A New Zealand doctor has been found to have breached a former patient's rights after she sought treatment for varicose veins and suffered a complication that led to her lower legs being amputated.
The doctor, who specialised in the treatment of varicose veins, breached the Code of Health & Disability Services Consumers' Rights (the Code) for failing to act after the complication was identified.
In a statement on Monday, the Health and Disability Commissioner said the woman, then aged in her seventies, underwent an ultrasound-guided foam sclerotherapy - a procedure to eradicate varicose veins through the injection of a chemical - in early 2020.
Varicose veins are twisted, enlarged veins that mostly appear in the legs and feet due to increased pressure from standing and walking, causing weak or damaged vein walls and valves. While generally benign and only a cosmetic concern, they can cause aching pain and discomfort, or signal an underlying circulatory problem in some cases.
The doctor discussed possible complications with the woman, including the risk of inadvertent intra-arterial injection, which he called a 'very rare complication', the Health and Disability Commissioner noted in its report on the case.
During the treatment, the doctor suspected he might have inadvertently injected the main artery in the right foot: he examined both feet, but did not notice any difference between them.
That evening, the doctor called the woman to check on her progress, during which she reported pain and blotchy skin in both feet. At this point the doctor recognised the issue had affected both feet and arranged a review appointment for the following day.
At the appointment, the woman said she was suffering high levels of pain and the soles of both feet had a mottled appearance. The doctor explained that intra-arterial injection may have occurred and used diagrams to describe this, apologising for the complication. The doctor advised the woman that the outcome would not be known for about six weeks, and kept in contact over the coming days with regard to pain management.
Less than a week later, the woman was admitted to a public hospital with discoloured and painful feet. She was then transferred to a larger hospital where she underwent below-the-knee amputation on both legs due to tissue death from a lack of adequate arterial blood flow to the affected areas.
In the report, Aged Care Commissioner Carolyn Cooper was critical that the doctor didn't "refer the patient to an emergency department immediately after recognising that a significant arterial event might have occurred".
Cooper found the doctor breached Right 4(1) of the Code, which gives consumers the right to have services provided with reasonable care and skill.
The doctor has since closed his practice and no longer performs any vein procedures. He told the Commissioner he is sorry for the "devastating complication" that occurred under his care and has written a letter of apology to the patient.
In the report, Cooper recommended the doctor provide the Health and Disability Commissioner with an audit report on his documentation of the outcome of vascular assessments from the last three months of his practice.
She also recommended the Australasian College of Phlebology and the Royal Australasian College of Surgeons formulate and adopt an emergency protocol for cases of actual and suspected intra-arterial injection.
Names have been removed from the report to protect the privacy of the individuals involved: the Commissioner will usually name providers and public hospitals found in breach of the Code, unless it would unfairly compromise the privacy interests of an individual provider or a patient.
