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Medical Negligence, Informed Consent, and Executive Leadership Responsibilities

Vera Oduraa Agyekum-Gyimah

University of Cumberlands

Legal & Ethical Issues in Healthcare Administration (BUHA-667-B01)

Dr. Clarence Wilson

July 26, 2026

Introduction

Medical negligence and informed consent are fundamental principles that protect patient

safety and uphold ethical healthcare practices. Patients can be exposed to avoidable damage and

healthcare institutions can incur severe legal and reputational repercussions when the physicians

do not provide the accepted standard of care or when they are unable to acquire valid informed

consent. An interesting example of the way the courts consider the allegations of medical

negligence is the appellate case Todd v. Sauls in which the court considers the duty of the

physician, the standard of care and whether the standard was violated. The hypothetical case of a

patient with gallstones who seems to be confused prior to giving consent to surgery further

highlights the need to evaluate the decision-making ability when carrying out elective operations.

In terms of the senior executive leadership, healthcare organizations need to set policies that

facilitate patient safety, legal and ethical decision making and minimize organizational risk.

Analysis of Todd v. Sauls

The Louisiana Court of Appeal in Todd v. Sauls (1994) case examined whether Dr. Sauls

had the relevant standard of care when attending to Mr. Todd who died later after complications

that were related to cardiovascular treatment. The court of appeal analyzed the issue of

negligence by analyzing the actions of the physician in the view of the accepted medical

standards and finally concluded that the jury instructions erred and that the evidence had to be

reviewed de novo. To lower the risk of death of Mr. Todd, Dr. Sauls would have ensured that all

the diagnostic results were critically assessed, identified the changing clinical risks early and

provided early interventions in line with the established practice of cardiovascular. Having

proper documentation, consulting specialists when necessary and constant observation of the
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changing status of the patient would also have enhanced compliance to the standard of care

(Todd v. Sauls, 1994).

Medical negligence must have four main components; duty, breach, causation, and

damages. The existence of duty is when the physician forms a professional relationship with the

patient and has a duty to act in a way that complies with the accepted medical standards of care.

Breach is a failure to meet the standard by the physician by action or omission. The evidence of

causation must indicate that the breach was the direct cause of the injury of the patient and

damages are the quantifiable damages that the patient or family have suffered. The court in Todd

v. Sauls (1994) case took the time to examine whether the actions of Dr. Sauls met these legal

requirements with the view to establishing whether negligence was committed. The knowledge

of these aspects helps healthcare leaders reinforce clinical governance and develop evidence-

based practices and minimize malpractice risks through encouraging the use of professional

standards.

Decision-Making Capacity and Informed Consent

The signature of a patient on a consent form is not sufficient to form valid informed

consent. Doctors need to evaluate a patient's ability to comprehend the corresponding medical

data, value the outcome of treatment choices, and reason using the available options and to

communicate a steady choice (Berens & Kim, 2022). The hypothetical situation, where the

patient became confused, could not understand the surgical procedure, and his answers were not

related to the consultation, are important warning signs that his decision-making ability could be

compromised. Studies indicate that the understanding of patients is often not sufficient even in

cases when formal consent forms are signed, and meaningful communication is a significant

aspect of ethical medical care (Pietrzykowski & Smilowska, 2021). The executive leadership
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must then insist on standardized capacity tests whenever clinical issues are raised by clinicians

when patients are preoperative and cognitive/behavioral issues are identified.

In a situation where issues about decision-making capacity are involved, physicians are

both legally and ethically obliged to delay nonemergency procedures until the capacity can be

properly assessed. The surgeon must re-evaluate the comprehension of the patient in plain

language, confirm the understanding through the use of the teach-back method, record all the

information and refer to the relevant specialists in case of suspected cognitive impairment

(Sherman et al., 2021). Should the patient eventually be found to be incapable of decision

making, a legally authorized representative should give his or her consent prior to surgery. Such

measures not only safeguard patient autonomy but also decrease the organizational liability

through showing that the established standards of informed consent and patient-centered care are

adhered to (Berens & Kim, 2022).

Hospital Leadership and Organizational Responsibility

The importance of hospital leadership cannot be overstated in the need to ensure that

physicians and other clinical staffs adhere to the procedures that are aimed at safeguarding

vulnerable patients. The executive leaders ought to enact extensive policies that involve the use

of competency tests whenever patients exhibit confusion, impaired memory or impaired

judgment prior to giving consent to treatment. Consistency across the clinical departments and

better legal compliance can be achieved through standardized documentation requirements,

educating the staff about informed consent, and decision-support tools. Moreover, healthcare

organizations ought to motivate physicians to consult whenever they are not sure about whether a

patient is capable of making informed healthcare choices (Gasparini et al., 2021).

Interdisciplinary teamwork also enhances patient safety by bringing in the expertise of

social workers, psychologists, psychiatrists, ethics committees, legal counsel and risk

management professionals. Such experts can offer useful insights in assessing complicated

competency issues, and they will assist in making sure that the legal rights and moral interests of

patients are not violated. In terms of a senior executive leadership, a culture of collaboration and

accountability will decrease adverse events that can be prevented, enhance organizational

governance and lessen the risk of malpractice. With a combination of effective competency

evaluation procedures and interdisciplinary decision-making, healthcare organizations will be

able to enhance patient outcomes and show their dedication to quality and ethical care.

Conclusion

The Todd v. Sauls decision highlights the importance of adhering to the applicable

standard of care and demonstrates how courts evaluate the essential elements of medical

negligence. More importantly, the hypothetical surgical case demonstrates that informed consent

can only be effective, when the patients have the ability to comprehend the nature and effects of

medical care. Efforts to ensure proper capacity assessment, proper communication of physicians

and interdisciplinary teamwork prior to elective procedures should therefore be put in place by

healthcare organizations in comprehensive policies. In the eyes of the top-level executive

management, costing in standardized informed consent procedures, competency assessment, and

organizational management enhances patient safety, ethical healthcare provision, and

considerably minimizes legal and financial risks.

References

Berens, N. C., & Kim, S. Y. H. (2022). Should assessments of decision-making capacity be risk-

sensitive? A systematic review. Frontiers in Psychology, 13.

[Link]

Gasparini, M., Moro, V., Amato, S., Vanacore, N., & Gambina, G. (2021). The evaluation of

capacity in dementia: Ethical constraints and best practice. A systematic review:

Evaluation of capacity in dementia. Annali Dell’Istituto Superiore Di Sanità, 57(3).

[Link]

Pietrzykowski, T., & Smilowska, K. (2021). The reality of informed consent: Empirical studies

on patient comprehension—Systematic review. Trials, 22(1), 57.

[Link]

Sherman, K. A., Kilby, C. J., Pehlivan, M., & Smith, B. (2021). Adequacy of measures of

informed consent in medical practice: A systematic review. PLOS ONE, 16(5), e0251485.

[Link]

Todd v. Sauls, 647 So. 2d 1366 (La. Ct. App. 3d Cir. 1994), writ denied, 651 So. 2d 289 (La.

1995). [Link]