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
Sally Walker's insides have been so badly damaged after a surgeon incorrectly implanted mesh into her body that her bladder has been removed and her vagina sewn closed.
"The mesh was rotting inside of me," the 73-year-old told the Herald.
Yet, on the outside she doesn't look ill.
"People will say to me 'God Sally, you look amazing' and I'm thinking if only you knew I sat at the end of the bed sobbing for half an hour after struggling to get out of bed this morning," Walker said.
The former Karitane nurse claimed her surgeon, Dr Paul Macpherson, now retired, did not provide enough information about the risks of mesh and did not tell her about alternative options before the operation.
After the mesh was inserted, she said she felt that he repeatedly dismissed her concerns about the device causing her severe pain and instead suggested it was bowel problems unrelated to mesh.
Walker said, in her opinion: "He should be held responsible."
Macpherson, who worked at a private clinic and publicly at Auckland DHB, retired in 2019 and has a medical condition.
The Herald put detailed questions about Walker's account of her treatment to the Macpherson family and received a reply from solicitors Wotton and 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.
However, Walker told the Herald she wanted to talk about Macpherson's treatment openly because he introduced the procedure at Auckland DHB and trained many other gynaecologists still practising. She and other patients were also worried that he may have been affected by his health issues before his retirement only three years ago.
A 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.
The number of health professionals involved in the decision-making varied on a case by case basis, the spokeswoman said.
HDC closes case, refuses to release report
Walker complained to New Zealand's healthcare watchdog, the Health and Disability Commission (HDC), in June 2020.
In an interview with the Herald, Health and Disability Commissioner Morag McDowell said she wanted to acknowledge the harm Walker had suffered from surgical mesh and the courage it took her to complain.
"The journey she describes is harrowing," McDowell said.
However, two years on from Walker's complaint, the HDC has decided to close 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.
The HDC is also refusing to release a report into Walker's care that it received four months ago from independent urologist and surgical mesh expert Dr Hazel Ecclestone, formerly based in London and now working at Taranaki DHB.
"I'm entitled to that report and I don't understand why I can't see it," Walker said.
She said she felt like she wasn't being told the whole story. She had been patient but the HDC had failed to be transparent.
"It's frustrating because I feel that there has been no resolution and I still don't feel totally validated. How am I meant to get closure?"
McDowell said she understood the decision was difficult for Walker to accept but she could not discuss the details.
"The decision to close this case uses the New Zealand Bill of Rights Act 1990, the Health and Disability Commissioner Act 1994 and principles of natural justice as its basis.
"I am unable to release the expert adviser's report until other parties have been consulted."
Wills said: "The HDC closed Ms Walker's case because Dr Macpherson's right to consider and respond to her complaint and to consider and respond to any adverse comment could not be adequately protected.
"In such circumstances, the HDC determined that it was unable to form an opinion on the facts and whether there had been a breach of the code."
Walker is one of 14 women whose care is being examined by HDC over complaints that they were harmed by surgeons implanting surgical mesh, many without informed consent.
The mum-of-three and a grandma-of-10 said her horrific experience started in 2009, decades after she had given birth to her youngest.
The then 59-year-old visited Macpherson privately as she was suffering from urinary incontinence and prolapse.
"My organs were coming out like a golf ball," Walker said.
Prolapse is a birth injury where the walls of the vagina have been stretched and the pelvic floor muscles weaken, causing organs - such as the bladder, uterus or rectum - to slip down. About half of all women who have a vaginal birth get a prolapse of varying severity.
The condition can be treated with physiotherapy but in severe cases, surgeons use mesh or native tissue to repair and support the weakened areas.
The use of surgical mesh, particularly when inserted through the vagina rather than the abdomen, has traumatised thousands of women across the globe, leaving them with life-long injuries.
Walker said Macpherson recommended a mesh repair, despite another surgeon advising it was not appropriate given Walker's previous bowel problems.
"You sort of go along with it and put your trust in him. Back then, Paul Macpherson was like a superhero and you only went to him. I just assumed he knew what he was talking about."
