A physicians duty to provide information to a patient sufficient to obtain her informed consent is non- delegable


Dr KK Aggarwal    23 June 2018

Informed Consent Should Involve the treating doctor: Medscape Excerpts: Shinal v Toms case: a 2017 decision from the Pennsylvania Supreme Court. In a 4-to-3 decision, the Supreme court ruled that a physician may not "fulfill through an intermediary the duty to provide sufficient information to obtain a patients informed consent."

The courts insistence that "the treating physician personally provide all consent-related disclosures is an anachronism in a team-based health care system writes Lynch and colleagues write in an article published online today in the New England Journal of Medicine.

"From the patients perspective, physicians time may be better spent on those specialized tasks that only they have the skill to perform, while other members of the team participate in the consent process as they do in other clinical tasks for which they are appropriately trained and supervised," they continue.

The Pennsylvania courts decision stemmed from a 2008 case handled by Steven Toms, MD. He perforated the carotid artery of Megan Shinal during a total resection of a recurrent craniopharyngioma, leading to permanent severe neurologic injury.

Toms testified at trial that he discussed with Shinal her goals and the risks and benefits of total vs subtotal resection, including the potential harm that ultimately occurred.

Shinal decided to undergo surgery, but the question of whether to proceed with total vs subtotal resection was unresolved at the time of the initial consultation with Toms.

Shinal subsequently spoke with the physician assistant about scarring, the craniotomy incision, potential radiation, and the date for surgery.

Shinal signed a consent form indicating that she had discussed the risks and benefits of alternative treatments. However, the form did not specifically address the differential risks of the two surgical options.

Shinal later sued, claiming that Toms failed to explain the surgerys risks. Shinal maintained that had she known that a lower-risk subtotal resection was an option, she would have pursued that alternative instead.

Dr Ajay Kumar receives ASGE Honorary Awards-International Excellence Award

This year’s recipient of ASGE Honorary Awards-International Excellence Awards is the second Indian to have received the prestigious award. The only other Indian to have been awarded the award was Dr Nageshwar Reddy in the year 2011.

International Service Award is a distinguished honor presented to an international member who has served in a significant way to advance the mission of the Society in the International community.

Dr Ajay Kumar was presented the award at the ASGE Crystal Awards in Washington DC on June 3, 2018. ASGE honoured several outstanding gastroenterologists who have contributed to the advancement of GI endoscopy during the Annual Crystal Awards Dinner on Sunday, June 3. Hosted by ASGE and the ASGE Foundation, the gala was held at the Ronald Reagan Building and International Trade Centre in Washington DC.

In Dr Ajay Kumar’s words; “There is no greater honor than being honoured by your own peers.”  

Ajay Kumar, MD: “As an ASGE member, I was always impressed by the way the Society was organized to provide leadership and guidance in the field of GI endoscopy and has done an impressive job in spreading education and establishing quality in endoscopy throughout the world. I feel honored to join the list of some of the most eminent contributors in the field of GI endoscopy across the world.”

Participate in survey on Inflammatory bowel disease



A Russian woman had a moving swelling on the face. She took a selfie when the bump first appeared, just below her left eye. Five days later it was above the eye, before migrating to her upper lip. The doctor found she had been infected by Dirofilaria repens - a type of parasitic worm that doesnt normally infect humans according to a new case report in the New England Journal of Medicine.

About Dirofilaria immitis (Dog heartworm) 

Is a vascular parasite, with the adult worm residing in the pulmonary artery and right ventricle in dogs. Most dogs are asymptomatic. The organism is transmitted to humans by AedesAnophelesCulex, or Myzorhynchus mosquitoes, which ingest blood-containing microfilaria from affected dogs. Two clinical syndromes of dirofilariasis occur in humans: pulmonary and cutaneous infection. Cutaneous infection occurs when the larva die after inoculation into the subcutaneous tissue and cause an urticarial eruption. If a larva survives (as in this case) and reaches the heart, it dies and forms an embolus, which travels to the lungs resulting in focal pneumonitis followed by granuloma formation.

Anti-inflammatory diet

The diet has four components, including three types of food to add and a group of foods to avoid.

