The surgery by a gynaecologist, identified only as Dr B, included the removal of both of her ovaries, but the process to that point lacked adequate informed consent, deputy commissioner Rose Wall found.
The woman had been experiencing varying levels of pain throughout her body and was suffering from abdominal pain after a complication in an earlier surgery to remove her gallbladder when the tumour was discovered.
In her decision Wall expressed concerns about the adequacy of information provided to the woman before she consented to surgery, including a lack of conversation about available options.
Wall also criticised the lack of clinical rationale for the surgery and outline of the potential risk associated with ovary removal.
The woman, referred to as Ms A, said she was never informed about how the removal of her ovaries would impact her quality of life and was told the removal of both ovaries was the only available option.
She said the removal had a “detrimental” effect on her physical and mental health, which had continued since her surgery.
“I was misinformed and ill-advised about the gravity of the nature of the surgery that was required,” she told the HDC.
Ms A made a treatment injury claim to ACC several years after the surgery, with an independent doctor, Dr C, giving advice to the corporation in 2017.
He told ACC the surgery wouldn’t have been his primary treatment, however, he said the gynaecologist may have been trying to save Ms A from a further operation.
“But the benefits of this needed to be weighed up against the risks of bilateral oophorectomy [removal of both ovaries and fallopian tubes] at [Ms A’s] age,” he told ACC.
Dr C advised that “most gynaecologists are reluctant to remove normal ovaries before the age of 55 years without careful discussion regarding the risks and benefits to that particular individual”.
It was not noted in the decision if Ms A’s treatment injury claim was successful.
The gynaecologist was found in breach of the Code.
In the case of the second patient in Manawatū, she only agreed to the removal of her uterus and fallopian tubes using a bikini incision and understood her ovaries would be retained during the surgery.
This understanding was part of her pre-admission appointment with an unknown doctor but, just 30 minutes before her surgery a month later, she was informed by the consultant gynaecologist at Te Whatu Ora Te Pae Hauora o Ruahine o Tararua MidCentral that the ovaries would also be removed.
A midline incision rather than bikini incision would be used by the surgeon which was clinically recommended, the HDC decision by Commissioner Morag McDowell said.
Aged in her 50s and referred to as Mrs A, the woman was recommended a hysterectomy after her post-menopausal bleeding was investigated and persisted following several appointments, as well as hot flushes.
She was under the impression the hot flushes would stop after the surgery but these persisted.
It was a concern of one doctor that she may have a rare form of uterine cancer but tests revealed no cancer present.
The morning of the surgery on August 5, 2020, was the first time the consultant gynaecologist, Dr B, discussed the removal of Mrs A’s ovaries with her.
Dr B told the HDC he was not aware of the details of earlier discussions with Mrs A by other doctors but believed she had been “thoroughly consented”.
The commissioner found the consenting process inadequate and said the woman felt pressured to go along with the latter plan because of how little time she had to make a considered decision.
“It was not appropriate to introduce such changes to the woman’s surgery so late in the process when there was insufficient time for her to make a considered decision to proceed with the surgery,” McDowell said.
“The informed consent process should have taken place in an environment that enabled the woman to communicate openly, honestly and effectively with her healthcare providers.”
Te Whatu Ora MidCentral was found to have gaps in its system by the commissioner, who made adverse comment on the former district health board’s processes.
These included failing to call the consultant for the woman’s pre-admission appointment as required, and clinical records from that appointment were unsigned meaning the doctor who saw her was unidentifiable.
In both cases, issues of informed consent were at the forefront, to do with adequate information provided to both women before they underwent their surgery.
The lack of appropriate paperwork was also an issue.
Both women will receive apologies from the clinicians involved, and Ms A will receive an additional apology from Te Whatu Ora.
