A doctor has been criticised for piercing a woman's bowel instead of her uterus in a report released today.
The Health and Disability report said a 46-year-old woman consented to get a vaginal hysterectomy at a public hospital after experiencing frequent and excessive bleeding. During the procedure attempts by the obstetrician and gynaecologist to open the pouch of Douglas, an extension of the peritoneal cavity located between the back wall of the uterus and the rectum, failed. She then accidentally identified the woman's bowel as the pouch and tried to open it creating a hole in her bowel.
The doctor stopped the procedure and asked a colleague for help. Because of difficulties with the vaginal hysterectomy they converted the procedure to a abdominal hysterectomy.
A surgeon was contacted to repair the woman's bowel. The surgeon was unsure about closing the hole entirely so made a loop colostomy also known as a stoma.
The abdominal hysterectomy was then completed.
After the surgery it is not recorded that the doctor told the woman about the surgical error and it was more than a month before the woman fully understood what had happened to her. The doctor and patient have a different recollection of what was said after the surgery.
The report quotes the woman as saying she was not made aware her bowel had been perforated.
"At no time did [Dr A] advise either me or my husband that there had been a treatment injury caused by her to my bowel. As I was on morphine a lot of the time I didn't comprehend most of what was happening around me ... The focus was on the pelvic adhesions not the 10 centimetre bowel injury. At this stage it was both my husband's and [my] understanding that I ended up with the emergency operation because of these [the pelvic adhesions], not because of the treatment injury caused by [Dr A]."
The doctor states that she repeatedly told the patient what had happened to her.
"I returned to the hospital later in the evening on the day of her surgery, to inform the patient of the outcome of her surgery and the complication that had occurred.
"I was very aware that the medication used for anaesthesia and pain control could affect [Mrs B's] cognition and memory and, therefore, I repeated the conversation regarding the surgery and complication on several occasions."
Health and Disability Commissioner Anthony Hill said the doctor has been found in breach of Health and Disability Services Consumers' Rights. He particularly criticised her lack of caution and failure to seek advice from a senior colleague earlier in the procedure.
"The OB/GYN's failure to seek advice and convert to an abdominal procedure earlier, together with her mistaken incision of incorrectly identified tissue amounted to a serious departure from expected standards and a failure to provide services to the woman with reasonable care and skill."
The doctor had been involved in prior adverse events at the hospital. Hill has recommended that should she return to practise in New Zealand that the Medical Council of New Zealand undertake a review of her competence before issuing a practising certificate.
Hill also recommended that the DHB introduce a credentialing process for advanced surgical procedures.