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Preoperative care of deteriorating patient following bowel surgery (06HDC09771)

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(06HDC09771, 18 January 2008)

General surgeon ~ Private surgical hospital ~ Colorectal surgery ~ Varicose veins ~ Standard of care ~ Communication ~ Right 4(1)

A woman complained about the services provided by a general surgeon and a private hospital. She consulted the surgeon regarding elective surgery for varicose veins. At the pre-surgery consultation she reported intermittent minor rectal bleeding. The surgeon agreed to investigate the cause of her bleeding while she was anaesthetised for her vein surgery. After performing the vein surgery, the surgeon introduced a sigmoidoscope, which revealed a polyp and a tumour in the rectal wall. He dissected the tumour from the wall of the rectum, which resulted in a visible hole. He repaired the hole.

The following day, he advised the woman that a tumour had been found, dissected and sent for histological examination. Three days later, she developed signs of peritonitis. She was returned to theatre for repair of a leaking anastomosis and construction of a stoma. When her condition did not improve, she was transferred, later that day, to a major public hospital's department of critical care. Three days later, she was transferred to a surgical ward and had additional surgery the following day to excise a short length of necrotic bowel and revise the colostomy.

It was held that the critical safety net of surgical and medical back-up was not activated when the woman needed it. The hospital did not provide the woman with care of an appropriate standard and breached Right 4(1).

The surgeon's management of the woman's care was held to be appropriate. He took into consideration his knowledge of the patient when recommending that she have a bowel examination while anaesthetised for her vein surgery. He advised her of the outcome of the surgery and responded to her concerns. When he became aware that the woman's condition had deteriorated and she required additional surgery, he responded appropriately. He treated the woman with reasonable care and skill and communicated with her appropriately, and did not breach the Code.

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