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Inadequate gynaecological cosmetic surgery and lack of consent (05HDC09254)

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(05HDC09254, 30 May 2007)

Gynaecologist ~ Plastic surgeon ~ Cosmetic surgery ~ Labial reduction ~ Postoperative care ~ Information disclosure ~ Documentation ~ Informed consent ~ Surgical technique ~ Rights 1(1), 4(2), 4(4) 5(2), 6(1)(b), 7(1)

A 41-year-old woman complained that labial reduction surgery was too extensive and not what she consented to. She was shocked to find that her labia had been removed.

It was held that the woman was not made aware of the amount of tissue that the gynaecologist planned to remove, nor that he planned to excise the labia minora and make folds from the excision site. There is no evidence that he discussed the anticipated appearance of the labia and vagina, or any potential risks or side effects from the surgery. In these circumstances, he breached Right 6(1)(b). He also did not give her sufficient information to enable her to give informed consent for the procedure, breaching Right 7(1).

The notes from the preoperative consultation were brief and did not include any diagrams of the procedure. There was no record of discussion about risks or possible adverse outcomes, and no record of any subsequent discussions before the surgery. He also made inadequate arrangements for postoperative cover and provided inadequate information about who to contact with any concerns. These failings amounted to a breach of Right 4(2). The gynaecologist did not provide services in a manner that minimised potential harm, and breached Right 4(4).

The gynaecologist's dismissive approach to the woman's concerns following the surgery was inappropriate and unprofessional. He failed to treat the woman with respect, in breach of Right 1(1). He had a duty to provide an environment where the woman could communicate openly, honestly and effectively about her postoperative concerns. By failing to provide such an environment, he breached Right 5(2).

The gynaecologist was referred to the Director of Proceedings, who decided not to issue disciplinary or other proceedings. A copy of the report was sent to the Medical Council with a recommendation that it consider the scope of practice issues raised by this case. The Medical Council subsequently issued a statement providing an outline of the standards expected of doctors who perform cosmetic procedures. The Council has also issued a guide for consumers, outlining what to expect when seeing a doctor for a cosmetic procedure. Copies of these guidelines can be obtained at:

http://www.mcnz.org.nz/portals/0/publications/statement%20on%20cosmetic%20procedures.pdf