Failure To Respect Refusal Of Consent To Treatment

Health and Disability Commissioner Anthony Hill today released a report finding an obstetrician and gynaecologist (O & G) and a district health board in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for using ablation to treat a woman’s endometriosis when she had specifically refused consent to that treatment.

The woman required surgery for suspected endometriosis. Surgical treatment of endometriosis usually requires removal of tissue by either surgical excision (cutting with surgical instruments) or ablation (cutting and burning using an electrical probe), or a combination of both techniques. The woman had researched the different treatments available and told her O & G that she did not want him to use ablation. She also told a junior doctor at an appointment before surgery that she did not consent to ablation, and the doctor had written her refusal of ablation in the woman’s clinical notes. The O & G did not read the clinic notes before surgery and treated the woman using ablation.

Anthony Hill considered that the O & G failed to pay sufficient attention when the woman told him that she did not want to have ablation performed. He was also critical that the O & G did not read the woman’s clinic notes before surgery or record important discussions about consent, including the woman’s concerns about ablation.

"Informed consent is at the heart of the Code," Mr Hill said.

"It was [the woman’s] right to make an informed choice about the procedure she was to undergo, and not to be treated with ablation when she had refused it."

Mr Hill also considered the district health board failed to provide the woman with appropriate care, because its systems for informed consent did not provide adequate guidance to staff.

Anthony Hill recommended that the district health board provide evidence to HDC about improvements to its informed consent processes. Mr Hill also recommended that the O & G and district health board apologise to the woman.

The full report for case 18HDC00131 is available on the HDC website.

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