Woman's eye accidentally damaged during delicate operation

The woman claims not to have known a doctor still in training was operating on her. Photo / iStock

An elderly woman whose right eye was accidentally damaged during an extremely delicate operation was surprised the procedure was done by a senior trainee surgeon rather than his fully-qualified supervisor.

"I do not recall at any of the appointments prior to my surgery being told that I might well be operated on by a doctor still in training," the woman told Health and Disability Commissioner Anthony Hill's investigation into her complaint.

But the senior ophthalmology trainee, who had worked as an eye surgeon overseas for more than a decade, said he clearly recalled telling the woman he would be the operating surgeon, according to Mr Hill's report on the woman's care at an unnamed district health board, made public today.

The woman, aged in her early 70s at the time of the right-eye operation under local anaesthetic in 2013, had cataract surgery to replace the lens and an "epi-retinal membrane peel". The latter is an extremely delicate procedure to remove a membrane similar to scar tissue that has grown across the macula. The macula is the central section of the retina; the retina is at the back of the eye and converts light to nerve signals.

During the procedure, the trainee inadvertently touched a soft-tipped, diamond-studded instrument called a "tano scraper" onto the retina. The supervising specialist ophthalmologist said the action took less than a second and occurred too quickly for him to prevent it. He took over from the trainee and completed the surgery.

The supervisor said there was no obvious reason for the scraper being placed directly on the fovea, the centre of the macula.

"I immediately said 'stop' and took over, but unfortunately the damage was done in that fraction of a second. This event was totally unpredictable; in all my years of teaching or practice I haven't ever seen anyone touch the fovea during any procedure.

"I can only speculate that it was a momentary lapse in concentration on [the trainee's] part.

"I have seen [senior ophthalmology trainees] touch other parts of the retina by mistake in the past, and I have also done so myself. However, almost invariably this is not due to putting the instrument in the wrong place but by pressing too hard in the correct place (i.e. misjudging the depth), as one can see where to place it."

The specialist said most complications caused by trainees can be fixed easily by the supervising surgeon. However, this was something that could not be remedied or improved.

"I have never seen this happen before and doubt I will ever see it again in the future."

The trainee said: "While I ensure my full attention and focus when performing eye surgery in general, I commit a very high level of concentration for procedures such as the peeling of epi-retinal membranes which require immense focus and precision.

"It was extremely unfortunate that the contact happened close to the centre of vision despite my full concentration. I am deeply sorry and will ensure that such accidents never happen. I have since operated and performed many epi-retinal membrane surgeries and never had a problem of such nature. I will continue to ensure high standard of care for all my patients and will endeavour to avoid such an event at all costs."

The specialist said the woman's vision would be permanently impaired as a result of the complication.

The Accident Compensation Corporation has accepted the woman suffered a treatment injury and deemed it to be a 21 per cent disability.

Mr Hill said the trainee - who is no longer practising in New Zealand - breached the code of patients' rights by not informing the woman of any increased risks from having such delicate surgery done by a trainee, leaving her unable to give informed consent.

He made an explanation to the woman as she was leaving the operating theatre and recorded the adverse event in a discharge summary, but Mr Hill said he failed to record it adequately and did not disclose it to the woman or her GP appropriately.

The specialist breached the code by failing to ensure the woman was properly informed about the adverse event.