A Wisconsin anesthesiologist faces informed consent negligence charges after an anesthetized rotator cuff patient died of cardiac arrest shortly after being given an interscalene block. The patient's widow says her husband should have been given the option of having the block while he was still conscious and might have been able to report symptoms indicating that intravascular injection had occurred — symptoms such as ringing in the ears, numbness and tingling around the mouth. Her husband, she said further, had a "short, fat, thick" neck, which made it more difficult to locate an appropriate injection site, and was taking a beta blocker, which would have masked early signs of intravascular injection.

In court, Robert Corish, MD, argued that he wasn't negligent — that he and many others choose to perform interscalene blocks on unconscious patients because they don't flinch when the needle is inserted, making it easier to correctly place the needle. He also testified that he prefers to administer blocks on unconscious patients because patients may end up not needing blocks and because changing conditions during surgery can make blocks inappropriate.

The case took an unusual twist when a circuit court jury decided Dr. Corish "fail[ed] to disclose information about the interscalene nerve block necessary for [the patient] to make an informed decision," but that he wasn't negligent.

An appeals court agreed with the widow's assertion that the seemingly contradictory verdict came about because the lower court made a mistake in the way it phrased one of its questions to the jury. It asked: "If a reasonable person, placed in [the patient's] position, had been provided necessary information about the interscalene nerve block, would that person have refused the interscalene nerve block?"

The proper question, the appeals court agreed, was not whether he would have refused to have the block, but whether he should have been given the option to have it before he was anesthetized. As such, the appeals court reversed part of the lower court's decision and sent the case back for a new trial to address the informed consent issue.

Attempts by Outpatient Surgery Magazine to reach Dr. Corish were unsuccessful.

Jim Burger