Te Whatu Ora ordered to apologise over inadequate follow-up care for woman suffering surgical mesh complications

Te Whatu Ora has been ordered to apologise to a woman for failing to provide her with appropriate care after surgical mesh surgery.  

In a report released on Monday, the Health and Disability Commissioner found Taranaki District Health Board - now Te Whatu Ora/Health New Zealand Taranaki - provided inadequate follow-up care after the woman underwent vaginal mesh tape sling surgery in 2016.   

Deputy Health and Disability Commissioner Rose Wall found Taranaki District Health Board breached the Code of Health and Disability Services Consumers' Rights (the Code). Commissioner Wall said the DHB breached Right 4(1) of the code, which gives consumers the right to whakamana (respect).  

The woman at the centre of the report experienced complications soon after the surgery and presented to the postoperative clinic at Taranaki Base Hospital six weeks afterwards with significant symptoms including pain, discomfort, and haemorrhaging.  

Despite reporting these symptoms, the woman experienced considerable delays in review, investigations, diagnosis and treatment.  

"The nature of her complications and the ongoing profound imposition they have had on her day-to-day life over this extended period cannot be overstated," Wall said.   

An initial delay of over a year was attributed to the retirement of a specialist and his subsequent return to practice, resulting in a hiatus in the woman's care.  

"I consider this issue lies with Te Whatu Ora at a systemic level," Wall said. "If the specialist retired, they needed to ensure that appropriate systems were in place to transfer the woman's care to another specialist to action any plans in a timely manner."  

Wall was unable to determine the cause of a second delay, of almost a year's duration, between the referral to urogynaecology services in the main centre and the woman being seen by that centre.  

"Previously, this Office has raised concern about failures by public health services to action referrals and manage follow-up in a timely manner.   

"As stated in those cases, it is the responsibility of healthcare organisations to ensure robust systems are in place to minimise the risk of errors occurring in the referral process and in arranging important follow-up."  

Wall also found the woman was not given enough information about the risks of vaginal mesh surgery by one of the specialists. She added the specialist also didn't provide proper recognition and response to the complications at the follow up consultation.  

The Deputy Commissioner said while the woman was given a pamphlet outlining possible complications, erosion of tape through the vaginal wall is the most reported mesh-specific complication given that this was a substantial risk, it warranted a conversation beforehand so the woman could make an informed decision.   

Wall recommended both the specialist and Te Whatu Ora provide a written apology to the woman for the deficiencies in care outlined in the report.  

Since the events, Te Whatu Ora has set up monthly multi-disciplinary meetings between the Urology and Gynaecology teams, to discuss and review all women referred with urinary incontinence issues. They have also recently established the New Zealand Female Pelvic Mesh service to support and care for women harmed by pelvic surgical mesh.  

Wall also noted changes in progress by Manatū Hauora of Health (in leading the surgical mesh work programme with oversight and monitoring by the Surgical Mesh Roundtable), Medsafe, and RANZCOG, which should go some way in reducing harm from surgical mesh in the future.