Multidisciplinary specialist treatment teams and abandonment of patients - who is responsible for what?

• Published date: 01 December 2020
• Author: D.J. McQuoid-Mason
• DOI: 10.7196/SAJBL.2020.v13i2.704
• Pages: 125-128
• Date: 01 December 2020

December 2020, Vol. 13, No. 2 SAJBL 125

FORUM

Consider the following hypothetical situation:

A 20-year-old female is involved in a motor car accident. She is

brought into casualty and is seen by the doctor on duty, who assesses

her to have abdominal pain, chest pain and facial and pelvic injuries.

A scan confirms the facial and pelvic fractures, but the abdomen is

clear. The patient is taken to the high care ward and managed by a

plastic surgeon for her facial injuries, an orthopaedic surgeon for her

pelvic injuries, and a general surgeon for the injuries to her abdomen.

The patient remains stable, but states that all decisions about her

treatment are to be discussed and decided by her parents, especially

her father. The patient is operated on by the plastic and orthopaedic

surgeons and transferred to the ward. The patient’s abdomen remains

soft throughout, but she continues to complain about abdominal pain.

The patient continues to be monitored by the three specialists. The

abdominal pain is attributed to the pelvic and chest injuries. After

a while, the general surgeon notices that the patient’s stomach is

becoming bloated. As the general surgeon is about to treat the patient,

he is informed by the patient’s parents that they are unhappy about the

care given by him, and tell him that his services are no longer required.

The parents also tell him that they do not want him to find another

general surgeon, as they have instructed the orthopaedic surgeon to

find another for them. Later, while they are doing their ward rounds

for other patients, the dismissed surgeon informs the orthopaedic

surgeon about the patient’s bloated stomach.

Later during the night, the nursing staff contact the original

surgeon and tell him that the patient is unwell. The surgeon tells

the nurses that he is no longer treating the patient, and asks them

to contact the orthopaedic surgeon. The orthopaedic surgeon visits

the patient and puts some treatment in place. The next day the

orthopaedic surgeon examines the patient, goes to a conference and

hands over his patients to a locum. The patient’s condition continues

to deteriorate. The orthopaedic surgeon is again contacted and told

about the continuing deterioration of the patient, and contacts

another general surgeon. The patient dies from a missed perforated

bowel injury and septic shock. The original surgeon is charged with

misconduct and failing to hand over the patient properly. He says that

he thought that the orthopaedic surgeon would immediately contact

another general surgeon, and inform the latter about the patient’s

bloated condition – especially as he had alerted the orthopaedic

surgeon about this when they were doing their ward rounds.

The following questions are posed: (i) Does a proxy work with

a legally and mentally competent adult child, or is it still the

responsibility of the practitioner to speak to the adult child? (ii) Did

the surgeon’s responsibility legally and ethically end once the parents

dismissed him? (iii) Can it be viewed as abandonment if the patient

is being managed by a multidisciplinary team? (iv) Did the failure to

identify the missed perforated bowel injury and septic shock amount

to negligence by the original general surgeon?

Does the proxy work with a legally and

mentally competent adult child, or is it

still the doctor’s responsibility to speak to

the adult child?

A proxy may be given by anyone who is mentally and legally able to

consent to treatment or a surgical operation. It may, for instance, take

the form of a written directive made in terms of the National Health

This open-access article is distributed under

Creative Commons licence CC-BY-NC 4.0.

Multidisciplinary specialist treatment teams and

abandonment of patients – who is responsible for what?

D J McQuoid-Mason, PhD

Centre for Socio-Legal Studies, University of KwaZulu-Natal, Durban, South Africa

Corresponding author: D J McQuoid-Mason (mcquoidm@ukzn.ac.za)

The legal and ethical position of treating specialists whose contractual relationship with a patient has been prematurely terminated by the

patient or themselves is discussed. The validity of a mandated parent terminating the treatment of a mentally and legally competent patient

by a surgeon member of a specialist team is considered. After a contractual relationship between a treating specialist and a patient has been

prematurely terminated, the specialist concerned still owes a duty of care toward the patient under the law of delict – until a new specialist

in the field has been properly briefed by the previous treating specialist to take over the treatment of the patient. Such previous treating

specialists may not rely on other specialists in the multidisciplinary treatment team, who are not specialists in the field, to take over the

treatment of the patient, or to brief the new specialist on the patient’s condition. In such circumstances, the original treating specialist may be

held liable for abandoning the patient. As a general rule, members of a multidisciplinary team may not treat patients outside their specialty –

except in emergency situations. In the latter case, however, they cannot rely on emergency as a partial defence, when they themselves have

created the emergency. Such members of the team may be cited as joint wrongdoers, if without good cause their conduct contributes to

the harm caused by the original treating specialist, after the latter has left the team and abandoned the patient by not ensuring that another

specialist in the field has been briefed to take over the patient.

S Afr J Bioethics Law 2020;13(2):125-128. https://doi.org/10.7196/SAJBL.2020.v13i2.704