Director of Proceedings v Platz [2021] NZHRRT 51 (25 November 2021)
The Director filed proceedings by consent against a general surgeon, Dr Klaus Platz, in the Human Rights Review Tribunal, regarding the care he provided to Mr A, aged 84 years, during three surgeries at a small hospital on one day, following which Mr A died.
Prior to the surgeries, Mr A lived independently, was active, and was still driving. An abdominal CT scan had revealed a large mass in the retroperitoneum[1] between the aorta[2] and the superior mesenteric artery (SMA),[3] with close relation to small bowel loops.[4] A multi-disciplinary team referred Mr A to the General Surgery Department for consideration of a possible diagnostic laparoscopic core biopsy[5] of suspected mesenteric lymphadenopathy.[6] Mr A made it clear to Dr Platz that he did not want any treatment or intervention that would reduce his current quality of life. Despite Mr A’s advanced age and co-morbidities,[7] Dr Platz decided to pursue a surgical biopsy of the large retroperitoneal lymph node mass at Thames Hospital, which had limited clinical support in the event of complications. Dr Platz’s surgical approach began laparoscopically and, finding no tissue to biopsy intra-abdominally, he proceeded to dissect into the retroperitoneum where the mass was located. Due to poor visibility and depth, Dr Platz converted to open surgery, continued the dissection, and found a black and blue tumour mass below and separated from other tumour masses. Dr Platz decided intra-operatively to remove the lower tumour mass as he believed that it had an intact capsule around it. In recovery, Mr A showed signs of intra-abdominal bleeding and was returned to theatre. Dr Platz found that Mr A’s abdomen was filled with blood. Dr Platz did not confine the second operation to a damage control laparotomy,[8] in order to reduce additional surgical stress on Mr A and stabilise him temporarily to enable urgent transfer to Waikato Hospital’s ICU. Rather, Dr Platz performed a prolonged and unnecessary three-hour operation trying to find the source of the bleeding, during which Mr A continued to deteriorate. Subsequently, Dr Platz performed a third operation to pack Mr A’s abdomen with gauze for transfer to Waikato ICU where, sadly, Mr A died.
The Commissioner’s independent expert advised that Mr A died from a catastrophic haemorrhage following an unnecessary operation in a small hospital that was not designed or supported for the surgery that Dr Platz performed. In particular, the expert identified the following failures in care:
- Dr Platz’s inadequate pre-operative investigations, and inadequate work-up and planning for the laparoscopic biopsy of a retroperitoneal mass;
- Dr Platz’s inappropriate decision to operate in a small and unsupported hospital, and to not abandon the first operation when he could not find any superficial intra-peritoneal mass to biopsy, and before the situation became irretrievable;
- Dr Platz’s decision not to confine the second operation to a damage-control laparotomy to ensure that Mr A had proper abdominal packing and was stabilised for transfer to Waikato Hospital. Rather, Dr Platz performed a long and unnecessary procedure during which Mr A continued to deteriorate.
Dr Platz accepted that his failures in care amount to a breach of the Code of Health and Disability Services Consumers’ Rights (“the Code”), and the matter proceeded by way of an agreed summary of facts. The Tribunal was satisfied that Dr Platz failed to provide services to Mr A with reasonable care and skill, and issued a declaration that Dr Platz breached Right 4(1) of the Code.
The Tribunal’s full decision can be found at:
https://www.justice.govt.nz/assets/2021-nzhrrt-51-director-of-proceedings-v-platz.pdf
[1] The retroperitoneum is the space in the abdominal cavity behind the peritoneum, which is the continuous membrane lining the abdominal cavity.
[2] The abdominal aorta is the largest artery in the abdominal cavity (beginning at the level of the diaphragm) and supplies blood to much of the abdominal cavity.
[3] The SMA is a major artery of the abdomen arising from the abdominal aorta and supplying arterial blood to the organs of the midgut.
[4] The small bowel (or small intestines) is a tubular structure within the abdominal cavity which aids digestion. It is divided into three different parts: the duodenum (the first and shortest part), the jejunum, then the ileum.
[5] Using a laparoscope and needle to obtain a small sample of tissue. The laparoscope is inserted through a small incision in the abdominal wall and allows a surgeon to see inside the body without open surgery.
[6] Disease or inflammation of the lymph nodes affecting the mesentery. The mesentery is the membrane that connects the bowel (intestines) to the abdominal wall.
[7] Mr A had a history of atrial fibrillation (he had a pacemaker) and hypertension. He had had open abdominal surgery to remove his gallbladder 35 years previously.
[8] Laparotomy is a surgical incision into the abdominal cavity.