One of the [many] things that come to mind is the culture within that theatre. Doing a procedure that isn’t in the consent form and hasn’t been discussed as part of the surgical plan, is usually discussed. Scrub nurses can and have challenged when things have deviated from normal, anaesthetists have a say, everyone comes to an agreement and things proceed (or not as the case may be).
Hell I’ve had to ring down to paeds to see if mom was happy for me to trim the other toenails during an in growing toenail removal as it wasn’t on the consent form and hadn’t been discussed!
the fact that it took parents complaining to bring this light is concerning to the general atmosphere in theatre and the potential attitude he has towards staff.