Surgery Photo: 123RF
A patient who suffered years of pain and complications following surgery - including surgical mesh perforating her vagina - has had her complaint against the gynaecologist upheld.
The mother-of-five had a hysterectomy and pelvic floor repair using the surgical mesh product in 2013 when she was in her 40s.
She had surgery to remove it five years later, after it was found to have eroded through the vaginal wall.
Deputy Health and Disability Commissioner Rose Wall found the unnamed gynaecologist breached the patient's rights by failing to adequately explain the risks of surgical mesh, including erosion and chronic pelvic pain.
"It follows that, without the necessary information, the patient was not able to make an informed choice and give informed consent to the surgery," Wall said.
"I am also critical that the gynaecologist did not document which alternative treatment options were discussed with his patient and what information was provided about these options."
Specialist gynaecologist Dr John Short, who reviewed the case for the commissioner, said the findings of the 2018 surgery to remove the mesh "strongly suggest that the sling was incorrectly placed in 2013".
The original surgery - carried out by a registrar under the supervision of the gynaecologist - was also inadequately documented - with the operation note containing "only limited information and few specifics", Short said.
"There is brief mention of the repair of a vaginal perforation but no description of where or how this occurred. Overall, the operation note is of a poor standard."
However, "one must be mindful of the five-year interval in interpreting the information", he concluded.
The patient told the commissioner the complications - and repeated intrusive examinations necessary - had been damaging to her dignity and privacy.
Changes to practice
The specialist said he was very sorry for what the patient had endured, but maintained he had done his "utmost" to ensure she was advised of her treatment options.
"I always strive to provide a high standard of care and have taken this complaint as a catalyst to implement processes to ensure a thorough level of documentation is captured in preoperative counselling."
Wall noted that since the event, the gynaecologist had made a number of changes to his practice.
He stopped using the Monarc transobturator tape (TOT) surgical mesh product (which was withdrawn from use in New Zealand in 2016 anyway) and had also "markedly increased" his level of documentation relating to preoperative counselling.
Wall recommended that he provide a formal written apology to the patient, complete the Health and Disability Commissioner's online learning course on informed consent, and ensure all treatment options and their risks were discussed clearly with patients, and documented on consent forms or in clinic letters.