Series of deficiencies cause patient to suffer injuries

The commissioner found there were a series of deficiencies in the gynaecologist's care of a female patient. Photo / 123rf

It has been revealed that deficiencies in two gynaecologists pre and post-operative care for a patient resulted in injury.

Health and Disability commissioner Anthony Hill released a report today which found the gynaecologists in breach of the Code of Health and Disability Services Consumers' Rights in relation to their care of a woman who had a laparoscopy to remove an ovarian cyst.

The 51-year-old woman suffered from a bladder injury during the operation and was diagnosed with a bowel injury only three days later, which required further surgical procedures.

An injury to the woman's bladder, as a result of adhesions, was repaired by an urologist in theatre.

The woman had a history of extensive adhesive disease, which Hill said the gynaecologist who performed the procedure did not critically consider the potential surgical difficulties of.

Hill said the man did not meet his obligations to keep clear and accurate clinical and surgical records.

It was also found that his preoperative discussion with the woman about the risks of surgery was made without knowledge of important clinical factors relevant to her decision of whether or not to proceed.

The bowel injury occurred after the gynaecologist handed over to a second gynaecologist for the woman's postoperative care.

Hill expressed concerns that the second gynaecologist delayed recognising the woman could be suffering from a bowel injury, despite it being brought to his attention by a senior house officer, three times.

The man also failed to personally review the woman or refer her for surgical review when blood results that contained bacteria most likely from the bowel were available to him.

The gynaecologist instead concluded the nausea experienced by the patient could be due to the side effects of the medication she was taking.

Hill considered that the DHB had overall responsibility for the series of deficiencies in the woman's care, including several administrative shortcomings.

He made recommendations to the DHB including requesting an update report on the progress and effectiveness of all steps taken to improve services as a result of this case, such as changes to policy.

Hill gave the first gynaecologist advice in relation to his documentation practices.

The second gynaecologist is no longer practising in New Zealand.

Hill recommended that in the event he returned to practise, the Medical Council of New Zealand should consider whether a review of his competence is necessary.

Mr Hill also recommended that RANZCOG consider whether the wording of a relevant consensus statement concerning advanced operative laparoscopy requires revision.