Sedated cancer patient asked for surgery consent

A surgeon who removed a woman’s lymph nodes as part of her cancer treatment has been censured for discussing treatment options while she was on sedatives.

The surgery left the wahine Māori patient with complications including a paralysed vocal cord and hoarse voice, which affected her ability to perform kapa haka – and therefore her mana.

The patient was diagnosed with thyroid cancer in December 2018 and there was suspicion it had spread to her lymph glands, the Health and Disability Commissioner stated in a ruling released yesterday.

In April 2019, the ear, nose and throat (ENT) specialist removed the woman’s thyroid gland and removed lymph nodes, which were found to be free of cancer. The patient claims this meant the surgery was unnecessary.

But when the patient had been asked to consent to the surgery in February, she had just had an ultrasound. The consent forms were given to her within two hours of her taking sedatives.

That was despite advice she should not make critical decisions for 12 hours after the sedation for her ultrasound. The ENT specialist claimed he did this to save the patient a return trip to the hospital.

Deputy Health and Disability Commissioner Dr Vanessa Caldwell found this was a breach of the requirements set out under the Code of Health and Disability and Consumers’ Rights.

The patient maintains the surgeon underappreciated the impact of a surgery affecting her voice.

Caldwell recommended Te Whatu Ora – Health New Zealand review its specific thyroid documentation.

‘‘I remind the treating team . . . of the importance of taking a holistic view of a patient’s needs in their deliberations. For the woman in this case, this involved taking into account the personal significance of the use of her voice.’’

She also recommended an audit of a selection of the surgeon’s clinical records, to make sure they complied with the Medical Council’s patient record guidelines.

Caldwell also recommended Te Whatu Ora and the specialist engage with the commissioner’s hohou te rongo (restorative process).

The specialist had completed a cultural competency course provided by Te Whatu Ora and was developing his understanding of his obligations under Te Tiriti o Waitangi, the deputy commissioner said.