Health and Disability Commissioner Morag McDowell has found that the senior doctor who oversaw the procedure and the obstetrics and gynecology trainee who performed the procedure breached the Code of Health and Disability Services Consumers' Rights because they failed to provide services with reasonable care and skill.
The breach related to the care provided to the woman in her 20s when she underwent a procedure at Greenlane Hospital to remove abnormal cells from her cervix following the results of a smear test.
The loop electrical excision procedure (LLETZ) to remove the abnormal cells began without local anesthesia, causing the woman significant pain, McDowell said in a report released today.
The woman has received advice and support from her GP for post-traumatic stress disorder as a result of what happened to her.
McDowell said administering local anesthetics was a basic step in the procedure and most doctors would have done this before starting.
“The applicable standard of care is the care and skill that an ordinarily careful colleague of the physicians involved would exercise under similar circumstances,” McDowell said.
An LLETZ procedure usually only takes five to ten minutes.
The woman said in her complaint that when the procedure was about to begin, the doctor told her, “Now you will hear a buzzing sound from the machine, but you will not feel anything.”
But she was then “filled with the most unbelievably horrific pain” and screamed as she felt the electrical ascending wire “cut through her cervix”.
Dr. B, the intern, told HDC that after the first vaginoscopy was performed, she began the LLETZ procedure by performing a “touch test” to make sure the electrical current was working.
She said this test caused the woman a lot of pain, causing her to scream, and then it was realized that no anesthetic had been administered before the test.
The woman, who is not named in the decision, said she was then told by one of the employees that they had to “get through that loop before they could address the pain,” and was scolded for shaking and held in her arms. an attempt to keep her quiet.
Dr. B told HDC that she did not remember staff restraining or scolding the woman for moving.
She said the LLETZ loop was immediately removed without reactivation, and all staff apologized to the woman.
She then switched places with the senior physician, Dr. A, who called for and administered the local anesthetic.
The woman said that at no point did anyone apologize, and she also claimed to have experienced a burning sensation in her vagina and on her thighs from the iodine administered as part of the procedure, but the doctors did not respond to her to assure.
Dr. B noted that iodine was not applied to a patient's thighs and stated that if they had been aware of a burning sensation, the doctors would have tried to relieve it with saline solution and offered pain relief.
The woman was then asked whether she wanted to reschedule the procedure so that it could be performed under general anesthesia, or whether she wanted to continue the procedure.
The woman said she experienced “tremendous shock and pain” but agreed to go ahead for fear the cells would develop into cancer if left untreated.
Dr. B told the HDC during the investigation that there was no local anesthetic syringe on the treatment table, resulting in a delay of “not more than five minutes” in preparing the syringe and applying the local anesthetic.
The senior supervising physician, Dr. A, told HDC that when supervising a trainee performing an LLETZ, she usually stood at the back and watched all the steps.
She did not notice that the local anesthetic solution had not been injected into the cervix and therefore did not intervene.
She acknowledged that this was an error of judgment on her part and a significant omission and breach of standards.
In response to the patient's concerns about iodine burn, Dr. A. said that more could have been done to inform her of the increased risk of symptoms due to the application of iodine during preparatory vaginoscopy and that it was possible that the woman had developed a late reaction to the iodine burn. it, which would not have been picked up during her stay in the clinic.
Dr. A told HDC that the woman was not present for a follow-up appointment and did not want to speak to her when she called for a follow-up appointment.
She then wrote a letter to the woman and copied it to her GP to apologize and discuss options for future care.
Te Whatu Ora – Health NZ said that if the team had continued to follow up with the woman, no six-month period would have passed before she received a formal apology and, importantly, the opportunity to offer her support in dealing with the trauma would not have passed. have been missed.
Health NZ described it as an “important learning experience” for the staff involved and for women's health services in the appropriate follow-up of patients after adverse events.
McDowell was adamant that the issues outlined were primarily the responsibility of the individual doctors involved, but she was critical of Health New Zealand – Te Whatu Ora Te Toka Tumai Auckland's failure to transfer the woman's consent form to her file upload.
She also said a more empathetic approach was warranted by Health New Zealand following the adverse event, including face-to-face contact to help with the woman's recovery.
She also recommended that the gynecologist and registrar issue a formal apology to the woman and that Health New Zealand consider introducing the use of saline at the end of all gynecological procedures involving iodine, and consider updating the policy on update side effects to require further treatment. for patients who have experienced an adverse reaction.
Health New Zealand, the gynecologist and the registrar have since made changes to their practice.
– Tracy Neal, Open Justice reporter