Disability Commissioner Tauranga Inquiry (part 1)

Part 1 of the Health and Disability Commissioner Tauranga inquiry

Introduction In December 2003, Health and Disability Commissioner Ron Paterson initiated an inquiry into the quality of care provided to five patients by Tauranga surgeon Ian Breeze, prompted by new complaints to the Commissioner’s Office. In January and March 2004, the inquiry was extended to include two further cases. The terms of reference for the inquiry were:

1. Did Mr Ian Breeze provide services of an appropriate standard to:

(1) Patient A, on whom Mr Breeze performed a cholecystectomy at Tauranga Hospital in October 1999, and who developed postoperative complications.

(2) Patient B, on whom Mr Breeze performed bowel surgery at Tauranga Hospital in March 2000, and who developed postoperative complications.

(3) Patient C, on whom Mr Breeze performed a cholecystectomy at Tauranga Hospital in February 2000, and who developed postoperative complications.

(4) Patient D, on whom Mr Breeze performed a repair of hernia operation at Norfolk Hospital in August 2000, and who developed subsequent complications.

(5) Patient E, on whom Mr Breeze performed a laparoscopic cholecystectomy at Norfolk Hospital in April 2002, and who developed postoperative complications.

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(6) Patient F, on whom Mr Breeze performed laparoscopic surgery at Southern Cross Hospital in September 1998, and who developed subsequent complications.

(7) Patient G, on whom Mr Breeze performed a left hemicolectomy at Tauranga Hospital in February 1999, and who developed postoperative complications.

2. Did Tauranga Hospital, Norfolk Community Hospital and Norfolk/Southern Cross Hospital take adequate steps to ensure that Mr Breeze was competent to practise surgery and to respond to any concerns about Mr Breeze’s practice?

Findings The first part of the Commissioner’s investigation – into the quality of care provided to seven patients by Tauranga surgeon Ian Breeze – has been completed. The following is a summary of the Commissioner’s findings:

Patient A (03HDC18935) In October 1999 Patient A underwent an open cholecystectomy at Tauranga Hospital, performed by Mr Breeze’s registrar with Mr Breeze’s assistance. Patient A developed a persistent postoperative wound infection.

The Commissioner found that while the operation was performed in accordance with professional standards, Mr Breeze did not adequately manage Patient A’s postoperative wound infection, and breached Right 4(1) of the Code of Patients’ Rights. The Commissioner recommended that Mr Breeze apologise to Patient A, and review his practice.

Patient B (03HDC18359) In March 2000 Mr Breeze performed bowel surgery on Patient B at Tauranga Hospital to remove a malignant polypoidal tumour in her right colon. Patient B developed faecal peritonitis from a leak in the surgical anastomosis (which another surgeon surgically repaired), and a faecal fistula and associated wound infection.

The Commissioner found that Mr Breeze did not breach the Code. There was no indication that the anastomotic leak was caused by poor surgical technique, and Mr Breeze treated Patient B’s faecal fistula and wound infection in a standard and appropriate manner.

Patient C (03HDC18925) In February 2000 Mr Breeze performed a laparoscopic cholecystectomy and intra-operative cholangiogram on Patient C at Tauranga Hospital. Patient C’s condition deteriorated postoperatively. Patient C was returned to theatre twice over the following two days, the first time by Mr Breeze (to repair a perforated duodenum) and the second time by another surgeon. Patient C was admitted to the Intensive Care Unit until her condition improved.

The Commissioner found that Mr Breeze did not breach the Code. Perforation of the duodenum is a recognised complication of the procedure undertaken, and was not the result of any lack of reasonable care and skill on Mr Breeze’s part during surgery. Mr Breeze’s subsequent care of Patient C was reasonable.

Patient D (03HDC18813) Mr Breeze performed a left inguinal hernia repair on Patient D at Norfolk Hospital in August 2000. Postoperatively, Patient D suffered from swelling, bruising, pain in his groin area, and persisting impotence.

The Commissioner found that although the operation was performed in accordance with professional standards, Mr Breeze did not adequately assess and manage Patient D’s postoperative condition. In addition, Mr Breeze did not give Patient D sufficient information about his condition. Accordingly, Mr Breeze breached Rights 4(1) and 6(1)(a) and (b) of the Code. The Commissioner recommended that Mr Breeze apologise to Patient D, and review his practice.

Patient E (03HDC19128) Mr Breeze performed a laparoscopic cholecystectomy on Patient E at Norfolk Hospital in April 2002. Mr Breeze did not inform Patient E prior to surgery that he had restrictions on his practice at two other hospitals in Tauranga. Patient E’s condition deteriorated postoperatively, and she was transferred to Tauranga Hospital, where she underwent further surgery to drain a haematoma.

The Commissioner found that Mr Breeze’s clinical treatment of Patient E was appropriate and in accordance with professional standards. However, Mr Breeze breached Right 6(1) of the Code by not informing Patient E of the restrictions on his practice prior to surgery. The Commissioner recommended that Mr Breeze apologise to Patient E and review his practice.

Patient F (04HDC00208) Mr Breeze performed a laparoscopic Nissen fundoplication on Patient F in September 1998 at Southern Cross Hospital, Tauranga. Postoperatively, Patient F suffered from abdominal pain, difficulty swallowing, and regurgitation. Patient F required further surgery to loosen the wrap on the Nissen fundoplication, following which she developed a small bowel obstruction and a mild wound infection.

The Commissioner found that Mr Breeze’s clinical care of Patient F was appropriate, and in accordance with professional standards. Accordingly, Mr Breeze did not breach the Code.

Patient G (03HDC19273) Mr Breeze performed a left hemicolectomy on Patient G at Tauranga Hospital in February 1999, for diverticulitis. Patient G had a prolonged and tumultuous postoperative recovery, complicated by a pre-sacral abscess.

The Commissioner found that Mr Breeze breached Right 4(4) of the Code in relation to his surgery on Patient G, and Right 4(2) of the Code in relation to his management of her postoperative pre-sacral abscess. The Commissioner recommended that Mr Breeze apologise to Patient G for his breach of the Code, and review his practice.

Copies of individual decisions Copies of the Commissioner’s above decisions, with details removed identifying all parties other than Mr Breeze, the Commissioner’s expert advisor, and the hospitals, may be viewed at http://www.hdc.org.nz.

Term of reference 2 The Commissioner expects to report on Part 2 of his inquiry, in relation to the response of the hospitals where Mr Breeze worked, by March 2005.

Background information The Code of Health and Disability Services Consumers’ Rights is a regulation under the Health and Disability Commissioner Act 1994. It confers a number of rights on all consumers of health and disability services in New Zealand, and places corresponding obligations on the providers of those services.

The key rights considered as part of the Commissioner’s inquiry were:

Right 4(1) – Every consumer has the right to have services provided with reasonable care and skill.

• Right 4(2) – Every consumer has the right to have services provided that comply with legal, professional, ethical, and other relevant standards.

• Right 4(4) – Every consumer has the right to have services provided in a manner that minimises the potential harm to, and optimises the quality of life of, that consumer.

• Right 6(1) – Every consumer has the right to the information that a reasonable consumer, in that consumer’s circumstances, would expect to receive, including – (a) An explanation of his or her condition; and (b) An explanation of the options available, including an assessment of the expected side effects, benefits, and costs of each option; …

At the end of an investigation, the Commissioner reports his findings to the parties, notifies the relevant registration authority (in this case the Medical Council) and professional College (in this case the Royal Australasian College of Surgeons), and may make follow-up recommendations, where appropriate.

No Further Comment The Commissioner does not intend to make any further comment on the inquiry until his report on Part 2 is released.

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