KEY POINTS:
A Westport woman who lost a leg following routine knee surgery at Grey Hospital failed to receive appropriate care from her surgeon, according to Health and Disability Commissioner Ron Paterson.
Chris Townrow, now 50, has been in a wheelchair since the operation.
Mr Paterson said orthopaedic surgeon Dr Robert Coup failed to provide appropriate pre-operative planning or post-operative care, and his documentation did not meet appropriate standards.
As a result, Dr Coup had breached the Code of Health and Disability Services Consumers' Rights.
Mr Paterson found the West Coast District Health Board's peri-operative care was appropriate, but questioned its support for a relatively inexperienced surgeon.
Mrs Townrow received right knee replacement on November 7, 2005, after suffering severe osteoarthritis which prevented her walking independently.
She was flown to Christchurch Hospital three days later. She had limited circulation in her leg caused by artery damage, probably when her knee was hyperextended after surgery. Surgeons were unable to save the leg and amputated above the knee.
Mr Paterson said her knee surgery had presented a "technical and clinical challenge". At the time, she weighed 134kg and was being treated for high blood pressure.
Dr Coup was a recently qualified orthopaedic surgeon. He was relatively inexperienced at joint replacement surgery, having performed fewer than 10 total knee replacements unsupervised, Mr Paterson said.
Dr Coup lacked insight and judgement in deciding to undertake such surgery with the limited support services available at Grey Hospital.
"Before he proceeded, Dr Coup should have discussed her case with a senior colleague at Grey Hospital, arranged for back-up support from other specialists, and made Mrs Townrow aware of the risks related to her weight."
Dr Coup's lack of experience seemed to have compromised his judgement and delayed her transfer to Christchurch, Mr Paterson said.
He recommended Dr Coup review his practice in light of the report and confirm he had discussed it with the head of department of the DHB where he is currently employed
Mrs Townrow said she was pleased Mr Paterson had recommended improvements.
"Now that this (the commissioner's report) is here, that's the end of it," she said.
She had also received a written apology from Dr Coup. The WCDHB has already apologised for her injury and for poorly handling her complaint.
It has paid all her medical bills and offered to fund a gastric by-pass so she could lose weight. She could then have surgery on her left knee enabling her to have a prosthesis fitted to her right leg, and walk again.
She rejected the by-pass in favour of a strict diet and last year shed 37kg, reducing her weight to 95kg. But she revealed today she had suffered depression before Christmas and put most of the weight back on.
Accident Compensation Corporation had refused to pay for counselling.
The corporation initially offered a lump sum of just $6632.23 for her lost leg. Mrs Townrow, who has begun dieting again, said the amount had increased by about $1000 after she appealed.
An ACC spokeswoman said today ACC had covered medical expenses as the result of the mishap, modified a vehicle, and provided a mobility scooter.
She said the mishap was estimated to cost ACC $215,000 over Mrs Townrow's lifetime.
Dr Coup said today: "In retrospect, of course I wish I had not gone ahead with this operation.
"As a general principle, however, I still feel that a patient who is clearly suffering a lot of pain and disability should not be denied joint replacement surgery just because they are a difficult case.
"In this individual case, I still feel Mrs Townrow should have been offered surgery but I should have sought the assistance of a more experienced surgeon."
Dr Coup said he was disappointed to have been found in breach of the Code of Health and Disability Services Consumer's Rights.
"I am far more disappointed at the serious complication suffered by Mrs Townrow. I have spent a lot of time thinking about this case and discussing it with colleagues long before and subsequent to the involvement of the HDC."
Dr Coup said he had reviewed his practice and had undergone further training in Toronto, Canada, in difficult hip and knee replacement, with an international expert.
- NZPA
