‘The equivalent of being savaged by a dead sheep” is Paul Catmur’s reading of the Health and Disability Commissioner’s findings in the case of a urologist who carried out what Catmur maintains was unwarranted cancer surgery, which delayed appropriate treatment by six months.
Catmur, a regular Listener contributor, target="_blank">wrote late last year about his battle to get his prostate cancer treated, having complained to the Health and Disability Commissioner (HDC), the watchdog role established by the government to protect patient rights.
After being diagnosed with prostate cancer, Catmur underwent a radical prostatectomy in August 2022 at a private hospital, but then found out the cancer had already spread, and the better treatment would have been radiation.
But he would have to wait another six months after surgery until that could happen. Not only had the correct treatment been delayed, but he also found out the disease spread was already evident on a PSMA PET-CT scan he had before the operation. Disease spread means surgery alone cannot “cure” the cancer, but unfortunately, Catmur was unaware of that until after surgery.
“Dr B [as the urologist is referred to in the HDC decision] failed to share the results of a scan, which showed the spread of cancer beyond the prostate,” Catmur says. “Once this happens, radiation is deemed preferable, as removal of the prostate would not be curative and further treatment would be automatically required. Despite this, Dr B proceeded with surgery, which, as might have been predicted, failed to clear all the cancer and has necessitated two subsequent periods of radiation treatment so far. I am currently waiting to see if they’ve been successful.”
Eighteen months after his complaint was lodged, the commissioner, Morag McDowell, has released her decision: the urologist was found to have contravened Catmur’s rights on three separate counts, which seemed like a significant vindication, says Catmur.
“I read on [in the report] to see what steps would be taken against a doctor for withholding information and carrying out an intrusive operation for which, in the HDC’s words, the patient ‘did not give informed consent’.
“I was astonished to discover that all that was required of Dr B was that he send me a letter of apology and promise to change his ways, at which point the commissioner announced that ‘no further recommendations are necessary’. Really? A surgeon had sliced me open unnecessarily and without consent, leaving me with lasting side effects, yet the only sanction he would receive was for him to shrug and say, ‘Whoops’?
“The report shows a clear example of a surgeon breaking the code and going on to perform a harmful operation yet does nothing about it other than a gently wagging finger.”
Catmur says his experience of the HDC system shows it is inadequate in seeking redress for the aggrieved patient, and in providing consequences for any wrongdoing. “It was supposedly set up to protect the consumer from the health sector, yet it serves to protect the health industry from being taken to task by the consumer. I know I am not the only one to feel these frustrations.”
Next steps
The HDC also cannot force practitioners or healthcare agencies to follow its recommendations, such as further training. It is up to health professionals’ registration bodies, in this case the Medical Council of New Zealand, to decide if disciplinary action is needed. The council has told him that once it receives the HDC decision, it will contact the urologist for his response and refer the matter to its notifications triage team, involving the chair and deputy chair of the council, medical advisers and senior staff, for consideration.
Morag McDowell’s report says she is now satisfied the doctor has apologised and changed how he manages such cases in the future, but is critical of many of his actions. The potential side effects of the surgery were not properly explained, nor were the results of the first PSMA PET-CT scan. The doctor believed the scan had overstated the extent of the disease.
The report also says the information given on whether Catmur should choose surgery or radiation was inadequate: instead of talking him through it, Dr B gave Catmur an 80-page booklet to take home that detailed treatment options.
“I … do not accept that it was sufficient to assume that Mr Catmur was aware of his option of a referral to a radiation oncologist because it was contained in the prostate cancer booklet,” McDowell writes. “This option should have been communicated to Mr Catmur when the treatment options were discussed, and I am critical that it was not.
“In my view, a reasonable consumer in Mr Catmur’s circumstances would have expected to receive a full explanation of their preoperative scan result, options for treatment and the associated risks, side effects and benefits of those treatment options, including the rationale for surgery as the preferred treatment option.”
She also found the doctor had not adequately documented what was discussed during consultations with Catmur, and this was another breach of the code.
However, on the issue of whether the surgery was unnecessary, McDowell accepted it was appropriate to offer in the circumstances. Another urologist who gave advice to her on the case said Catmur had a relatively poor urinary flow rate, which would have been made worse by radiation but better with surgery. The adviser said surgery in these conditions was a viable option.
“While I suspect this expert advice might change as urologists and radiologists get better at interpreting PSMA PET-CT scans, it is the current standard,” the urologist adviser said.
Yet in 2022, this was not the view of the radiation oncologist reviewing Catmur’s case as part of an ACC investigation. This doctor said referral to a radiation oncologist for another opinion should be automatic for anyone contemplating a radical prostatectomy.
And McDowell agrees with her urologist adviser that the case should have been discussed in a multidisciplinary meeting with radiologists and a radiation oncologist before surgery.
“I have recommended that Dr B reflect on this aspect of his care.”
Apology refused
The ACC has refunded Catmur the $30,000 he paid for his surgery and awarded another $36,000 for injuries caused. It is currently deciding whether to pay for further treatment resulting from the delay.
But Catmur sees Dr B as getting off lightly, while leaving the patient worse off and out of pocket. “Dr B retains his anonymity because the HDC feels that naming him might cause damage to his reputation. No kidding.”
In response, McDowell says the HDC often names the group provider, such as the hospital or medical centre involved, but individuals “may have stronger privacy interests, which must be carefully weighed against the public interest.
“For example, we may name a provider if they frequently breach the code, do not comply with our recommendations, or where we have strong public safety concerns.”
She adds that the “HDC is focused on taking an educative approach to complaints to ensure that providers learn from complaints and action is taken to improve quality and safety”.
But it’s all too little, too late for Catmur, who refused to accept an apology from Dr B. “When I finally read the apology, I wasn’t surprised to find that it was both inaccurate and insincere. It felt like it had been written by a schoolboy with prodding from his mum, and I declined to accept it.
“This, of course, had no effect on anything, but it made me feel slightly better, an outcome that has been sadly lacking over the past couple of years.”
