A locum obstetrician and gynaecologist from the US who had only worked at a hospital in New Zealand for six months failed to properly explain the techniques available to a Kiwi woman who needed her uterus removed.
Deputy Health and Disability Commissioner Rose Wall said the risks of a morcellation technique, used when removing a woman's uterus, weren't sufficiently explained so the woman wasn't able to give informed consent.
Wall said the consultant had discussed various surgical complications with the woman, but did not inform the woman adequately about the disadvantages of morcellation as compared to open surgery - in particular, the consultant did not tell the woman about the difficulty in making an accurate pathological diagnosis following morcellation.
Morcellation is a procedure where the uterus is cut into smaller pieces to assist its removal. The surgery, which saw the woman's uterus, fallopian tubes and ovaries removed, occurred in April 2017.
Before the procedure, the woman had an ultrasound and biopsy that showed a pre-cancerous condition associated with abnormally thick tissue on the inside of the endometrium (complex atypical endometrial hyperplasia or CAH).
The biopsy did not find that the woman had cancer - this did not rule out of the possibility of malignancy. The woman was later diagnosed with recurrent endometrial cancer in 2018.
The consultant had come from the US and worked as a locum obstetrician and gynaecologist at the DHB for six months. She used morcellation rather than removing the uterus intact, to avoid the need for a large incision.
Wall considered it wasn't unreasonable to have proposed minimally invasive surgery and morcellation. However, she found the consultant who removed the woman's uterus did not adequately explain the disadvantages of morcellation in comparison to open surgery, particularly the difficulty in making an accurate pathological cancer diagnosis if the uterus is cut into smaller pieces.
Wall found the consultant breached Right 6(1) of the Code of Health and Disability Services Consumers' Rights (consumers have the right to information a reasonable consumer would expect to receive) and Right 7(1) (services may be provided to a consumer only if that consumer makes an informed choice and gives informed consent).
"Guidelines are clear that patients must be engaged in the discussion of the method of tissue extraction, including the risks and benefits of alternative management options. This is information that a reasonable consumer in these circumstances would expect to receive."
Wall made several recommendations, including the DHB provide a written apology to the woman, establish a policy or guideline for using morcellation and ensure there are adequate processes for locum specialists/consultants to be oriented to the expected processes at the DHB.
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