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The Health and Disability Commission said an additional procedure performed on a Wairarapa woman was done “without express written consent”.
A doctor and DHB have been ordered to apologize to a Wairarapa woman after carrying out an additional operation on her vagina without her consent.
The gynaecologist performed the Fenton’s procedure while the patient was under general aesthetic, which was outside the scope of the consent that had been granted, a Health and Disability Commissioner report concluded.
The woman told the commission that she did not agree to the Fenton’s procedure, which involves removing scar tissue on the perineum, but the gynaecologist said that he genuinely believed he had consent.
“I did not go into this surgery expecting in any way to be cut near the perineum area, and had not prepared logistically or psychologically for the healing time involved with this,” the woman told the commissioner.
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“It was distressing to find that I had been cut all over again, when I hadn’t expected to be. It was more healing and time off work than I had anticipated.”
After the patient presented with “problematic symptoms” in 2016 the gynaecologist proposed to examine the woman’s urethra and bladder under general anaesthetic, and perform surgery if necessary.
During the procedure, the gynaecologist noticed some abnormalities in another area so removed scar tissue, as I considered that this might help to alleviate the woman’s symptoms.
The patient’s signed consent form had a clause that said that additional procedures may be carried out if it was “in the patient’s best interests and can be justified for medical reasons”.
Piers Fuller / Stuff
The Wairarapa Hospital in Masterton is where the surgery took place.
The commissioner ruled that this clause was misleading and that the surgeon did not have “express written consent” to perform the Fenton’s procedure.
“Surgical services may be provided to a competent adult in non-emergency situations only if that patient makes an informed choice and gives informed consent, irrespective of what the doctor considers to be in the patient’s best interests,” the report said.
As part of the commissioner’s findings, I recommended that Wairarapa DHB apologize to the woman and review its training on informed consent.
The commissioner also found that Wairarapa DHB did not do enough to prevent the gynaecologist from breaching the code.
The report recommended that Wairarapa DHB urgently review its consent form, and said consideration should be given to the development of a national consent form that all DHBs could use which meets the guidance of the HDC.
Wairarapa District Health Board chief executive Dale Oliff said they accept the findings of the report and have apologized to the patient.
“We are grateful for the learning that has resulted from this investigation, and thank the patient and our staff involved for their professionalism and cooperation during this difficult time,” she said.
The DHB has revised the consent form, and said they were working with clinicians to provide refresher training to ensure full understanding and clarify expectations around informed consent.
