every aspect of informing their patients’ consent, thus delaying seriously ill patients access to physicians and the critical services that they provide.”
This landmark decision arose from a medical malpractice lawsuit where the patient alleged that the operating neurosurgeon failed to explain the risks of the surgery for a recurrent non-malignant tumor in the pituitary region of her brain or to offer her the lower risk surgical alternative of subtotal resection of the benign tumor, followed by radiation. During the surgery, the patient’s carotid artery was perforated, resulting in hemorrhage, stroke, brain injury, and partial blindness. The patient met once with the neurosurgeon but had her questions about the surgery answered on two separate visits by a physician assistant. In 2002, Pennsylvania enacted the Medical Care Availability and Reduction of Error Fund (“MCARE”) Act. This Act plainly states that that “a physician owes a duty to a patient to obtain informed consent[.]” Therefore, the trial jury could not consider in its deliberations whether the information was given to the patient by the physician assistant. The jury had returned a verdict in favor the neurosurgeon. With this June 2017 ruling, the case must undergo a new trial.
The process of informed consent will depend upon the jurisdiction in which you practice. A review of your informed consent process is warranted even if you do not practice in Pennsylvania.
Shinal v. Toms, No. 31 MAP 2016 (Pa. June. 20, 2017) (Baer, J., dissenting)
Pennsylvania Coalition of Nurse Practioners: PA Supreme Court Narrows Informed Consent Requirement
AMAWire: Informed-consent ruling may have “far-reaching, negative impact”
Medicolegal Issues in Breast Reduction
Click yes to consent: Acceptability of incorporating informed consent into an internet-based testing program for sexually transmitted and blood-borne infections
What emergency physicians should know about informed consent: legal scenarios, cases, and caveats
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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