Woman not told hysterectomy would cause menopause
A woman who had a hysterectomy was not told the surgery would bring on menopause.
The woman, in her 50s at the time of the surgery, was not given enough information to give informed consent to the treatment, a report has found.
Deputy Health and Disability Commissioner (HDC) Rose Wall found the woman’s specialist obstetrician and gynaecologist breached the Code of Health and Disability Services Consumers’ Rights for failing to provide her with adequate information to consent to treatment.
The woman, who could not be named for privacy reasons but was referred to in the report as Mrs B, had a total bilateral hysterectomy and a bilateral salpingo oophorectomy (removal of the ovaries and fallopian tubes) to manage heavy menstrual bleeding.
Wall found the specialist (referred to in the report as Dr A) breached Mrs B’s right to make an informed choice by failing to inform her that removal of her ovaries would render her menopausal.
Wall also found Dr A failed to give Mrs B information about the surgical risk of injury to the bladder wall, which did happen and caused a complicated recovery.
The surgery happened after Mrs B experienced heavy menstrual bleeding, causing anaemia, and was referred in 2019 by her GP to Dr A, a specialist, to manage her symptoms.
Dr A found Mrs B had multiple non-cancerous tumours and adenomyosis, a condition in which endometrial tissue exists within and grows into the uterine wall.
Following a particularly bad period that led to an iron infusion, Dr A recommended Mrs B get a total hysterectomy and salpingo oophorectomy (removal of the ovaries and fallopian tubes) for “long-term benefit”.
Dr A told the HDC that before any surgery, he usually discussed the procedure in detail, often drew diagrams to explain the surgery, and provided the patient with a brochure.
He said that would have happened with Mrs B during a consultation on February 12, 2020. However, there was no record of that discussion.
A couple of weeks later, Mrs B signed the private hospital’s consent form for her procedure.
The form stated she had been informed of the risks but it did not note the specific risks and complications of the procedure.
She had the surgery a few days later, performed by Dr A who reported it was a success.
She was told pain was to be expected afterwards, but it continued to be “unmanageable”.
In the two days after her discharge, she developed extreme pain and bloating in her abdomen.
She was unable to speak with Dr A, and instead spoke with the clinical receptionist and nurses, who told her it was “just pain from the operation” and it would settle.
But it did not settle and a few days later her stomach was “grossly swollen” and she was in extreme pain.
A pelvic ultrasound revealed a “nick to the bladder” and she was given a catheter for two weeks. She later developed signs of sepsis.
Mrs B eventually became incontinent and after several trips to hospital, a camera and dye test found her bladder was not fixed, and another procedure was required. She also had a vesicovaginal fistula, an unwanted opening that forms between the bladder and the wall of the vagina, causing urine leakage.
Wall said while the postoperative care met accepted standards, she found Dr A breached Right 6, which gives consumers the right to full information.
“Her complaint highlights the importance of the informed consent process, and, in particular, consumers being given all the relevant information to enable them to make an informed decision on their care.”
Wall made several recommendations for Dr A to improve his management of informed consent and recommended he apologise to Mrs B.
Dr A apologised for the “upset and distress” caused. He had learned from the process and would have signed consent forms tailored to the procedure, he said.