An untimely delay: Unnecessary cancer surgery and the year-long wait for investigation into surgeon’s actions
Last year, I was diagnosed with aggressive prostate cancer. I had an operation to remove the prostate, known as a radical prostatectomy. This is an invasive procedure that leaves you incapacitated and wearing a catheter for the next couple of weeks.
Typical side effects of the operation are damage to sexual function, a degree of incontinence, and increased urgency to urinate. This I accepted as the cost of removing a potential deadly disease from my body. However, as it turned out, I should never have had the operation at all.
The problem was not so much that the operation didn’t remove all the cancer, but that it couldn’t possibly have done so. The actions of the surgeon in carrying out this unnecessary procedure led to a delay in treatment of my cancer, and further compromising side effects.
It also prompted the radiation oncologist who assisted with my subsequent ACC investigation to call for an immediate complaint to the Medical Council.
Doctors are people, too, and while the New Zealand healthcare system is full of many dedicated and hardworking people, from time to time there will be issues. One measure of the overall health of the system is how well it deals with failings when they occur. In this case, it wasn’t just the system that was found lacking, I would suggest the systems set up to police this system are failing, too.
It’s been a year since I made a complaint to the Office of the Health and Disability Commissioner (HDC), the watchdog body set up to protect patients. Last month, it decided to look into the case, a process it anticipates will take at least another six months – that’s as an “urgent” case. The Medical Council, which says it has strong legal powers to protect patients from harm when a doctor falls short of its standards, has decided to wait for the HDC decision before taking any action.
Hard choice
Although prostate cancer is considered a relatively survivable form of cancer, it still kills many men. If treatment is necessary, the initial choice is generally between surgery to remove the diseased prostate or radiotherapy, which can also destroy cancerous areas in and around the prostate. Both methods are designed to be curative (to rid the body completely of cancer) and were presented to me as being roughly equal in terms of risk, efficacy and side effects. The decision would therefore come down to me choosing between the discomfort and dangers of surgery versus the inconvenience and stress of undertaking radiotherapy every day for a month.
The initial contact for prostate cancer treatments is a urologist, all of whom are surgeons. In this instance, I opted for surgery, which several friends had already undertaken.
A month before the operation was scheduled, the surgeon recommended that I have a scan to check that the cancer had not spread beyond the prostate (PSMA PET-CT scan, for the medically minded). This was important because any spread meant that the operation could not remove all traces of cancer and radiation would instead be recommended.
The surgeon reported back that the scan was clear, other than a slight mark on the ribs, which was deemed inconsequential. Thus, the operation should proceed as planned. I went into hospital, and after a couple of weeks to allow my body to calm down from all the joy and relaxation that only an invasive operation in the groin can bring, I undertook PSA (prostate-specific antigen) blood tests to check that the operation had worked. It hadn’t. I still had cancer.