Ruth Johnston, from rural Hawke's Bay, lost both her legs shortly after experiencing complications with a treatment for her varicose veins. Photo / Paul Taylor
Ruth Johnston has learned to crawl outside when she wants to work on her garden at her rural Hawke’s Bay property.
One small victory at a time, she’s fighting back from losing both of her legs.
Johnston’s story is one of struggle - punctuated by small rays of light - since she went for treatment for varicose veins in her legs in February 2020.
And she’s just received another small mercy.
A now-released Age Care Commissioner’s report into the case has found her doctor made a mistake which could have contributed to the loss of her legs.
The doctor involved, known as Dr B in the report, says he’s truly sorry, has accepted the findings, and that the case has completely changed the way he approaches his work.
The report found he failed to provide Johnston services with reasonable care and skill, in breach of the Code of Health and Disability Services Consumers’ Rights.
One thing is for certain - Johnston does not want her case to be swept aside.
She was known only as Mrs A in the report, to her immense frustration.
She wants to be seen, she wants medical professionals to take note, and above all, she wants to prevent it from happening to anyone ever again.
So she and her partner Martin called Hawke’s Bay Today.
WHAT HAPPENED?
On February 19, 2020, Johnston was undergoing ultrasound-guided foam sclerotherapy, a common treatment to eradicate varicose veins.
Age Care Commissioner Carolyn Cooper’s report says the GP doing her procedure immediately stopped when Johnston swore in pain as her second foot was being injected.
He suspected that he had accidentally injected the dorsalis pedis artery, the main artery in the foot, the report states.
In the following days tissue death due to a lack of blood flow meant there was no option but to amputate both of her legs below the knee.
Johnston quickly made a complaint to the Health and Disability Commissioner, which launched an investigation into her case.
The investigation, carried out by Cooper, looked into whether Johnston (aka Mrs A) had received the appropriate standard of care from Doctor B.
The report found that the first six hours in cases of suspected accidental artery injection were the critical period for any potential intervention.
But Dr B did not realise the severity until several hours later when he followed up with Johnston over the phone and heard Johnston was experiencing pain and blotchiness in both feet, the report says.
Johnston told Cooper that her feet had a “horrible yellowish, bloodless look”.
“I am critical that Dr B did not refer Mrs A to an emergency facility immediately when he recognised that a significant arterial event might have occurred,” Cooper’s decision says.
“Not doing so, may be considered a significant departure from standard practice.”
Six days later, Johnston went to Hawke’s Bay Hospital and was diagnosed with a lack of arterial blood flow to her feet before she was transferred to Wellington a week later and underwent a bilateral below-the-knee amputation a few days after that.
Cooper’s report gave Dr B “adverse comment” - the commission’s equivalent of a firm telling off - because he did not assess Johnston for any signs of arterial disease before the procedure.
It did not find him in breach in relation to the pre-procedural assessments.
Cooper wrote that she was unable to determine whether or not Dr B provided the expected standard of care during the procedure as it could not be determined whether an injection into both arteries had occurred or whether it was a rare complication that occurred despite intravenous injection.
THE EFFECTS
The first few months after coming home were frustrating for Johnston, dealing with ACC, living a less active lifestyle and adapting to a house that was not designed for someone with no legs.
“They gave us some ramps so they could push the wheelchair in and a stool so I could slide into the shower.”
The first Covid lockdown had begun and she went without at-home support from nurses for some time amid the confusion.
Her husband Martin had to retire from fulltime work so he could be around to look after her.
“There is so much you can’t do and that is the frustration. We were always active, we were always doing things,” Johnston said.
“It makes for a hard life, and a slow one.”
Learning to use her prosthetics was also a bumpy road.
“I thought that I would just get these things plonked on the end of my stumps and I would just get up and walk. But it is not like that at all,” she said.
“Initially it was so painful I could not stand up. Where the end of the bone hits the prosthetic, it is like jamming it into a brick wall.”
She told Hawke’s Bay Today her biggest fear was that her complaint would be a waste of time and nothing would change.
Having read the report, and its findings, she still has concerns. She said she felt there should have been some form of consequence for her doctor.
“He gets his identity covered up, but I can’t cover up the disability I’m left with,” she said.
Martin said he felt the lack of determination about whether the procedure had been botched highlighted a failure of the system as there did not appear to be any immediate obligation to investigate the procedure.
“If you’re an employer and someone is seriously injured, you have to report it to WorkSafe and they come and investigate it. There was nothing like that for him, no investigation after,” he said.
“It felt like they hoped it would go away.”
DOCTOR: I OFTEN REFLECT ON THIS CASE
Cooper’s decision notes that although the cause of the complication remains uncertain, Dr B told the commission that it was a unique and probably “first of its kind” case of “bilateral arterial spasm” associated with ultrasound-guided sclerotherapy.
“‘[I]f this is truly the first and only case of bilateral ischaemia associated with sclerotherapy ever recorded, then it would be setting an extremely high bar to expect anyone to consider and recognise it.’,” Dr B was recorded as stating.
Cooper noted that Dr B told her he had sold his practice, and had retired from some aspects of his work.
“Dr B stated that he is truly sorry for the ‘devastating complication’ that happened under his care, and that he often reflects on this case,” Cooper wrote.
“Dr B said that he firmly believes that ‘everything that can be done, must be done to try to prevent this complication happening again, not only in New Zealand but worldwide’.”
He told Cooper the case had completely changed the way he approaches aspects of his work.
“In the many months since that terrible day, I have read all the relevant literature I could find.”
Dr B said in the decision that his initial impression that an intra-arterial injection occurred was incorrect and based on circumstantial evidence, and he had learnt that the outcome was possible even with intravenous injections.
“Dr B said that in retrospect, if he had been more aware of the potential for bilateral extensive tissue necrosis despite correctly placed injections, he would have recognised the problem sooner and treated Mrs A differently,” the decision said.
A statement from a lawyer acting on behalf of Dr B sent to Hawke’s Bay Today said he accepted and had taken on board the findings, and the report spoke for itself.
His statement described the HDC’s policy around naming practitioners as “robust” with an approach that focuses on the “public interest”.
“It is apparent that the HDC determined in this case that it was not in the public interest to name,” the statement said.
A spokesperson for HDC said that while reports will often name the group provider such as the hospital or medical centre involved if a breach of the Code is found, individual providers had stronger privacy interests which were 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 [if] we have strong public safety concerns. We must also consider how the decision to name a provider might affect all other people involved in a complaint.”
James Pocock joined Hawke’s Bay Today in 2021 and writes breaking news and features, with a focus on environment, local government and post-cyclone issues in the region. He has a keen interest in finding the bigger picture in research and making it more accessible to audiences. He lives in Napier. james.pocock@nzme.co.nz
Paunovic moved to Havelock North with her family from Croatia seven years ago.