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Information and care provided to patient undergoing liver cancer treatment (09HDC01870)
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(09HDC01870, 4 March 2010)
Gastrointestinal and hepatobiliary surgeon ~ Private
hospital ~ Public hospital ~ District health board ~
Selective Internal Radiation Therapy (SIRT) ~ Liver cancer ~
Information ~ Risk of anastomotic leak ~ Right 6(1)(b)
A 64-year-old man was diagnosed with advanced colorectal cancer
with secondary cancer in the liver. After chemotherapy was no
longer effective, he was referred to a gastroenterology and
hepatobiliary surgeon in his private practice for assessment and
ongoing treatment. The surgeon discussed the treatment options and
provided an information booklet about liver cancer diagnosis and
treatment. He advised that without treatment the patient's life
expectancy was three to six months, and recommended Selective
Internal Radiation Therapy (SIRT), with ongoing hepatic artery
chemotherapy (HAC). This treatment is costly and was available only
through the private sector. The patient did not have medical
insurance, so the costs of the treatment were specifically
discussed. The patient was advised that there was a 5% risk of an
anastomotic leak. Expert advice was that the risk was in excess of
20%.
The patient opted to have the treatment and was admitted to a
private hospital where he underwent an anterior resection of the
rectum, cholecystectomy and insertion of a hepatic artery access
port.
The patient made a slow recovery and two weeks later developed
an anastomotic leak and peritonitis. He was transferred to the
public hospital for surgery was discharged home one month later. He
died two months after discharge without having the SIRT.
It was held that although the standard of care was appropriate,
the surgeon breached Right (6)(1)(b) because of the failure to
accurately disclose the risk of anastomotic leak and offer the
choice of a defunctioning ileostomy.
The surgeon was referred to the Director of Proceedings who
decided to lay a charge of professional misconduct before the
Health Practitioners Disciplinary Tribunal, which heard the matter
in August 2009. In a decision dated 21 December 2009 the Tribunal
found the surgeon guilty of professional misconduct and
subsequently imposed the following penalties:
(a) Conditions on the surgeon's practice
including that he undergo:
(i) a mentoring programme to run
for a minimum period of 18 months and a maximum of 3 years; and
(ii) a practice audit;
(b) Censure;
(c) A fine of $20,000; and
(d) 50% of costs of both the Director of Proceedings
and the Tribunal.
Permanent name suppression was declined. A copy of the
Tribunal's decision can be found at http://www.hpdt.org.nz/Default.aspx?tabid=230