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

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Health and Disability Commissioner Hospital prior to the induction of labour. She said that if she was not augmented, then at least they had staff on duty 24 hours to support her, and she would have an induction of labour first thing in the morning. Midwife D felt unsafe to continue to care for the woman, as she (the midwife) had already lost one night’s sleep, and she had no back-up care for other clients who were also overdue. Midwife D felt that Dr Hasil would not listen to her request for admission, saying that she was just trying to “dump her on Wanganui”. Dr Hasil explained that he considered that there was no obstetric indication to admit the woman. Midwife D told him that she would send her to Palmerston North and cancelled the induction of labour for the next day. The patient was augmented and gave birth at 3.31am the next morning. Dr A recalls Dr Hasil’s explanation of the matter, which was that he had talked to Midwife D in a half-joking frivolous manner, and that she had taken it the wrong way and had put the phone down. Patient G (complaint 1155) On 1 June 2006, Patient G signed a consent form for the “marsupialisation of Left Bartholin’s Cyst 21 ”. Dr Hasil performed surgery on 7 July 2006 at Wanganui Hospital, and Patient G was discharged. Five days later when the swelling had settled, she wondered why she was swollen and uncomfortable on both sides of her body. She then discovered that she had sutures on both the left and right labia. She contacted her general practitioner, who confirmed that she had had surgery on both sides, but there was no indication as to why. Her general practitioner suggested they wait for the operation note. In her complaint letter to the DHB, dated 7 August 2006, Patient G said she had agreed to the removal of a left-sided cyst and later discovered from her general practitioner that she had also had surgery on a right-sided cyst. The hospital staff had not informed her that she had undergone bilateral surgery. On 15 August 2006, the DHB acknowledged receipt of her complaint about the additional surgery undertaken without consent and said that it would be investigated. Dr Hasil was also informed of the complaint and that it had been forwarded to Dr A, who would handle the investigation. In a letter to Patient G, dated 19 October 2006, the CEO outlined the outcome of the investigation into her complaint. The CEO stated that while Patient G was under anaesthetic, Dr Hasil detected a similar sized cyst on the right side and decided to perform a marsupialisation on that cyst also. He felt that it was a related problem and that treatment was necessary and in Patient G’s best interests. This would prevent another general anaesthetic with its associated risks. It was also pointed out that Patient G had consented to “the treatment of any other necessary and appropriate related problems”. 21 A cyst in one of the Bartholin’s glands, which are located on each side of the vaginal opening. Marsupialisation is a procedure where a small, permanent opening is surgically created to help the gland drain. 38 February 2008
Opinion 07HDC03504 The CEO acknowledged that Patient G was not informed of the additional treatment prior to her discharge, and apologised for the series of events that had occurred. He stated that the lack of communication should not have occurred, and that the staff involved apologised that she was not fully informed prior to discharge. The CEO requested that the clinical team adhere to normal practices regarding informed consent for patients, which includes the surgeon, house surgeon or nursing staff advising the patient of any additional treatment, prior to discharge. Incident of 5 October 2006 (incidents 7376 and 7377) On 5 October 2006, a pregnant woman attended the outpatient department at 8.30am, as arranged with Dr Hasil the previous day. This was not regular practice. There was some confusion as to who was on call for obstetrics and gynaecology, and concern about the roster. The Service Manager, Community and Rural Services, said that Dr A was on call that day but had forgotten. Although Dr A disputed this, his initials “[…]” had been handwritten on the draft roster, indicating that he would be on call on 5 October 2006. Although Dr Hasil was not on call on 5 October, he was contacted on his cellphone and found to be incoherent. Dr Hasil was asked to come in and, when he did, it was noted that he had a strong smell of alcohol. Nurse A reported the matter and filled out incident report forms. Nurse A then called the CEO’s office and explained the situation as she was so concerned about the safety of the service and had lost confidence that anything would be done. This created some acrimony between her and the Service Manager, Community and Rural Services. Dr Hasil was immediately placed on sick leave and advised that he should seek the counselling services of the Employee Assistance Programme. He was also provided with medical assistance. Dr Hasil attended an Accident and Medical Clinic that day. He obtained a medical certificate stating that he was medically unfit for work for 14 days. He saw two members of the Mental Health Crisis Team the following day. On 5 October 2006, Medical Advisor Dr C telephoned the Medical Council’s Health Manager to report that Dr Hasil had turned up at work intoxicated and that this was the second time in six months. Dr C agreed to send a formal letter after the meeting of 9 October at Wanganui Hospital. The Medical Council received Dr C’s letter on 16 October. The Council arranged for Dr Hasil to be assessed by an independent psychiatrist, and then arranged a rigorous return to work programme for him. This involved engagement with a clinical psychologist, drug and alcohol treatment services, breath testing, blood counts, consideration of Antabuse and approved clinical supervision, and limited work hours to allow dedicated time off to attend appointments. The details are set out in Appendix 7. On 9 October 2006, an investigation meeting was held at the DHB and attended by Dr Hasil, his support person, the Service Manager, Community and Rural Services, the General Manager, Human Resources, and Dr C. Dr Hasil admitted that he had been drinking alcohol while on call on Wednesday 4 October. He explained that he had been February 2008 39
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