Case Summary

Prasanth S. Dhananka, a young man, underwent open-heart surgery at Nizam’s Institute of Medical Sciences (NIMS), Hyderabad. The consent form signed by him was vague and lacked specific information about the nature, risks, and complications of the surgery. Post- surgery, he suffered from severe complications, including paralysis of the lower limbs due to spinal cord ischemia, a known but rare risk in such surgeries.

He filed a complaint alleging medical negligence, primarily on the grounds of inadequate informed consent. He claimed that he was neither informed of the specific risks involved nor of alternative treatment options.


Key Medico-Legal Points

a) What Went Wrong:
Generalized Consent: The hospital took a broad, non-specific consent for “surgery,” without detailing the nature of the procedure (open-heart surgery), its risks, or complications.
Failure to Inform Risks: Known complications like spinal cord ischemia were not disclosed to the patient beforehand.
No Discussion of Alternatives: There was no evidence that less invasive or alternative treatments were discussed or offered.
Lack of Detailed Documentation: The documentation of pre-operative counselling was vague and failed to meet the standards of informed consent.

b) Negligence by the Hospital: The Supreme Court held that obtaining only a general consent does not satisfy the
requirement of “informed consent. The medical team failed to ensure that the patient fully understood the nature and risks of the surgery. The court emphasized that hospitals and doctors have a legal and ethical duty to explain specific procedures, possible risks, outcomes, and alternatives before undertaking any invasive treatment.


Court’s Reasoning

The Supreme Court laid down strong principles regarding informed consent, stating:

Consent must be specific and informed: Patients must be told what the procedure entails, why it is needed, and what its major risks are. A general or blanket consent form is not sufficient for major surgeries.

Risk disclosure is a duty: Even rare but serious risks (like paralysis) must be disclosed if their consequences are severe.

Patient autonomy is paramount: Patients have a right to make informed choices; depriving them of information violates their rights and dignity. The court cited international standards and the principles of patient autonomy and self- determination as key components of ethical medical practice.


Court’s Ruling & Outcome

The Supreme Court ruled in favor of Prasanth S. Dhananka, holding the hospital liable for medical negligence on the grounds of failure to obtain proper informed consent.

The court awarded compensation for the patient’s disability, suffering, and loss of livelihood.

The judgment highlighted that even if a procedure is performed competently, lack of informed consent can constitute negligence.

It reinforced the importance of respecting the patient’s right to information and decision-making.


Learnings for Doctors and Hospitals

  • Consent must clearly explain the name of the procedure, why it is being done, and how. General consent is not valid for high-risk or major surgeries.
  • All significant risks—especially life-threatening or disabling ones—must be discussed, regardless of their frequency.
  • Patients must be informed about any less invasive or alternative treatment options available.
  • Discussions about risks, benefits, and patient questions must be documented in the medical record.
  • The patient’s right to make informed choices must always be honoured. Forcing or rushing consent undermines trust and legality.


Implications for Medical Practice

This case highlights that even technically successful medical procedures can become legally indefensible if informed consent is lacking. The duty to communicate transparently is as important as the duty to treat. Consent is not just a formality—it is a cornerstone of ethical and legal medical practice.


Conclusion

Nizam’s Institute of Medical Sciences vs. Prasanth S. Dhananka reaffirmed that informed consent is a legal and ethical necessity, especially for invasive procedures like cardiac surgery. The court clarified that general or broad consent does not absolve liability if patients are not properly informed of the risks and nature of treatment. This case serves as a strong reminder that respecting patient autonomy through thorough and transparent communication is non-negotiable in modern medical practice.


Reference:

Prasanth S. Dhananka vs. Nizam’s Institute of Medical Sciences, 2009, Supreme Court of India