Surgical mesh injuries: Ministry of Health challenged on slowness of response

The Ministry of Health has been challenged over the pace and effectiveness of its response to surgical mesh injuries in New Zealand.

Parliament’s Health Committee is considering a petition in the name of Sally Walker, a patient who suffered debilitating injuries after surgical mesh was incorrectly implanted in 2008. She is asking Parliament to suspend the implantation of mesh for stress urinary incontinence (SUI), a common birth injury.

Walker, who has collected accounts from 30 women who have been harmed by mesh implants, told her story to the Herald last year as part of the series In Her Head.

Ministry of Health chief medical director Dr Joe Bourne said today that a “pause” on using mesh for this procedure was being investigated by the ministry.

But unlike the United Kingdom, which suspended the use of mesh in 2018, the ministry was so far unable to find a legislative or regulatory way to do so.

Even if there was agreement by public and private hospitals to halt procedures, “we are unlikely to be able to enforce that”, Dr Bourne told MPs.

If the ministry recommended a pause, it would discuss with gynaecology and urology colleges and the NZ Medical Council how this could be done.

Dr Bourne also said urinary incontinence problems were common and the ministry wanted to be sure it had a range of alternative treatments for women if it were to place a pause on the use of mesh.

He outlined other changes being made by the ministry, including the establishment of a credentialing system which assessed whether surgeons were qualified to carry out mesh procedures.

So far, this system had focused on the most complicated procedures involving mesh. It was not yet known how many surgeons had met the criteria established by the ministry.

Other initiatives included education for doctors on preventing harm in surgical mesh operations, and a registry of surgeries involving mesh. The registry was expected to be up and running by the end of the year at the earliest.

Health committee chair and Green MP Jan Logie challenged the ministry on what was being done to protect women who were being implanted with mesh at the moment.

A restorative justice process on surgical mesh involving 600 women, which led to many of the changes, was “years ago”, she said.

While a system had been set up to check whether doctors were qualified to use mesh, there was no way to stop them if they were found not to meet the criteria, Logie said.

Finally, the ministry’s focus also appeared to be on the public sector despite most of the harm taking place in the private sector.

“Talk me through all that, because that’s not sounding great to me,” she said.

Dr Bourne did not immediately address her concerns because of time constraints, but said they were partly a result of the way the New Zealand health system was constructed.

Walker told the Herald the fact that the ministry was considering a pause to mesh use was a significant step.

“They have never come out with that before,” she said. “To be recognised and heard, that will make a lot of women feel a lot better.”

The committee also heard from a Scottish doctor who was involved in a review of the procedure in his home country but resigned in protest at the findings being diluted.

Dr Wael Agur, a urogynaecologist from Glasgow, said he previously supported the use of pelvic mesh in operations but his views changed after studying the evidence and seeing the impact that mesh complications had on women.

Scotland suspended the use of surgical mesh in 2014 and the rest of the UK followed suit in 2018.

Dr Wael Agur, urogynaecologist from Glasgow, appeared remotely before the Health Committee this morning. Photo / Parliament livestream

Dr Agur said that as in New Zealand, there was some initial opposition in Scotland to a suspension on mesh use. But nine years later, MPs or officials had no regrets about their decision.

“Subsequent scientific evidence and several other unfolding events confirmed, and continue to confirm, that the original decision to suspend all mesh procedures was the right course of action,” he said in his written submission.

He said that the understanding of chronic pain - one of the most serious complications of surgical mesh - had grown over time. It was once thought that the risk of chronic pain was 1 per cent, but that later rose to 5 per cent, and one study has placed the risk at 18 per cent.

Dr Agur also questioned whether improving surgical skills in New Zealand would address the harm caused by mesh implants. He felt the problem was the mesh itself.

“The mesh pause is based on the precautionary principle and I believe is also underpinned, at least partly, by the understanding that the device-related risks could not be adequately mitigated by improving surgical skills.”