Source: Health and Disability Commissioner
Deputy Health and Disability Commissioner Rose Wall found Taranaki District Health Board’s ongoing care and follow-up, post surgery, was inadequate. For failing to provide services with reasonable care and skill, Taranaki District Health Board breached Right 4(1) of the code, which gives consumers the right to respect | whakamana.
The female patient at the centre of this report, experienced postoperative complications soon after TVT-O mesh surgery. She presented to the postoperative clinic at Taranaki Base Hospital six weeks after surgery 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,” said Ms Wall.
An initial delay of over a year was attributed to the retirement of a specialist and his subsequent return to practice, resulting in a haitus in the woman’s care.
“I consider this issue lies with Te Whatu Ora at a systemic level,” said Ms Wall. “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.”
Ms 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,” said Ms Wall. “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.”
Ms Wall also made an adverse comment about the care given by one of the specialists pertaining to the information provided to the woman about the risks of the TVT-O procedure and the recognition and response to the woman’s complications at the six week follow up consultation.
Ms Wall said that, while the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) leaflet outlines that erosion of tape through the vaginal wall is the most reported mesh-specific complication, given that this was a substantial risk, it warranted a verbal discussion with the patient to allow her to consider the complications in more detail.
Ms Wall recommended that 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.
Ms 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.
