In Her Head is a Herald campaign for better women's health services. Health reporter Emma Russell investigates what's wrong with our current system and talks to wāhine who have been made to feel their serious illness is a figment of their imagination or "just part of being a woman".
Warning: Graphic content
Merrissa Haa says she refused to sign a consent form for surgical mesh to be inserted into her body so her surgeon convinced her he would instead use "tape" and that it was safe.
Her life, she said, was changed forever after that surgery.
"I remember screaming 'I've had four children and I would rather give birth to them all now than this pain'," Haa, 48, told the Herald from her home near Taupō.
Haa has supplied the Herald with copies of her medical records, including an ACC approval letter granting her treatment injury coverage for "mesh erosion" and inflammation surrounding the device which has caused severe pain.
She also showed her own written request not to have surgical mesh and a medical note signed by Lake DHB gynaecologist Dr Barton Matshe sent to Auckland DHB, dated eight months before her surgery, saying "Merrissa does not want a mesh operation".
Haa did not complain to the Health and Disability Commission at the time because she didn't have confidence her case would be properly investigated.
She now wants to share her story as part of the Herald's In Her Head campaign because she believes she was "tricked into getting mesh" and her health needs were ignored.
In 2019, the mum-of-four and grandma-of-eight was diagnosed with urinary incontinence and double prolapse, a common birth injury causing women's vaginal organs to collapse, sometimes leaving them with loss of bladder and bowel function. Often women are also in severe pain.
Surgical mesh - a medical device used to repair weakened structures and to provide additional support - has been used in New Zealand to treat prolapse and urinary incontinence.
However, at the time of Haa's diagnosis, she said "horror stories were emerging of women being butchered by mesh and left in life-long pain".
Lakes DHB was unable to treat her so referred her to Auckland DHB, where she met her surgeon, Dr Paul Macpherson, who is now retired.
While Macpherson agreed to fix her prolapse with alternative sutures, Haa said, he insisted on using a "bladder sling" to treat her urinary incontinence.
"He told me he wouldn't use the mesh I'd been reading about and would use tape instead, it was safe, he kept calling it a tape."
Haa said she asked him if he'd use it on his mother. She believes he side-stepped the question, saying he repeated "it's not mesh, it's tape, it's safe, I've done thousands of these operations".
"I feel like I've been robbed of my life," she said.
After waking up from the surgery in severe pain, she said she was terrified and wanted to leave the hospital immediately. It wasn't until she was home that she discovered surgical mesh had been used, she said.
"I realised I'd made a terrible mistake and I felt like such an idiot."
The impact on her life had been soul-destroying, she said.
Her 12-year-old son went to live with his father for six months because she couldn't take care of him.
"My family unit kind of broke down because I couldn't be a mother."
She tried to have sex with her husband but it sliced his penis, Haa said.
"Sex is so painful to me, it's like there's a knife in there stabbing me ... I can't be intimate with my husband and we only got married in January [last year]."
Friends stopped inviting her to social gatherings because they knew she couldn't come, she said.
"I've missed weddings, birthdays, parties and so many important events because my life has become lockdown, I've always got to make sure I'm near a toilet.
At her worst, Haa said she was living on eight Tramadol a day.
"I used to be fun and outgoing."
She had the mesh removed last year but is still living in unbearable pain.
"My surgeon who removed the mesh said it would take about a year for it to go away but a part of me feels like the damage has already been done and this is just something I'm going to have to live with the rest of my life."
Macpherson, who worked at a private clinic and publically at Auckland DHB, retired in 2019 and has a medical condition.
The Herald put detailed questions about Haa's account of their treatment to the Macpherson family and received a reply from solicitors Wotton Kearney.
Senior associate Kate Wills said Macpherson was now retired and was unable to defend himself against the claims because of the medical condition.
She asked the Herald not to name Macpherson or mention his health issues. To publish these details would be a breach of fairness and privacy, she said.
Former Health and Disability Commissioner Ron Paterson - now a professor of health law and policy at the University of Auckland - said he was aware there remained "significant concerns" of women still being harmed by gynaecological surgeons who were not properly trained to select appropriate patients and implant mesh without causing harm.
