Obstetrician/gynaecologist Breached The Code For Management Of Ectopic Pregnancy 21HDC00031

In a report published today, Deputy Commissioner Rose Wall found an obstetrician/gynaecologist at Health New Zealand | Te Whatu Ora breached the Code of Health and Disability Services Consumers’ Rights (the Code) for management of an ectopic pregnancy.

The woman at the centre of the report, underwent a second obstetric ultrasound scan (USS) following episodes of pain and bleeding at six weeks of pregnancy.

An obstetrican and gynaecologist diagnosed the woman with an ectopic pregnancy, suggested conservative management of the condition and briefly mentioned the use of methotrexate ‘in passing’.

However, this was not documented in the electronic patient management system and the woman felt concerned that her fallopian tube could rupture. Four days later, the woman underwent surgery for the ectopic pregnancy, which included removal of her right fallopian tube (salphingectomy).

In her decision, Ms Wall found the conservative management plan taken by the clinician was a clinically appropriate option. However, she concluded that insufficient information was provided to the woman to enable her to understand the treatment options available, and their associated risks and benefits.

"Each option (conservative, medical (with the use of methotrexate) or surgical), needed to be explained fully to the woman by the clinician. I do not accept that there was a fulsome discussion, and this is reflected by her complaint to HDC in which the woman indicated that she might not have lost her fallopian tube if the obstetrician/ gynaecologist had offered her appropriate and timely treatment."

Ms Wall found the clinician breached Right 6(1) and 7(1) of the Code for failing to provide full information | whakamōhio and failing to enable the woman to make an informed choice and give informed consent | whakaritenga mōu ake.

Ms Wall also found the clinician breached Right 4(2) the Code for inadequate documentation which failed to provide an appropriate standard of care | tautikanga.

"In my view, given the clear standards set out by the Medical Council of New Zealand, the omission to document fell well short of the expectations of a reasonable doctor," Ms Wall said.

"The lack of documentation also resulted in a lack of clarity about what was said during the consultation, which left the woman confused."

Ms Wall’s report highlighted several issues with district hospital’s systems. This included the wide practice of clinicians giving verbal advice without completing documentation and clinicians using different treatment guidelines from those set out by the district.

Ms Wall was also critical of the lack of discharge summary for the woman’s ED presentation and lack of process to register her patient attendance on its administration system. Finally, she noted that the use of small assessment spaces in ED for early pregnancy complications does not accommodate a patient’s need for privacy and safety.

"Whilst I acknowledge that this process of using small assessment spaces may be due to resource constraints, I am concerned that it places consumers in a vulnerable position," Ms Wall said.

Since the events the obstetrician/gynaecologist and Health NZ have made changes, outlined in the report. Ms Wall made several further recommendations for both parties.

Note: The full report of this case can be viewed on HDC’s website - see HDC's ' Latest Decisions'.

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