It wasn’t until the parents saw “some ooze” coming out of their son’s nose that they realized something wasn’t right.
He was due to be discharged from the private clinic following other procedures approved for his ongoing breathing problems, so the parents warned the nurse.
At that point, the nurse noticed another anomaly: The boy’s adenoids had not been removed despite that procedure being part of the surgery plan.
Since then, the Health and Disability Commissioner (HDC) has identified a series of clerical errors in the boy’s case, after his parents complained to the watchdog.
As a result of the investigation into the case, it was determined that the clinic and the operating surgeon are in violation of the Code of Health and Disability Services Consumers’ Rights (the Code).
The Commissioner’s report, which does not name either party, emphasizes the need to ensure that a patient’s right to decide to refuse treatment is upheld, and emphasizes the importance of providing appropriate information to inform to obtain permission.
The report states that the family first met with the ENT doctor in December 2019, in the report Dr. Called A, to discuss treatment of the boy’s breathing and allergies.
The parents agreed and consented to their son’s surgical treatment, which was to take place in April 2020.
The approved and signed procedures include removing the boy’s tonsils and tonsils, cleaning his ears, and imaging his voice box, trachea and ears.
In February 2020, Dr. A to the parents to recommend that the boy undergo cauterization of his inferior turbinate (CIT) at the same time as the other scheduled procedures.
The CIT procedure involves making an incision or cauterizing the swellings on the side walls of the nose (the turbinates).
The following month, the ENT doctor’s clinic wrote to the mother to add the CIT procedure to the consent form and have it signed. However, the parents refused the CIT procedure and this was acknowledged by the clinic staff.
Despite the confirmation, the email rejecting the CIT procedure was not placed in the boy’s electronic file, meaning Dr. A was unaware that the boy’s parents had refused the procedure.
When it came time for the boy’s surgery in July 2020, following a postponement due to Covid, Dr. A are data and recommendations in the boys file, which still included the CIT procedure.
Before the surgery, there was a miscommunication between the mother and Dr. A about consent to the procedures to be performed. As a result, the CIT procedure was written and signed on the consent form, contrary to the opinion of the parents that they had not given consent.
The mother told the HDC: “We laughed and said we wouldn’t understand the medical jargon, and repeated it fine as long as it’s just ear check, vocal cord check, adenoid and tonsil removal. [Dr A] confirmed that this was what he wrote.”
The CIT procedure was performed, but the boy’s adenoids were not removed because only an insignificant amount of adenoid tissue was present.
After the surgery, a short discussion about the outcome took place between Dr. A and the parents before the boy was transferred to another ward for recovery and monitoring.
About six hours later, the parents noticed for the first time that, contrary to their expectation, their son’s adenoids had not been removed and the CIT procedure had been performed.
After the investigation, the commissioner believed that the clinic was responsible for ensuring that the parents’ decision to refuse the CIT procedure was implemented and given to Dr. A.
Because this “critical information” was not communicated, the clinic had violated the code.
The clinic had advised the HDC that when new clinical information is received, the usual process was to forward the information to Dr. A and save the email in the patient notes.
The clinic told HDC there was “no acceptable explanation” as to why the email was not stored in the boy’s electronic file, but said the timing of the initial Covid lockdown had caused significant stress to clinic staff.
“This was a most regrettable act of omission during a period of crisis.”
The clinic also stated that it was their usual practice for staff to contact Dr. A to confirm that the email was received and handled.
It acknowledged that Dr. A “was not fully and clearly informed verbally about” [the boy’s] decision of the parents”
dr. A had also broken the code, the commissioner found, because despite his ignorance of the family’s denial of consent due to the clinic’s system failure, he retained overall legal responsibility and liability for obtaining informed consent for the procedures. .
Furthermore, the commissioner criticized Dr. A with the family about his decision not to have the boy’s tonsils removed.
He admitted to not telling the boy’s parents in their postoperative briefing that the tonsils had not been removed.
The ENT also acknowledged that he had failed to provide the family with sufficient information about the CIT procedure and that this was followed by a miscommunication on the day of surgery as to whether the procedure should be included in the proposed procedures that would be scheduled that day. are carried out.
He acknowledged the seriousness of the parents’ concerns and told the HDC he was very sorry that they felt his consent process lacked the “usual rigor” and that.
“Dr. A explained that as a result of this complaint, he has made meaningful changes to his practice and that of the clinic,” the report said.
The boy’s parents told the HDC they want accountability and recognition that their son could have been better.
“They stated that there were ‘multiple opportunities to correct their understanding and that the informed consent process was ‘patchy’ at best,” the report said.
“They hope the concerns expressed can lead to a review of the process and prevent something.”
similar to any other young patient.”
The commissioner advised the clinic to issue a written apology to the family and to review the effectiveness of its new policy, which requires further consultation with a patient when there is more than three months between the initial consultation and the day of surgery. sit.
-By Tara Shaskey
Open Justice multimedia journalist