Foods to add include pre-biotics, such as oat groats and most fruits and vegetables, which are believed to feed the beneficial bacteria in the gut; pro-biotic foods with live cultures, such as plain yogurt, miso and kefir, which provide a variety of bacteria; and other foods necessary to meet complete recommended daily allowances of nutrients.

Foods that would feed the harmful types of bacteria and therefore should be avoided include certain grains and sugars.

Court can ask you to deposit money to safeguard frivolous complaints

Calcutta High Court has directed a petitioner to deposit Rs 10 lakh before it decides whether the PIL filed is maintainable and requires detailed hearing. The petitioner, a NGO, has filed a PIL in the high court seeking directions to exhume the body of a six-month-old girl for post-mortem to probe medical negligence charges against an Asansol-based private medical facility. The petitioner has not only faulted the hospital’s diagnosis and treatment, but also questioned the grounds on which the death certificate had been issued.

The high court order directs the petitioners to deposit Rs 10 lakh with the court registrar. If the court later finds the application not maintenable or frivolous, the amount shall be forfeited for “wasting the court’s time”.

In a 2010 order, the Supreme Court had laid down certain directions to decide the maintainability of PILs.

  1. Courts, before entertaining a PIL, should ensure that it is aimed at redress of genuine public harm or public injury.
  2. The court should also ensure that there is no personal gain, private motive or oblique motive behind filing the PIL.
  3. The court should also ensure that the petitions filed by busybodies for extraneous and ulterior motives must be discouraged by imposing exemplary costs or by adopting similar novel methods to curb frivolous petitions and the petitions filed for extraneous considerations.

The HC is likely to hear whether the petition is maintainable on June 28.


FSSAI new recommendations

FSSAI has agreed to reduce the trans-fat content in vanaspati and bakery shortenings and margarines to less than two per cent, taking the call to further reduce the trans-fatty acid (TFA) content in food. In a statement, FSSAI said, “It has been agreed that this plan will be implemented in a phased manner. That will effectively bring the level of trans-fats in food in the country to zero.” And with the consensus developed on the TFA level in fats or oils being less than two per cent, this would now be taken up by the food authority for approval, and a draft will be notified soon. The final regulation will take about three to four months.

It only happens in India but spoils the image of the medical profession

 The family members of a 50-year-old patient were horrified after a government hospital in Maharashtra informed them of his death and handed them the body. It was only after the body was brought to the home of the "deceased" Avinash Dadasaheb Bagwade that family members realised it wasnt his. Avinash Bagwade was, in fact, very much alive and receiving treatment at the hospital. 

The hospital also failed to identify the person whose body was handed over to the Bagwade family after conducting the post-mortem. 

The incident took place at the Sangli civil hospital, where Bagwade was admitted for liver ailment. The relatives received a call from the hospital informing them that he was dead. Some relatives arrived at the hospital and accepted the body.


Alzheimers Disease virus link

Analysis of large data sets from post-mortem brain samples of people with and without Alzheimer’s disease has revealed new evidence that viral species, particularly herpesviruses, may have a role in Alzheimer’s disease biology. Researchers funded by the National Institute on Aging (NIA), part of the National Institutes of Health, made the discovery by harnessing data from brain banks and cohort studies participating in the Accelerating Medicines Partnership - Alzheimers Disease consortium. Reporting in the June 21 issue of the journal Neuron, the authors emphasize that their findings do not prove that the viruses cause the onset or progression of Alzheimer’s. Rather, the findings show viral DNA sequences and activation of biological networks — the interrelated systems of DNA, RNA, proteins and metabolites — may interact with molecular, genetic and clinical aspects of Alzheimer’s.

Three giants merge to look after their employees

Dr Atul Gawande, has been chosen to head a yet-to-be-started health venture put together by Amazon, Berkshire Hathaway, and JPMorgan Chase. Gawande will begin his role as CEO of the venture — which will be based in Boston — on July 9. The entity, which was announced in January, does not yet have a name. It will be focused on employee healthcare and will operate independently of its three parent companies and of any profit motive, according to a joint statement. The new venture will initially focus on using data and technology to provide "simplified, high-quality and transparent healthcare at a reasonable cost" for their 500,000 American workers.

Happy Saturday

Dr K K Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO

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