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

Mohsina Khatoon a non-Covid mucormycosis patient before and (right) after being affected by it

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 rise.

Dr Prithesh Shetty, Khan Bahadur Haji Bachooali Ophthalmic hospital

The 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 region.

mid-day its article titled ‘Non-Covid woman dies due to black fungus despite right surgery' dated June 1, had highlighted the condition of Mohsina Khatoon, 43, from Uttar Pradesh.

Wasim Khan, 22, her nephew speaking from Lucknow said, "It was a shock, when doctors told us that the infection was spreading and sought consent to perform life-saving 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 weeks."

Dr Wiqar Shaikh, professor of Medicine, Grant Medical College and Sir JJ Group of Hospitals said that the central health ministry has confirmed more than 28,000 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, Amphotericin-B, for 14 to 21 days. Another drug is posaconazole. But Dr Shaikh said that unfortunately these drugs have not done wonders in post-Covid-19 mucormycosis and the black fungus has been seen to spread from the sinuses to the eyes and then to the brain. "Once this happens, the only life-saving 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 patient," said Dr Shaikh.

Time of intervention crucial

Dr Shashank Joshi, consulting neuro surgeon, said, "In mucormycosis cases, time of intervention is important to save patients' lives. Pending consent is a hindrance for doctors to perform life-saving procedures."

Dr Prithesh Shetty, consultant Oculoplasty Ocular Oncology and Ocular Prosthesis at Khan Bahadur Haji Bachooali Ophthalmic hospital in Parel, said, "I 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 defeated."

‘But consent is necessary'

However, Dr Subhash Hira, professor of Global Health at the University of Washington-Seattle said "The informed consent of the patient or her/his 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 treatment."

Advocate Gopinath Shenoy, Senior Medico Legal consultant, and former district consumer court judge, said, "In 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 v/s Dr Prabha Manchanda case. The only exception to this law is in a situation where the doctor plays the role of loco-parentis, 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 patient's life."

Shenoy added, "If relatives delay consent, the same needs to be recorded in the treating doctor's 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 dispute."