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Damage To Woman’s Uterus During Routine Procedure

Deputy Health and Disability Commissioner Rose Wall today released a report finding an obstetrician/gynaecologist in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failures in her care of a woman undergoing a routine procedure.

The woman visited the doctor regarding treatment for heavy menstrual bleeding and contraceptive options. The doctor recommended thermal ablation (removal of a thin layer of tissue in the uterus) to control the heavy bleeding and an intrauterine contraceptive device (IUCD).

Following the thermal ablation procedure, the woman began experiencing severe contraction-like pain and sought further treatment from the doctor at the public hospital where the doctor also worked. The doctor’s differential diagnosis was that the IUCD was causing the pain and removed it. Following the procedure the woman was sent home, and she began experiencing more severe pain that kept getting worse.

The woman called an ambulance and was taken to the public hospital, and assessed by Emergency Department staff. She was found to have suffered a thermal injury to her uterus during the earlier thermal ablation procedure.

This resulted in the woman undergoing a hysterectomy (removal of the uterus), bilateral salpingectomy (removal of one or more of the fallopian tubes), a Hartmann’s procedure (removal of part of the colon and/or rectum) and an associated stoma (diversion of the bowel to an opening in the abdominal wall).

Deputy Health and Disability Commissioner Rose Wall found that aspects of the services provided to the woman by the obstetrician/gynaecologist were inadequate, and breached Right 4(1) of the Code.

Ms Wall considered that the obstetrician/gynaecologist should have proceeded with caution when she encountered difficulties during the ablation procedure, and should have documented the complications that occurred.

"A woman has suffered an extremely unfortunate outcome as a result of damage during an apparently routine procedure," said Ms Wall.

The Deputy Commissioner considered that when the woman was seen the following day at the public hospital the obstetrician/gynaecologist should have referred the woman to the on-call Gynaecology team. She also considered that after the IUCD was removed the obstetrician/gynaecologist should have ensured adequate monitoring and follow-up before the woman was discharged.

The Deputy Commissioner was also critical of aspects of the systems in place at the district health board (DHB), in particular the lack of clear guidelines for patients from a private outpatient context being assessed at its facilities.

The DHB agreed to undertake an audit of its clinicians’ private gynaecology patients who are referred or transferred to the public hospital for review, to ensure that they have been referred to and admitted by the acute team in accordance with its updated policy. The doctor provided a written apology to the woman.

The full report on case 17HDC00636 is available on the HDC website.

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