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Assessment prior to anaesthetic procedure (12HDC00991)
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(12HDC00991, 26 November
Anaesthetist ~ Epidural steroid injection ~ Standard of care
~ Inadequate examination ~ ANZCA standards ~ Documentation ~
Professional boundaries ~ Rights 4(1), 4(2)
A woman complained about the services provided by an
anaesthetist at a private clinic, where she underwent an epidural
The woman was referred to the anaesthetist by her sports
physician for consideration of an epidural steroid injection to
help treat her chronic lower back and left leg pain. After speaking
with the anaesthetist twice on the phone, she attended a
The woman took a support person with her to the consultation.
The anaesthetist asked the woman about her history and conducted a
brief physical examination. There is no evidence that the
anaesthetist gave adequate consideration to the woman's history and
symptoms, and he did not conduct a sensory examination. The
anaesthetist documented in his notes that the woman had mostly
mechanical low back instability with a suggestion of radiculopathy
but no nerve root compression.
During the consultation, the anaesthetist talked at length about
his own health. After almost two hours in the consultation, the
anaesthetist explained the risks and benefits of the epidural
steroid injection, and the woman decided to proceed.
The Australian and New Zealand College of Anaesthetists (ANZCA)
standards for epidural injections require appropriate assistance
for major regional analgesia and that adequate sterile precautions
are taken. The anaesthetist did not have an assistant present
during the procedure and did not wear a gown or mask. The
anaesthetist did not record his method of identifying the epidural
space or loss of resistance, or any observations made during the
The woman experienced significant pain following the procedure
and cancelled her follow-up appointment with the anaesthetist. The
anaesthetist did not contact the woman after the procedure.
It was held that the anaesthetist did not conduct a thorough
examination of the woman prior to the epidural procedure, breaching
Right 4(1) of the Code. It was also held that the anaesthetist's
failure to use an assistant, his inadequate sterile precautions,
and his failure to document his identification of the epidural
space or loss of resistance, or whether there was any paraesthesia
or fluid backflow, did not comply with professional standards and
therefore breached Right 4(2) of the Code.
The anaesthetist also introduced his own health condition into
the consultation, which had the effect of making the woman feel
that her experience was being minimised and devalued, breaching
Right 4(2) of the Code.