The Health and Disability Commissioner is slamming a surgeon who failed to effectively communicate with a patient whose belly button was removed without consent during surgery.
The woman was getting surgery to repair an umbilical hernia, but during the procedure, the surgeon removed her umbilicus - the clinical name for the belly button - due to an unexpected complication, a report from the Health and Disability Commission on Monday said.
The woman complained that post-operatively she was not told that her umbilicus had been removed and she only discovered this when her dressings were removed about one week after surgery.
Health and Disability Commissioner Morag McDowell said she was satisfied the surgeon carried out the surgery with reasonable care and skill, and when difficulties were encountered during the procedure, it was reasonable for them to remove the woman's umbilicus.
But she was worried about the adequacy of the information the surgeon gave to the woman post-operatively and the failure to document the discussions both before and after the procedure.
McDowell said that under the Code, every consumer has the right to effective communication in a way that allows them to understand the information they're given, and in an environment that means both them and their provider can communicate effectively.
She said the surgeon had a responsibility to communicate to the patient that it had been necessary to deviate from the expected surgery and remove her umbilicus. This must be explained in a way that allowed the woman to understand, process, and retain the information.
"Given it was likely the woman was still sedated and not thinking clearly immediately following her surgery, this was not the appropriate time or environment for the surgeon to undertake this conversation with her," McDowell said.
McDowell also noted the District Health Board's (DHB) use of a standard Agreement to Treatment form. This form included a standard statement that the proposed procedure had been discussed and the surgeon had explained the reasons and expected risks of the procedure in relation to the patient's clinical history and condition. There was no space on the form to document any specific details of that discussion with the patient, she said.
While it's up to the clinician to document their discussions with patients, McDowell said the format of the consent form didn't prompt the surgeon to document the specific details of discussions with the woman.
Following this case, the surgeon agreed to undertake further training on communication and documentation and volunteered to develop a brochure on umbilical/incisional hernia surgery.
The DHB also agreed to review its standard Agreement to Treatment form to include space on the form for specific risks discussed to be documented.
The surgeon told the Health and Disability Commission that all issues discussed during the consent process are now documented and post-operative ward rounds are documented by junior doctors adequately and clearly.
The DHB said the brochure on umbilical/incisional hernia surgery is currently in the process of being developed. In the meantime, the surgeon and the DHB agreed to consider using the Royal Australasian College of Surgeons brochure on hernia surgery until this has been completed.
