Black fungus: Surgeons say delay in consent could cause death of patient

A delay in getting a written consent regarding surgery from relatives can lead to dangerous spread of mucormycosis ENT and neuro surgeons have warned They say that by the time the relatives decide on consent the damage is beyond repair and this is a new challenge for health care experts Over 90 patients are fighting mucormycosis at the state run JJ hospital and the number of cases is on the riseDr Prithesh Shetty Khan Bahadur Haji Bachooali Ophthalmic hospitalThe surgeons are concerned after the recent demise of a man in his early forties who was suffering from mucormycosis The fungus had spread within a short span of time resulting in both eyes getting infected and subsequently spread to the cerebral regionmidday its article titled lsquoNonCovid woman dies due to black fungus despite right surgeryrsquo dated June 1 had highlighted the condition of Mohsina Khatoon 43 from Uttar PradeshWasim Khan 22 her nephew speaking from Lucknow said ldquoIt was a shock when doctors told us that the infection was spreading and sought consent to perform lifesaving surgery The doctors in Mumbai performed surgery to save her life but she could not be saved We now feel that we should have got her to Mumbai immediately instead of taking her to a private hospital in Lucknow where she was kept for nearly two weeksrdquoDr Wiqar Shaikh professor of Medicine Grant Medical College and Sir JJ Group of Hospitals said that the central health ministry has confirmed more than 28000 mucormycosis cases in India At the Sir JJ Group of Hospitals currently there are approximately 92 cases and there are 7 cases in his ward The treatment for mucormycosis is an injectable antifungal drug AmphotericinB for 14 to 21 days Another drug is posaconazole But Dr Shaikh said that unfortunately these drugs have not done wonders in postCovid19 mucormycosis and the black fungus has been seen to spread from the sinuses to the eyes and then to the brain ldquoOnce this happens the only lifesaving treatment available is aggressive surgery wherein the parts affected have to be surgically removed Unfortunately if consent for surgery is delayed the black fungus could result in the death of the patientrdquo said Dr ShaikhTime of intervention crucialDr Shashank Joshi consulting neuro surgeon said ldquoIn mucormycosis cases time of intervention is important to save patientsrsquo lives Pending consent is a hindrance for doctors to perform lifesaving proceduresrdquoDr Prithesh Shetty consultant Oculoplasty Ocular Oncology and Ocular Prosthesis at Khan Bahadur Haji Bachooali Ophthalmic hospital in Parel said ldquoI generally explain surgery to the spouse or children or any immediate relative The more the relatives the more opinions given to the patient and this causes confusion and delay in surgery Hence the whole purpose of doing an emergency surgery is defeatedrdquolsquoBut consent is necessaryrsquoHowever Dr Subhash Hira professor of Global Health at the University of WashingtonSeattle said ldquoThe informed consent of the patient or herhis kin is important because it requires surgical intervention and expensive injections For several reasons that consent is delayed and the black fungus spreads rapidly into the eyes nose or the brain Despite this spread and likely bone erosions happening fast the legality of completing the informed consent cannot be done away with even if it means some delay in beginning with the treatmentrdquoAdvocate Gopinath Shenoy Senior Medico Legal consultant and former district consumer court judge said ldquoIn any invasive procedure a written consent is mandatory as per the law and this has been laid down by the Supreme court in Sameera Koli vs Dr Prabha Manchanda case The only exception to this law is in a situation where the doctor plays the role of locoparentis when the patient is unconscious and his relatives are not present and unable to give consent and the doctor has to carry out invasive procedure for saving the patientrsquos liferdquoShenoy added ldquoIf relatives delay consent the same needs to be recorded in the treating doctorrsquos note as delay in giving consent is considered as contributory negligence on part of the relative This is recorded as defence for the doctor in case of any disputerdquo