GRASS VALLEY, Calif. May 26, 2017 – Editor’s note: The following remarks were made by Dr. Roger Hicks at Wednesday’s NID Board of Directors during the public comment period. You can watch Dr. Hicks’ remarks in the video below.
Informed Consent is the process in medicine for getting permission before doing a treatment or procedure. It’s a discussion that a clinician has with a patient before starting a treatment or performing surgery. It’s transparency in medicine.
Informed consent includes several essential elements. The conversation includes explaining the procedure or recommended treatment plan, discussing relevant information, such as the need for the proposed treatment and the purpose of it, and a discussion of the risks, benefits, and alternatives. For consent to be valid, the patient must understand what is said, and the consent must be voluntary.
If, after going through this process, the patient says yes, then informed consent has been granted. And there’s another possible outcome- informed refusal. In either case, the person is fully informed.
When I see a patient in our clinic, he or she tells me what his or her symptoms are, and I do my exam. I usually have a good idea of what the problem is and what the treatment should be or what additional tests are needed. But I don’t just plunge ahead with what I think is best– I get informed consent.
It wasn’t always like this. Back in the old days, the doctor might say, (especially if the patient was a woman),
I know just what to do dear. Don’t you worry your pretty little head about the details. You just leave it all up to me and everything will be just fine. I know what’s best for you.
We don’t do that anymore in healthcare. But it seems the NID Board is living back in the old days. By refusing to livestream the meetings and make their decisions transparent, it seems like the NID Board doesn’t want us – the people who elected them- to know what they’re doing. It feels paternalistic and condescending, like one of those old-time doctors.
NID prescribed Centennial Dam for us, but there is no informed consent. First, and most important, we don’t know if it’s even needed. We don’t how it will be paid for, nor what those who are financing the project will want in return. And we haven’t been told about the possible side effects. The risks are many, and include possible waste of taxpayers’ money, destruction of Native American sites, condemnation of private land through eminent domain, lower real estate value for homeowners in the area and the loss of a free-flowing river with its riparian habitat and recreational opportunities.
Before spending any more of our money on this project, it’s time for NID to take a cue from the medical community. Informed consent is considered the right thing to do in healthcare, both ethically and legally, and it has become standard of practice in medicine. Failure to obtain informed consent before performing a medical intervention can be grounds for malpractice. NID should adopt best practices and get informed consent- or informed refusal- for Centennial Dam. A good first step towards this goal would be to live-stream its meetings, as is done by Grass Valley, Nevada City, Truckee, Nevada County, and many other governmental bodies.
Roger Hicks, MD
Yubadocs Urgent Care