09HDC01565 - Health and Disability Commissioner

Health and Disability Commissioner
―I explained that there were general risks such as infection and bleeding. I also
explained that there was a risk in some cases of major intraoperative bleeding
from anomalous arterial and venous structures but that this was not common. I
also explained that in some cases, despite excellent haemostasis at the time of
surgery, that a post-operative haematoma could develop and compress the
brainstem causing a spectrum of neurologic deficits which could be mild or as
severe as tetraplegia/paralysis, or at that level cause breathing difficulties. I also
explained that these neurologic complications could also occur as a consequence
of direct injury to the upper spinal cord and brainstem during the operation but that
this was an uncommon complication. I then explained that if these complications
did occur that there would be a risk to life. I then informed him that there was a
risk of leakage of cerebrospinal fluid if the wound did not heal appropriately and
that the risk of this was low and was usually managed with either additional
sutures or reclosure of the wound with antibiotic cover. I explained that in this
scenario meningitis could develop. I then explained the cardiovascular risks such
as stroke, heart attack and the risk of clots in the legs (deep venous thrombosis)
which could embolise to the lungs (pulmonary embolus) (these could be life
threatening) could occur. I then explained that there was also a risk of chest
infection and further anaesthetic risks such as a reaction to the anaesthetic which
would be explained in more detail by the anaesthetist.‖ 12
29. Dr F noted that Mr A seemed uncomfortable with some of the potential complications
and risks, with particular concern about the risk of paralysis. Dr F explained that
although the risk was low he could not guarantee this would not occur, and that Mr A
had to weigh up whether the risk-benefit ratio was favourable or not. Dr F states that
he confirmed some of the risks were indeed major, and that he asked Mr A if his
headaches were severe enough to warrant taking those risks, reiterating that the
operation was not guaranteed to alleviate or cure his headaches and that his condition
did not require urgent surgery. Dr F states: ―As such, I did not allow [Mr A] to sign
the consent form and asked that he discuss what had been said with his mother ([Mrs
C]) to help him clarify things in his own mind.‖ Dr F advised Mr A to consider the
situation over a few hours and stated that they would meet again for a further
discussion regarding the operation, its risks, and any ongoing concerns.
30. Mrs C recalls that Dr F explained that an incision would be made in the back of the
head to allow access to the base of the skull. From there bone would be removed from
around the skull to allow the brain to have more room. Bone might also need to be
removed from the vertebrae. Mrs C recalls that her son was worried and agitated
because he had not previously understood that it would be an operation on his spine.
She states that Dr F confirmed her son was not committed to the procedure and that he
could back out if he wished.
31. Mrs C says that after the meeting with Dr F, she sat with her son for about two hours,
during which time he became increasingly agitated.
12 Emphasis in this paragraph (italics) is Dr F‘s.
5 September 2012 6
Names have been removed (except Canterbury DHB and the experts who advised on this case) to
protect privacy. Identifying letters are assigned in alphabetical order and bear no relationship to the
person’s actual name.