Less than a week after her operation she started experiencing severe bleeding and chronic pain. She said she tried contacting Macpherson but he didn't return her call.
Over the next four years, she visited him at least 12 times but during each appointment she said she felt that she was repeatedly dismissed.
On five separate occasions he conducted a rectal examination. Walker said he was convinced it was a problem with her bowel and nothing to do with how the surgical mesh was inserted into her body.
By 2013, she said she had given up on her visits to Macpherson.
"I was sick of not being listened to, being misled with his information or rather lack of. He just kept fobbing me off," Walker claimed.
"His lack of formative notes to myself and my GP made me question how confident he was in himself," Walker said.
For the next five years she experienced many infections and suffered in crippling pain. Since the day of the operation, in 2008, she hasn't been able to have sex with her husband.
In 2017, she was referred to urologist Eva Fong after another specialist, Dr Michael Mackey, found lesions from the surgical mesh.
"I owe Eva my life because by that point I was going into sepsis shock because the mesh was rotting inside of me," Walker said.
"I was in and out of North Shore Hospital, my body was breaking down."
The Herald has seen a scan, performed in 2017, showing the damage caused by the mesh.
She had 10 more operations to try to repair the harm.
"Eva tried to save my bladder but the damage was too far gone and we decided to really save me, my bladder had to come out," Walker said.
"I had [my bladder] out and it took me a week to get used to. I placed the bag on my bedroom drawers and I wouldn't look at it and then one day I'd touch it and then gradually I would pick it up and place it on my stomach where I knew the stoma would be," Walker said.
"Then it turned to custard," Walker said, as her stomach broke down because of the rotting mesh.
"I had to have a nasal tube and I was really sick and one night I had become so sick it was touch and go ... that caused me post-traumatic stress."
Her trauma didn't end there.
Last year, she had an operation to close the opening of her vagina to stop her other organs from slipping out.
She believes if surgical mesh had never been inserted into the wall of her bladder it's likely she would still have the organ and her vagina wouldn't have needed to be sewn closed.
Documents support Walker's case
Walker's complaint to the HDC, sent by barrister Kate Davenport. QC, outlines nearly a dozen visits to Macpherson over two years, where she says her concerns were dismissed.
Her medical records show her GP at the time, Dr Jane Greville, said Macpherson apologised for not addressing her concerns a couple of years ago.
Walker was granted treatment injury coverage from ACC for the damage caused by the mesh.
The ACC report accepting Walker's claim said its principal internal clinical adviser, a consultant urologist, found her injuries were "a direct result of the placement of Prolift mesh and the erosion of this which has required surgical repair and reconstruction".
The report said: "Erosion of mesh into the bladder is a rare and unexpected complication of treatment, and is not a necessary part or an ordinary consequence of treatment."
Walker's medical records show that after her bladder was removed her urologist Fong noted "evidence of gross chronic inflammation through the full thickness of the
bladder, which is indicative of the damage from the mesh implantation within the wall of the bladder itself".
The surgical mesh in Walker's operation should have been implanted between her vagina and bladder.
Walker said her story was the tip of the iceberg.
"The way surgeons are inserting mesh destroys women's lives and it's not right."
Her aim in speaking out is to ensure all surgeons using mesh for women's pelvic operations are appropriately qualified so no more Kiwi wāhine are harmed by the practice.
Robbed of life choices
She told the Herald she felt Macpherson had taken the choices of her life away.
"I had to give up the job I love because I can't even lift a baby," the former nurse said.
The past 10 months had been the worst for her husband, she said. She could feel his anger all the time. Despite that, she counts herself lucky they are still together.
"We met when I was 15 and he was 18, we have been together 58 years so we know each other pretty well. I've spoken to other women whose marriages had broken up as a result [of mesh damage] or their husbands have had affairs through intimacy problems.
"A while ago I said to him I'd just love to throw you down on the bed but I just can't go there and he's much the same. We have a weird sense of humour but it carries us through and no one should have to live like that."
Mesh errors 'common'
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 (ie 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.