The nurse's legal duty stops there. It is not necessarily true the physician is doing an unauthorized procedure, just because there is no consent form in the chart.  COURT OF APPEALS OF WISCONSIN, 1997.

   In a recent case from the Court of Appeals of Wisconsin, the physician performed an intraoperative tubal ligation during a cesarean delivery.

   When the physician asked for the instrument needed to do a tubal ligation, two nurses circulating in the operating room looked for a signed consent form in the patient's chart, and told the physician there was no consent form in the chart for a tubal ligation. The physician went ahead anyway.

   Three days later, one of the nurses who had been in the operating room brought the patient a standard consent form for tubal ligation and asked her to sign it "just to close up our records." Another nurse, who had not been in the operating room during the procedure, actually signed the patient's name on the surgical consent form for a tubal ligation and back-dated it to the day of the procedure.

   The court ruled nevertheless the hospital faced no legal liability in the patient's civil lawsuit. The patient had filed suit on grounds of lack of informed consent for surgery. To be able to rule in favor of the hospital, the court stated it did not have to judge the nurses' actions after what had happened in the operating room.

   According to the court, the law is well-settled that the legal duty to advise a patient of the risks, alternatives and consequences of surgery lies with the patient's doctor.

   The nurses in the operating room checked the patient's chart to ascertain whether the appropriate signed consent forms were present. One of the circulating nurses informed the physician that a written consent form for the tubal ligation was not to be found in the patient's chart, and observed the physician acknowledging hearing that.

   At this point the court said the nurses had no legal duty to take further action. The court pointed out it could have been just a clerical mistake that a proper signed consent form had not made its way into the chart. Or there could have been some other valid explanation for the physician going ahead.

   In any event, as far as determining legal liability after the fact in a civil lawsuit, the nurses were not to blame. What happened was beyond the scope of their legal responsibility, in the court's view. The hospital also was not to blame, the court said, either as the nurses' employer or for having provided the use of an operating room to this physician who practiced independently. Mathias vs. Hospital, 569 N.W. 2d 330 (Wis. App., 1997).