"My understanding is the issues are ongoing and that's deeply concerning," Paterson said.
Auckland DHB, which employed Macpherson until his retirement in 2019, also asked the Herald not to name him.
A spokeswoman said medical decisions were often made by a multi-disciplinary team, which involved a range of health professionals who work together to make decisions on patient care, not just one doctor.
"We have not yet been able to fully investigate this, so we feel it would be unfair to single Dr MacPherson out in this instance."
The number of health professionals involved in the decision-making varied on a case-by-case basis, the spokeswoman said. She could not confirm if there was a multi-disciplinary team making decisions on Haa's care to implant mesh.
Auckland DHB declined to comment on Haa's case citing patient privacy, despite the Herald supplying the DHB with a privacy waiver signed by Haa.
"We were sorry to hear of Merrissa's experience and the journey she has been on post-surgery. For ethical and privacy reasons we can't comment on details of individual patient care, or on details of individual employment."
In August, a DHB spokeswoman said it was going to contact Haa about her concerns.
Haa said another surgeon called her to apologise for what had happened to her and asked what they could do better.
"I told him to stop calling it tape, call it what it really is, mesh."
In the OIA documents released in September 2018, Auckland District Health Board's chief executive Ailsa Claire said surgical mesh had been used as a treatment option at the DHB's Women's Health department since 1997 after they were introduced by Macpherson, who had trained in both in Europe and Australia.
"He became a preceptor for Gynaecare retropubic midurethral sling or TVT and has trained many gynaecologists since in the safe placement of these products," Claire said.
"Dr Paul Macpherson is one of the most experienced gynaecologists in New Zealand at removal of vaginal mesh, having performed this operation as either partial of complete removal since prior to mesh kits being available (i.e. prior to 2005) when gynaecologists and urologists were placing meshes fashioned from those used for hernia repair as nothing else had worked," Claire said.
In 2012, the Herald quoted Macpherson in a story about surgical mesh being the subject of international lawsuits and health warnings as the device was still being implanted in hundreds of New Zealanders.
At the time, the gynaecologist said he repaired at least one mesh-related surgery error each week.
Macpherson, who was a member of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, supported the ongoing use of mesh to repair severe or recurring tissue weakness.
Macpherson said, seven years before retiring, the way the mesh was implanted into the body could cause complications.
"If it is too close to the bladder it will irritate it. If mesh is put in too tight it will stay there. It is a difficult operation to do and best done by people who have undergone training and have done a reasonable number of them."
He said only about 10 doctors in New Zealand were trained to operate with surgical mesh and there were strict guidelines on who could use it.
Health Minister responds
Associate Health Minister Ayesha Verrall said she understands the health and disability commissioner is considering the case of Sally Walker, a woman who had her bladder removed and vagina sewn closed after a surgeon incorrectly implanted mesh into her body.
Verrall was speaking in response to a Herald investigation published yesterday, which covered Walker's experience.
The 73-year-old told the Herald the surgical mesh, which had been incorrectly implanted into her body during an operation to treat prolapse, was "rotting inside of me" and had led to years of pain and numerous operations.
The former Karitane nurse claimed her surgeon, Dr Paul Macpherson, who retired in 2019 and has a medical condition, did not provide enough information about the risks of mesh and did not tell her about alternative options before the operation.
Walker complained to New Zealand's healthcare watchdog, the Health and Disability Commission (HDC), in June 2020 but two years on the HDC closed her case because "Dr Macpherson is unable to participate or respond," according to a letter signed by deputy health and disability commissioner Rose Wall to Walker earlier this month.
Verrall, speaking at a media stand-up yesterday afternoon, said she understood Walker's case was being considered by the HDC and therefore it would be inappropriate for her to comment.
However, when the Herald told her Walker's case had been closed by HDC, she said: "I haven't seen the specifics of that particular case so I'll have to look back at that."
Since yesterday's investigation was published, dozens more women have come forward with claims they too were harmed by mesh procedures.
"I sit here crying while reading your article, as I'm one of these women trying now to make a decision to have my bladder and urethra removed. I see the psychologist today on a journey to making this decision," one woman emailed the Herald.
The Herald will continue to follow up.
Emergency services were called to the scene about 8.30pm.