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A woman who was denied a hysterectomy to help relieve endometriosis symptoms had her rights breached by her gynaecologist, the health and disability commissioner says.
The woman, who was in her late 20s and had two children, had requested the hysterectomy after experiencing ongoing pain and bleeding from endometriosis.
She was told by her gynaecologist that such a decision would need to go to a multi-disciplinary meeting (MDM) due to her age, and she was given the impression she needed to try Mirena, a hormonal IUD birth control, first.
A Health and Disability Commission report referred to the woman as Mrs A, and the gynaecologist as Dr B.
Mrs A said she understood that her age was the reason Dr B declined her request for a hysterectomy, and his assumption that she might want more children in the future.
She said she had also declined a Mirena on multiple occasions previously and felt Dr B had 'verbally coerced' her into agreeing to the Mirena insertion.
She told the commission that her understanding was that Dr B would present her case to the MDM if she tried the Mirena, and she felt that if she did not agree to try the Mirena, Dr B would not entertain the idea of a hysterectomy.
Deputy health and disability commissioner Deborah James said the gynaecologist breached the woman's Consumer Rights by not fully informing her of the available options, and by not enabling her to make an informed choice and give informed consent.
"Ensuring the patient was aware of the different options was very important, but it was also important that the gynaecologist gave sufficient weight to the woman's wishes and preferred treatment option," James said.
"I am not satisfied that sufficient weighting was given by the gynaecologist to the wishes of the woman, who should have been at the centre of the decisions made about her care."
She said the information provided to Mrs A about trialling the Mirena made it seem like it was a prerequisite to her case being presented at an MDM and subsequently to proceed to a hysterectomy, but this was not the case.
James said there was no evidence to support Dr B's advice that her case required further discussion from the MDM, and consensus from different consultants.
"It appears that hysterectomy was an available option, irrespective of the need for MDM or consensus. In my view, this is the kind of information that a reasonable person in the woman's circumstances would expect to receive, particularly as she specifically requested a hysterectomy," James said.
The woman sought a second opinion and underwent a hysterectomy, which she said had been life changing.
"I can now be the active, healthy, present mother I had always hoped to be for my two children. My pain has significantly reduced and I am no longer bound by my dysfunctioning body. It is so disappointing that this level of freedom was not afforded to me sooner."
James made several recommendations for the gynaecologist, including that he familiarise himself with the Medical Council of New Zealand's Good Medical Practice publication and statements on communication and consent, and that he consider writing to patients immediately following an MDM with a note stating what was discussed and recommended.