09HDC01565 - Health and Disability Commissioner

Health and Disability Commissioner
156. Dr E considers it unfair to conclude that patients should be explicitly told who is
operating in ―most‖ cases, ―when there is an equally logical conclusion that can be
drawn by reasonable patients … and a simple step reasonable patients can take if they
hold concerns about the identity of the person performing the operation‖. Dr E states
that ―the reasonable patient in [Mr A‘s] circumstances would ask if this was an issue
of concern‖. Dr E states that he has spoken to surgical and anaesthetic colleagues in
New Zealand and Australia, and the majority state their registrars/trainees usually do
significant portions of a procedure under supervision without this being specifically
discussed with the patient. Dr E therefore considers his practice is ―usual practice or
even an acceptable standard of care‖.
157. Dr E also notes the surgery was being performed in a public training hospital where
most patients expect that junior doctors and training specialists will be involved in the
treatment process. In addition, the consent form clearly stated that the procedure
would be performed by an appropriate, not a specific person. As the form was signed
by Mr A, Dr E submits it is reasonable to conclude Mr A had read and understood
this, or if he did not read it, that it was not a high priority for him.
158. Dr E states that a craniocervical decompression is essentially a high cervical spinal
decompression, and in his view, this is ―not a ‗serious‘ operation in the spectrum of
neurosurgical procedures‖.
159. Dr E disagrees with Dr Nye‘s advice that there was ―an apparent lack of instruction
given to nursing staff‖. Dr E states: ―Instructions were clear on postoperative orders,
the patient was also monitored as per PCA protocol and there is an overriding
neurosurgical postoperative care protocol in place.‖
160. Dr E states that while the oxygen saturation probe is a useful tool it has many
downfalls. He notes that oxygen saturation readings need to be considered in context
with many other factors, and that ―a single reading is essentially meaningless unless
accompanied by other clinical concerns‖.
161. Dr E provided further information regarding his supervision of Dr G and Dr F. He
states that registrars are instructed about the requirements for patient care and
department protocols, both in writing and verbally. He states that Dr G and Dr F were
both instructed as to the requirements of his postoperative orders long before they
looked after Mr A. The postoperative orders were ―according to‖ Dr E‘s expectations
and wishes.
162. Dr E notes he was Mr A‘s initial contact point, and set his treatment plan in action. He
states that he ―oversaw and supervised the consent process‖, he was present during the
surgical procedure, and he was happy with all stages of the operation.
163. Dr E notes he asked his registrars about Mr A‘s well-being before leaving the
hospital, and that it is his usual practice to have any concerns about patients under his
supervision directed to him in the first instance, rather than to the consultant on call.
Dr E states that he does not consider the consultant in charge is responsible for
―policing the instructions left for junior and nursing staff in the deep hours of the
5 September 2012 28
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.