Health and Disability Commissioner, Morag McDowell has found a surgeon in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to effectively communicate with a woman whose umbilicus (tummy button) was removed during surgery for repair of an umbilical hernia.
During the woman’s surgery, the surgeon removed her umbilicus due to an unexpected complication. 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 following surgery.
Ms McDowell was satisfied the surgeon carried out the surgery with reasonable care and skill, and when difficulties were encountered during the surgery, it was reasonable for the surgeon to proceed with the removal of the woman’s umbilicus.
However, Ms McDowell was concerned with the adequacy of the information the surgeon provided to the woman post-operatively, and the failure to document the discussions both pre- and post-operatively.
Under the Code, every consumer has the right to effective communication in a manner that enables them to understand the information provided, and in an environment that ensures both the consumer and provider can communicate effectively.
Ms McDowell considered the surgeon had a responsibility to communicate to the woman that it had been necessary to deviate from the expected surgery and to remove her umbilicus, in a way that enabled her 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 this conversation with her,” says Ms McDowell.
Ms McDowell also made adverse comment on the DHB’s 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.
While it is ultimately the clinician’s responsibility to document their discussions with patients, Ms McDowell said the format of the consent form did not 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 has informed HDC 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 has advised 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.
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