Apology recommended after five-year wait for mesh fix
Te Whatu Ora Taranaki has been told to apologise to a woman who waited five years for treatment of her post-surgery complications and ongoing health issues.
In a report released yesterday, the Health and Disability Commissioner found Te Whatu Ora’s ongoing care and follow-up post surgery was inadequate and failed to provide services with reasonable care and skill.
Deputy Health and Disability Commissioner Rose Wall recommended the specialist and Te Whatu Ora (at the time, the Taranaki District Health Board) provide a written apology to the woman for the deficiencies in care outlined in her report.
On May 16, 2016, the patient referred to a Ms A had a TVT-O mesh procedure (transvaginal tension-free vaginal tape obturator).
Surgical mesh could be inserted to treat pelvic organ prolapse and urinary incontinence.
Problems with this surgery had been reported worldwide, and there was a New Zealand Facebook page called Mesh Down Under with 1800 followers for women who had suffered complications after such surgeries.
Wall’s report discussed the adequacy of the information provided to Ms A prior to undergoing the procedure and the appropriateness of her postoperative care when she experienced complications.
Ms A experienced complications soon after the TVT-O mesh surgery was performed.
She went to the postoperative clinic at Taranaki Base Hospital six weeks after surgery with symptoms such as pain, discomfort and haemorrhaging, Wall said.
Despite reporting these symptoms, the woman experienced considerable delays in review, investigations, diagnosis and treatment.
The woman endured “significant complications” for nearly five years before revision surgery was performed, and a more substantial attempt was made to remedy her situation and alleviate the adverse symptoms, Wall said.
“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.”
An initial delay of more than a year was attributed to a specialist temporarily leaving medical practice, resulting in a break in the woman’s care.
“I consider this issue lies with Te Whatu Ora at a systemic level. If the specialist temporarily left medical practice, 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.”
Wall said she was unable to determine the cause of a second delay of almost a year’s duration, between the referral to urogynaecology services at a tertiary centre and the woman being seen by that centre.
“Previously, this office has raised concern about failures by public health services to action inter-hospital referrals and manage follow-up in a timely manner.”
Wall also raised concerns about the care given by one of the specialists concerning the information provided to the woman about the risks of the TVT-O procedure.
Erosion of tape through the vaginal wall was the most reported mesh-specific complication.
As there was a substantial risk, there should have been a verbal discussion with the patient so she could consider the complications in more detail, Wall said.
Wall was critical about the specialist’s recognition and response to the woman’s complications after being alerted to her symptoms when the woman was reviewed by the specialist’s registrar at the six-week follow-up consultation.
Te Whatu Ora Taranaki had now set up monthly multi-disciplinary meetings between the urology and gynaecology teams, to discuss and review all women referred with urinary incontinence issues.
They had also recently established the New Zealand Female Pelvic Mesh Service to support and care for women harmed by pelvic surgical mesh.
The Health and Disability Commissioner found that Te Whatu Ora Taranaki had breached the Code of Health and Disability Services Consumers’ Rights in relation to its management of postoperative complications developed by a patient following TVT-O mesh surgery.