Surgeon faulted over care of hernia patient

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A general surgeon has been faulted over pre- and post-operative care of a woman who had an incisional hernia.

The surgeon breached the woman's rights under the code of patient's rights, said Health and Disability Commissioner Anthony Hill in a written decision made public this afternoon. The decision does not name any of the parties.

The woman experienced a discharge from the site of an incisional hernia that had developed after a caesarean section. She was referred to a regional public hospital, where she was seen in the surgical outpatient clinic by the surgeon.

He recommended a hernia repair, but did not conduct an adequate pre-operative review of the woman, in that he did not review her relevant history, including the history that she was born with a condition requiring significant abdominal surgery.

The surgery proceeded and although the surgeon experienced some difficulty with adhesions during the operation, he did not document this in the woman's clinical records.

The following day, the usual Friday morning ward round did not go ahead because it was a public holiday weekend.

The woman deteriorated over the holiday weekend while under the care of a second general surgeon. The second surgeon was initially suspicious of infection and ordered an urgent CT scan, which could not proceed as the hospital's CT scanner was not working.

An urgent ultrasound was performed instead, which revealed a collection of fluid superficial to the hernia repair.

The woman's condition improved after receiving intravenous antibiotics and fluids in the intensive care unit.

The first surgeon discharged the woman home after the holiday weekend, despite the woman's complaints of abdominal pain overnight, a low grade temperature, difficulty mobilising, and faecal ooze from her wound.

However, she was admitted to hospital again three days later and CT scans identified that she had developed a fistula and had multiple intra-abdominal collections. She required further surgical management.

The first surgeon's pre-operative review of the woman was substandard, as he did not review her full relevant clinical history.

"It was the surgeon's responsibility to read the notes to the extent necessary to satisfy himself that he had all the information that he, as the operating surgeon, needed to know before he proceeded to perform surgery on the woman," said Mr Hill.

Mr Hill also stated that it was not appropriate for the surgeon to discharge the woman following her first admission when she had an appearance of bowel fluid from her wound, and the surgeon did not document his surgical findings accurately.

The post-operative care provided by the second and a third surgeon was reasonable in the circumstances and neither was found in breach of the Code.

However, the district health board was criticised because the system that was in place at the public hospital for handing over care on a weekend had not been carried over to public holidays, which affected the continuity of services provided to the woman.