A gynaecological oncologist and registrar have been asked to apologise after a woman wasn't given local anaesthetic before a procedure that involved a live electrical loop being placed on her cervix.
The woman (Ms C), in her 20s, was undergoing a procedure at Auckland's Greenlane Hospital to remove abnormal cells from her cervix following results from a smear test.
Health and Disability Commissioner Morag McDowell said the woman was caused "significant pain" after the gynaecological oncologist (Dr A) - who was supervising - and the obstetrics and gynaecology registrar (Dr B) - who was carrying out the procedure - didn't administer local anaesthetic before starting.
McDowell's report also said Ms C was told weeks before the procedure that she would receive anaesthetic. She stated that she signed the consent form accepting this and received a pamphlet describing the anaesthetic.
McDowell said administering the anaesthetic was a "basic step" before the procedure took place. It involved an electrical wire loop being inserted vaginally to remove any abnormal cells.
"It is a day-stay procedure that requires only local anaesthetic to numb the area. Usually it takes only 5–10 minutes to complete," McDowell said.
Ms C told the HDC that as the procedure was about to begin, she was told: "Now you're going to hear a buzz from the machine but you won't feel a thing."
She said when the doctor began the procedure, she "was filled with the most incredibly horrific pain" and was screaming as she felt the electrically surging wire "cut through" her cervix.
Ms C told the HDC she was then told by one of the staff they "had to get through that loop before they could address the pain", and that she was scolded for shaking and was held down in an attempt to keep her still.
She said that at no point during the procedure was she apologised to or told that a mistake had been made.
Ms C said Dr B told her that her legs were shaking and interfering with the procedure and asked her to control them.
She was then asked whether she would like to reschedule the procedure so that it could be completed under general anaesthetic, or if she wanted to continue with the procedure.
"Ms C told HDC that at this time, her body was experiencing 'immense shock and pain'. However, she said that she was afraid that the cells would develop into cancer if left untreated, and so she agreed to continue.
"She stated that she was unsure that she would be able to return to Greenlane Clinical Centre after the pain she had felt, and that her choice to complete the procedure was made out of 'fear and necessity'," the report said.
Ms C told the HDC that she also experienced a burning sensation during the procedure, but when she raised this, the clinicians didn't respond to her concerns.
She said she suffered burns to her vagina and upper thighs from the iodine.
Dr B told the HDC once the initial vaginoscopy had been performed, she began the procedure by performing a touch test (which involves touching the electrical loop briefly to the cervix wall) to ensure the electrical current was working.
She said the test caused Ms C a significant amount of pain, causing her to yell out, and it was then realised that anaesthetic hadn't been administered before the test.
Dr B told HDC that the loop was removed immediately without reactivation, and all staff apologised to Ms C. Dr B said she then swapped places with Dr A, who called for and administered the local anaesthetic.
Dr B told HDC that she does not remember any of the staff holding Ms C still or down or scolding her for moving.
Dr A said she was shaken by the pain they had involuntarily caused.
Ms C did not present for her follow-up appointment six months later and refused to speak to Dr A when she called. Dr A then wrote a letter to Ms C and copied in her GP to apologise.
McDowell has since made a raft of recommendations, including that Dr A and Dr B apologise to Ms C.
She also said a more empathetic approach was warranted by Health New Zealand after the incident, including personal contact to assist in the woman's recovery.
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