Wellington, Dec 8 NZPA - A doctor who botched the circumcision of a wriggling four-year-old, severing an artery in the boy's penis, may face further disciplinary action, after a report by the Health and Disability Commissioner was released today.

The botched operation, which saw the boy require emergency hospitalisation, was performed at an unnamed medical centre in January by a general practitioner, assisted by a doctor unqualified to practice in New Zealand and the doctor's wife.

The commissioner's report recommended the doctor in charge of the operation review which patients he performed operations on -- "giving particular consideration whether he should undertake circumcisions in boys aged older than six months".

"This case illustrates what can happen when a doctor is unfamiliar with, or chooses not to follow, recommended guidelines for a surgical procedure. It also highlights why patients (or their parents) need to be provided with adequate information so they can make an informed choice and give their informed consent."

The case was referred to the commissioners' director of proceedings, to decide whether action should be taken.

Copies of the report were also forwarded to the New Zealand Medical Council, which certifies doctors to practice, and the Ministry of Health.

On arriving at the medical centre, the parents and the young patient were directed to the waiting room, with the doctor busy performing a circumcision on another patient, a 14-year-old boy.

The family were concerned to hear the screams of the older boy.

The clinic's manager, and wife of the operating doctor, told them, although the 14-year-old had been given the maximum dose of morphine, he was "too sensitive and could not handle the pain", the report said.

The boy's mother told the commissioner the child was taken into the operating room, was given an injection, then cut into seconds later, before the painkiller had time to take effect.

Seeing her son in pain caused the mother to start crying, at which point she was ordered out of the room by the doctor, apparently for passing her anxiety onto the child and disturbing him. About 10 minutes later, the boy's father was also ejected from the room.

"We could hear our son crying for help and begging us not to leave him there by himself. He kept asking them to let us in but they wouldn't listen," she said.

After about an hour, the boy's father walked in to the operating room to see the doctor apparently talking to another doctor on the phone about how he didn't know what was going on. He saw the clinic manager and the unlicensed doctor were holding the boy "as if they were holding a wild animal", the report said.

About an hour-and-a-half after the boy went into the operating room, the doctors called an ambulance, due to uncontrollable bleeding.

The doctor, however, said the boy was subdued and calm, while the father complained of dizzy spells and became pale, and was asked to leave the room, lest he collapse during the operation.

He did admit the child became "extremely difficult to handle" and, due to the strength of the four-year-old's pelvic muscles, enlisted the aid of two people to hold him still.

"It's really difficult because the pelvic muscles are tough and the forearm muscles are not that strong," the doctor said.