Roman Hasil and the Whanganui DHB - Health and Disability ...

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Health and Disability Commissioner shortages and other supervision responsibilities undertaken by [Dr A], I think that the level of supervision would be much the same as that provided in many other DHBs. 3. Please comment on the appropriateness and adequacy of the steps taken by [Dr A] to audit Dr Hasil’s practice. In the role of supervisor, [Dr A] would not specifically audit Dr Hasil’s practice but rather endeavour to ensure that his supervision plan was effectively implemented. This would have involved a weekly team meeting, peer review over a month, the Obstetric Standards Review Committee meeting and the quarterly Perinatal Review meeting. Although these meetings should have run regularly, it seems that they did not always occur and not all staff were able to attend. 4. Did [Dr A] respond appropriately and adequately to the concerns about Dr Hasil and, in particular, to the following: 4.1 The incidents involving Dr Hasil’s use of alcohol; 4.2 Staff concerns; 4.3 Patient complaints; 4.4 The number of failed sterilisation procedures? I have responded to these issues under the Whanganui DHB section. 5. Please comment on any other aspects regarding the adequacy and appropriateness of the steps taken by [Dr A] to ensure that Dr Hasil was competent to practise, which you consider warrant additional comment. Patient C … 1. Was Dr Hasil’s pre-operative assessment of [Patient C] appropriate? [Patient C] was referred to Dr Hasil by the surgeons with ongoing and progressing iliac fossa pain. She was seen by him on 25 August 2005. There is a very brief clinical history in the clinical notes. The recording of the past clinical history is inadequate, and little comment is made related to the nature of the pain. He found no obvious abnormalities on pelvic examination. He commented in his letter to the GP that a CT scan had identified a cystic lesion measuring 8 x 6cm in the left pelvis. On the basis of these observations he appropriately asked for an ultrasound scan and tumour markers. The ultrasound finding showed a cyst on the left ovary measuring 5 x 4 x 3cm with high vascularity and although the tumour markers were negative, I think on balance that it was reasonable to proceed with a laparoscopy/laparotomy and adhesiolysis, and possible bilateral oophorectomy. 2. Please comment on the appropriateness and adequacy of the information provided to [Patient C] about the bilateral salpingo-oophorectomy and adhesiolysis procedure. What information should Dr Hasil have provided [Patient C] about the procedure? 160 February 2008
Opinion 07HDC03504 There is no evidence in the notes related to a detailed discussion with [Patient C] of the effects of bilateral oophorectomy at any stage. It would be standard practice to inform any patient undergoing bilateral oophorectomy of the side effects, and this discussion would also involve the options for hormone replacement. The standard organisation consent form signed by both [Patient C] and Dr Hasil confirms the procedure as laparotomy/laparoscopy +/- bilateral oophorectomy but it is not possible to say whether any discussion occurred related to the consequences. There is also no comment in the follow-up notes related to the issue of the effects of removing both ovaries, and no comment related to hormone replacement therapy. Dr Hasil should have discussed the potential outcomes of the procedure in more detail. These should have included: (a) the likelihood of improving her main complaint (left iliac fossa pain) (b) the details of the operation to be performed (c) the possible risks of the procedure, including bleeding and possible damage to other organs in view of the known adhesions (d) the effects of removing the ovaries. 3. Did Dr Hasil perform [Patient C’s] operation with reasonable care and skill and in accordance with professional standards? The technical aspects of the operation appear to have occurred appropriately and have been carried out with appropriate care and skill.” Additional advice I sought clarification from Dr Brown on a number of points. He provided the following additional expert advice: “1. I refer to question 16 (page 13 of your advice) and the letter from Whanganui DHB dated 12 April 2007 in response to the inquiry. Under request 11, Whanganui DHB discusses changes to its systems as a result of this incident in the areas of human resources, complaints and incident management systems, and service audit and peer review. Do you have any additional comment in this regard? Apart from the review directly related to the failed tubal ligations and the actions taken as a result of the review, the DHB has also commented on changes made (or that they are considering to make) as a result of the incident. In the area of human resources, their proposals for centralising the administration of medical recruitment are appropriate but as I have mentioned elsewhere, the strengthening of the credentialling system is as important. The strengthening of the clinical governance system and increased support for IMGs [international medical graduates] is also welcomed. An electronic Complaints & Incidents management system has already been introduced and appears to be functioning well now. February 2008 161
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Roman Hasil and the Whanganui DHB - Health and Disability ...

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