Radiation Therapy Complications
Clinical Situation
When conization of the cervix disclosed early invasive carcinoma, a woman's gynecologist advised her to undergo a radium implantation and referred her to the radiation therapy department. When he was first contacted about treating the patient, the radiation therapist presumed that the obstetrician had fully discussed the implantation procedure with the patient. The patient was not told about any unpleasant side effects or possible complications of the procedure. Neither the gynecologist nor the radiation therapist explained to her that a hysterectomy was an alternative therapy to radium implantation. 

As a result of the procedure, the patient experienced persistent vaginal burning and diarrhea, and eventually developed a radiation-induced rectouterovaginal fistula, requiring a radical hysterectomy and a bowel resection. 

The patient sued the radiation therapist for failure to obtain her informed consent for the radiation therapy. She contended that if she had been informed that a hysterectomy was an alternative to radiation, she would have elected to have the hysterectomy. The radiation therapist contended that he was called into the case only as a consultant, and therefore it was the gynecologist's responsibility to obtain an informed consent for the implantation procedure.

Applied Principle
The gynecologist had a duty to disclose the clinical alternatives to the procedure when advising the patient to submit to radiation therapy. Once the patient was referred to have the procedure performed by the radiation therapist, the therapist was then required to disclose the inherent and material risks associated with implantation. The gynecologist and the patient reasonably presumed that the radiation therapist, who performed the procedure, would take such responsibility.

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