Couple unhappy about unconsented procedure
A MOTHER whose baby died when her uterus ruptured during birth had her ovary removed without consent during the ensuing emergency Caesarean.
The doctor performed the oophorectomy despite Melanie Hughes having already lost 4 litres of blood during the birth.
He is the same senior doctor called twice by a midwife to attend the busy delivery suite at Waikato Hospital that night, but arrived after Hohepa Hemara WaltersHughes was born lifeless early on April 5.
The little boy was resuscitated but died two days later after suffering a catastrophic brain injury during the uterine rupture.
His death was the subject of an investigation by Waikato DHB which found missed opportunities and miscommunication led to the tragedy.
Hughes knew she had a cyst on her ovary before the birth but no tests had been done to rule out cancer and noone had talked to her about treatment or having it removed.
The senior doctor, who arrived during the emergency Caesarean to find Hohepa being resuscitated, decided not to give Hughes the tubal ligation she had consented to, the DHB review found.
‘‘. . . due to the baby’s poor condition SMO1 [senior medical officer] decided to try to preserve the possibility of another pregnancy.
‘‘As described in clinical record, a large mass was noted [approximately 56cm] on left ovary and to avoid Ms M requiring further surgery to remove this at a later date, the decision was made to remove the mass at this time,’’ the review stated.
After removal of the mass there was only a thin capsule left of the ovary so the rest was removed, according to the review.
There was no evidence Hughes had consented to the procedure, which was undertaken during a lifethreatening situation after Hughes had lost 4 litres of blood due to the rupture.
‘‘I didn’t know until months later,’’ Hughes told the Herald. ‘‘I was quite disappointed because I was supposed to get my tubes tied at the same time but they left my tubes in.
‘‘I wasn’t aware about the ovary at all.’’
Hughes’ partner and Hohepa’s father, Martin Walters, said
Hughes’ Caesarean came after a ‘‘red alert, a siren’’ and he was shocked at how long the surgery took.
‘‘We were very distressed [when we found out],’’ Walters said.
Hughes said the cyst later tested benign but the Herald understands that if it had been malignant, removing it could have spread cancer cells around her abdomen.
The Te Kuiti couple, who have reconciled after the trauma of losing their third child caused them to temporarily split, say they were alarmed at the discovery of the unconsented procedure.
It comes after the Medical Council of New Zealand released an updated statement on informed consent late last year following revelations gynaecology patients were having procedures done on them without consent, while they were anaesthetised.
Medical Council chief executive Joan Simeon said at the time informed consent was a very important aspect of care.
‘‘Without informed consent, the treatment may be unlawful.’’
In a statement Waikato DHB said it could only provide general comment because of patient privacy.
‘‘There are at times emergency situations in which it is necessary to take immediate action to preserve the life or health of a patient.
‘‘There may also be occasions in which the need for an additional procedure is identified which has not been previously anticipated and/or a patient is not able to provide consent at the time that the need for treatment is identified.’’
It said the DHB had met the family and continued to work with them but Hughes and Walters do not believe the DHB has satisfactorily answered questions over why their otherwise healthy baby died.
Hughes had been booked to have a Caesarean section later that fateful morning but went into spontaneous labour.
There was 57 minutes between her arrival at Waikato Hospital at 12.25am and the uterine rupture, during which a Caesarean could have saved Hohepa’s life.
A shift report from that night, seen by the Herald, shows the senior doctor on call was telephoned twice by a midwife to attend the unit.
The review found the doctor did not believe he was being asked to come into the suite and that communication needed to be clearer.
Attempts to reach the doctor for comment have been unsuccessful. — The New Zealand Herald