HDC says informed consent not provided for procedure to remove uterus

The Deputy Health and Disability Commissioner says the risks of a morcellation technique used when removing a woman’s uterus were not sufficiently explained so the woman was not able to give informed consent. Morcellation is a procedure where the uterus is cut into smaller pieces to assist its removal.

Rose Wall found a consultant breached Right 6(1) of the Code of Health and Disability Services Consumers’ Rights (consumers have the right to information a reasonable consumer would expect to receive) and Right 7(1) (services may be provided to a consumer only if that consumer makes an informed choice and gives informed consent…).

Before the procedure, the woman had an ultrasound and biopsy that showed a pre-cancerous condition associated with abnormally thick tissue on the inside of the endometrium (complex atypical endometrial hyperplasia - CAH). The biopsy did not find that the woman had cancer.

The consultant had come from the United States and worked as a locum obstetrician and gynaecologist at the DHB for six months. She used morcellation rather than removing the uterus intact, to avoid the need for a large incision.

Ms Wall considered it was not unreasonable to have proposed minimally invasive surgery and morcellation. However, she found the consultant who removed the woman’s uterus did not adequately explain the disadvantages of morcellation in comparison to open surgery, particularly the difficulty in making an accurate pathological cancer diagnosis if the uterus is cut into smaller pieces.

"Guidelines are clear that patients must be engaged in the discussion of the method of tissue extraction, including the risks and benefits of alternative management options. This is information that a reasonable consumer in these circumstances would expect to receive."

Ms Wall made several recommendations including the DHB provide a written apology to the woman, establish a policy or guideline for using morcellation and ensure there are adequate processes for locum specialists/consultants to be oriented to the expected processes at the DHB.