The removal of a woman’s right fallopian tube without adequate informed consent before a surgical procedure was a “severe departure from accepted standards,” the Health and Disability Commissioner has found.
A Health and Disability Commissioner (HDC) report released today detailed the woman’s care and found that she was not provided the “right to information that a reasonable consumer could expect to receive” under the Code of Health and Disability Services Consumers’ Rights.
The complaint by the woman — known as Ms B — centres on a surgery for the removal of a suspected ovarian cyst on her left fallopian tube, for which she provided written consent to remove the left ovary and fallopian tube.
Ms B said that prior to the surgery she was advised that her left ovary and fallopian tube might need to be removed, but that her right ovary and fallopian tube would not be affected.
However, on the morning of the surgery in February 2019, the surgeon documented that Ms B agreed to the removal of her right fallopian tube, in a procedure known as a salpingectomy.
“As her main concern was to reduce her risk of cancer, I offered her prophylactic right salpingectomy to reduce the future risk for ovarian cancer as well as the removal of the abnormal ovary and tube on the left,” the doctor told HDC.
He noted during their conversation “it was evident that Ms B was very anxious and afraid of her future cancer risk in light of her family history of cancer”.
The doctor “only gained verbal consent” during the pre-operative discussion and did not document the informed consent.
“It is unclear exactly what [was] discussed with Ms B in relation to the right salpingectomy, and it was not added to the written consent form,” the report said.
After the surgery, the woman told the HDC she asked about her right fallopian tube and was told it was unaffected. The removal of both tubes was noted in her discharge summary.
It was not until a year later in February 2020, when the woman underwent an ultrasound and was informed by the technician that it appeared that she had only one ovary and no fallopian tubes.
“Upon further investigation, Ms B’s GP confirmed with her that both fallopian tubes and the left ovary had been removed during the February 2019 surgery,” the report said.
Ms B said she was concerned that her right fallopian tube had been removed without her knowledge, and that she was not informed after the surgery that it had been removed.
She said that she felt the series of events had taken away her chance of becoming a parent.
The doctor accepted that the consent form documentation was inadequate and did not reflect the preoperative discussion he had with Ms B.
He also acknowledged that a conversation about the removal of both fallopian tubes in the setting, “should not be done” as he stated that when someone is fearing for their life or in pain, they are most likely not in a mental state to process all the information given to them.
Health New Zealand agreed with the HDC report that informed consent for Ms B’s surgery was “inadequate and did not reflect the pre-operative discussion as documented in the clinical inpatient notes”.
Health NZ stated “We apologise that our practice was not adequate on this occasion, and we have stressed the importance of this for the future”.
Deputy Health and Disability Commissioner Dr Vanessa Caldwell was critical of the doctor for advising the woman of the change in surgical plans, to include the right salpingectomy, in the preoperative holding bay while she was experiencing signs of acute stress relating to the procedure.
“The environment in which this option was put to her was inappropriate. It affected her understanding of her surgery and the effect the procedure would have on her fertility was profound.”
Caldwell said the risks, benefits and options related to the procedure were not explained to the woman appropriately, particularly its potential effects on her fertility, and said the inadequate informed consent was a severe departure from accepted standards.
A number of recommendations were also made, including that the doctor provide a formal apology to the woman and completes HDC’s the online learning modules about the Code.
