A breast-reduction operation that went wrong has cost a doctor $20,000 and put him under supervision for three years. The doctor faced a Health Practitioners Disciplinary Tribunal in Napier in June, and the tribunal's decision was issued yesterday. The Napier surgeon's name remains suppressed. "Dr A" was charged with failing to givethe patient adequate information about the procedure: * In particular he failed to tell her that because of her height-to-weight ratio and her smoking there was a significantly increased chance of major tissue loss post-operatively. * He also did not tell her that because she was obese and/or had a sternal notch to nipple distance of 49cm, the Lejour vertical mammoplasty was not a suitable technique for her and other procedures were available. * He did not tell her that following surgery it was possible she would be unable to breast feed. * In February, 2005, he performed a Lejour vertical mammoplasty, which was an inappropriate procedure. * Between February and March, 2005, he failed to provide the patient with adequate information about her post-operative condition. Following the February 15, 2005, operation the woman, who had weighed 105kg , appeared to be recovering as expected until infection set in. On February 22 she awoke at 5am and there was a major leak of blood and discharge on her bed. It was from her left breast. Her right breast was also inflamed. A runny brown, smelly discharge continued. Dr A treated her infections, but her problems continued until eventually, on March 20, she was admitted to Lower Hutt Hospital where, under general anaesthetic, the wounds of both breasts were thoroughly cleaned, necrotic tissue was excised, and the wounds washed out. By April 6, the wounds were healing satisfactorily, but there had been significant tissue loss and shape was compromised. ACC covered the cost of corrective operations in October 2005, June 2006 and February this year. The tribunal, after hearing evidence from witnesses, including the complainant, members of her family, Dr A, other doctors, a nurse and a former patient, found the charge proved. It ordered: * Dr A should practise for the next three years under the supervision of a general surgeon approved by the Medical Council of New Zealand (MCNZ). * For three years he should not undertake any techniques or procedures of the kind which he has not previously undertaken. * He shall not undertake any plastic or reconstructive surgery, including cosmetic surgery. Dr A may not resume practice with regard to any such surgery or procedure until his practice had been audited by the MCNZ and the MCNZ was satisfied as to his competence. * Dr A is to undertake education on his responsibilities with regard to informed consent, and training about surgical risk factors including obesity and smoking, and about recognised post-operative complications. The tribunal censured Dr A and fined him $5000. He was ordered to pay costs totalling $15,000.
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