Disclosure Of Complication To Patient Following Eye Surgery

Health and Disability Commissioner Anthony Hill today released a report finding an ophthalmologist in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to promptly tell a patient about a complication encountered during surgery.

A woman underwent a cornea transplant to treat a progressive eye disease causing distorted vision. She had undergone two previous corneal transplants, but both procedures had failed.

During surgery, the ophthalmologist discovered that the donor corneal tissue had been treated with LASIK surgery, making it unsuitable for the transplant. The ophthalmologist decided to continue with the surgery using the donor tissue because there was a possibility that it could work successfully, and he believed that waking the woman up at this stage would have risked her losing the eye permanently.

Rather than inform the woman about these events when he reviewed her the next day, the ophthalmologist decided to wait for a time when he could explain fully what had occurred and when the woman would have a support person present. The ophthalmologist went on leave and did not see the woman again until two weeks later, which is when he disclosed the issue.

Unfortunately, the corneal graft later became opaque and vascularised, and subsequently failed.

Mr Hill considered that the ophthalmologist’s decision to continue with the surgery was reasonable, but that by failing to disclose the issue to the patient until two weeks later, he had breached the Code. Mr Hill considered that the ophthalmologist should have told the woman sooner and that it was unreasonable for him to decide that disclosure would cause her unnecessary stress.

Mr Hill recommended the ophthalmologist provide an apology to the woman for the delayed disclosure and that he review HDC’s "Guidance on Open Disclosure Policies". Mr Hill also recommended that the DHB consider updating its open disclosure policy, to include guidance on what to do when a lead clinician is not available.

Due to the issues the case raised regarding the screening of corneal tissue for previous LASIK surgery, the Commissioner recommended that the Ministry of Health consider asking clinics to include this risk in their consent process. He also recommended that the Eye Bank consider the issues identified in the report and look at trialling the use of machines to test for prior LASIK surgery in donated corneas.

The full report for case 18HDC01420 is available on the HDC website.

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