Ron Paterson

Wellington, March 25 NZPA - A gynaecologist breached a patient's right to give informed consent to a procedure when she "drilled" the woman's ovaries as a treatment for suspected endometriosis, Health and Disability Commissioner Ron Paterson has ruled.

The 29-year-old woman complained to the commissioner about the issue of consent, and also about her post-operative care under the gynaecologist, identified only as Dr B.

The woman was assessed by Dr B on February 9, 2004, as needing a "look see" laparoscopy and surgical treatment of any endometriosis -- a condition where tissue similar to the lining of the uterus grows outside the uterus causing heavy bleeding and pain.

Dr B found that the woman had polycystic ovary syndrome (PCOS) and performed a widely-recognised treatment known as ovarian drilling or "golf balling" to deal with the condition. The procedure involves drilling many small, deep holes in the surface of the ovary.

Dr B supplied a file note to the commissioner which stated that Ms A had decided to go ahead with the laparoscopy and golf balling "if and as required and any other surgery I may consider will be beneficial for her at the time of the laparoscopy to resolve her ongoing pain".

However, the note was supplied to the commissioner with additional records some months after Dr B's initial response to the complaint. It has been "unearthed" from storage "after extensive searching", her legal counsel said.

The note was on plain, unheaded paper and contained no information to identify the patient, other than a shortened version of her first name and her initials.

The woman said the first she knew of the golf balling procedure was when she consulted another gynaecologist months after her surgery.

With regard to her post-operative care, the woman complained that when she woke up in the recovery room after the surgery she was in "horrific pain" and "covered in blood coming from the (surgery) site".

She said she was "knocked straight out and (had) no idea what was fixed, changed, or even occurred". Another gynaecologist, who was in the room at the time, told the commissioner the woman looked pale and was in pain. Her sheet had blood on it, she said.

According to Dr B and the clinical notes, the patient's recovery was uneventful.

Although there was no record of Dr B visiting the woman while in the hospital ward, Dr B assured the commissioner it was her "absolutely routine practice" to see each of her patients daily.

In the days after her discharge home, the woman said she suffered ongoing pain, was treated with antibiotics and was readmitted to hospital for treatment, where she was reviewed by a number of doctors.

In findings released today, Mr Paterson ruled that "in the absence of reliable records" Dr B did not obtain informed consent for the golf balling procedure before the surgery.

"There was no legal justification for her to drill Ms A's ovaries," he said.

Mr Paterson found that Dr B's post-operative care of the patient was of an acceptable standard and did not breach the Code of Health and Disability Services Consumers' Rights.

He recommended that Dr B apologise to her patient and review her practice in light of the findings.