A woman's bowel was perforated during a procedure to remove an ovarian cyst. Photo / 123RF
A woman's bowel was perforated during a procedure to remove an ovarian cyst. Photo / 123RF
A woman has been left with a permanent colostomy bag after a specialist removed a 30cm cyst from her left ovary without consent and perforated her bowel in the process.
The woman, in her 20s, underwent surgery for what she thought was the removal of a cyst from her right ovary, a decision released today by the Health and Disability Commissioner (HDC) detailed.
But during the June 2019 procedure, the specialist in obstetrics and gynaecology, who is referred to as Dr B in the decision, unexpectedly discovered the cyst originated from the left ovary.
He removed part of it and another senior gynaecologist, Dr D, removed the remaining part. An additional left-sided cyst was also discovered and removed.
Following the surgery, the woman, who is not named in the decision, became unwell and was diagnosed with a perforated bowel causing sepsis.
She underwent emergency surgery to remove part of her bowel. As a result, the woman now has a permanent colostomy bag.
In a complaint to the HDC, she said she had consented to have a cyst removed only from her right ovary and had not consented to left-sided surgery or to the removal of any additional cyst discovered during the surgery.
She was hesitant to have surgery on her left side after having an earlier procedure in that area.
Expert advice available to the investigation confirmed there was an increased risk of bowel injury due to the woman’s scar tissue from her earlier left-sided surgery.
Dr B was also aware this meant increased complexity of surgery, he told the HDC.
Health and Disability Commissioner Morag McDowell heard the woman's complaint. Photo / Dean Purcell
A pre-surgery appointment with Dr C, a consultant obstetrician and gynaecologist, took place a month before the procedure.
Dr C failed to include in the Gynaecology Elective Surgery Booking form that the woman had undergone surgery in the past, despite that information being included in the referral form from the woman’s GP.
He also excluded the risk of injury to organs when documenting the risks associated with the surgery on the consent form, signed by him and the woman.
On the day of surgery, Dr B countersigned the consent form. He accepted he did not document the risk of injury to organs.
Dr B told HDC that having regard to the woman’s previous surgery, which he said he was aware of, he believed he would have discussed with her that there was a risk of injury to the bowel. But there was no evidence of such a discussion taking place.
He referenced his “normal practice” when it came to discussing prospective risks, but due to the time which had passed, he was unable to recall the specifics of the conversation.
The woman told the HDC that neither Dr C nor Dr B had mentioned a specific risk of injury to the bowel or other organs.
She said: “I would not have agreed to a [l]eft sided surgery unless it was life-threatening or the risks [were] fully explained before I went into surgery.”
The woman told the HDC she felt “what happened to me was unfair” and she was still trying to deal with the “trauma”.
Commissioner Morag McDowell found Dr B had breached the Code of Health and Disability Services Consumers’ Rights by failing to advise the woman of the increased risk of injury to the bowel.
There was a level of uncertainty prior to surgery about the origin of the cyst and given the woman’s reluctance to left-sided surgery, this uncertainty should also have been advised to her, McDowell found.
“The specialist was aware of the uncertain nature of the cyst’s origin, and I would have expected him to communicate that uncertainty to the woman, alongside an explanation that intraoperative findings could necessitate a deviation from the original plan,” she said in her decision.
“In light of the woman’s hesitations about left-sided surgery due to her surgical history, I consider this to be information that a reasonable consumer in her circumstances would expect to receive.”
As a result, the woman was not able to make an informed choice about proceeding with the cystectomy, so the commissioner found a second breach had occurred - that of the right to make an informed choice and give informed consent.
McDowell also made an adverse comment about Dr C for not identifying discrepancies in information regarding the woman’s surgical history.
She stated it was likely the consultant also did not raise the risk of injury to the bowel at this consultation.
The hospital, where the operation took place, undertook its own investigation and has apologised to the woman.
McDowell recommended an anonymised version of her decision be used by Te Whatu Ora, which was found not to have breached the code, for educational purposes.
Dr B, who has retired from clinical practice, has provided a written apology to the woman.
If he returned to practice, it was recommended he undergo further training in communication and informed consent.
Tara Shaskey joined NZME in 2022 as a news director and Open Justice reporter. She has been a reporter since 2014 and previously worked at Stuff where she covered crime and justice, arts and entertainment, and Māori issues.
