An elderly woman’s lower legs had to be amputated after her doctor failed to take immediate action when a complication was identified following an operation to treat her varicose veins.

The patient, aged in her 70s, had a consultation with her doctor, a vocationally registered general practitioner, on January 22, 2020, about longstanding problems the condition was causing in both legs.

Surgery to address the issue was carried out about 40 years previously but the varicose veins had gradually returned, resulting in her suffering from painful, heavy, restless legs and cramps at night.

The Health and Disability Commissioner launched an investigation, after tissue death due to a lack of blood flow required the amputation of both the woman’s legs below the knee.

The investigation, carried out by Aged Care Commissioner Carolyn Cooper, looked into whether the patient, identified only as Mrs A, had received the appropriate standard of care from Doctor B.

Cooper, ruled the doctor failed to provide his patient services with reasonable care and skill in breach of the Code of Health and Disability Services Consumers’ Rights.

“I am critical that Dr B did not refer Mrs A to an emergency facility immediately when he recognised that a significant arterial event might have occurred,” Cooper’s decision, released today, stated.

She said it was important to note the outcome of care provided was not a relevant factor when assessing the standard of care provided, because sometimes even an appropriate standard of care could result in an adverse outcome.

Complications associated with the agreed treatment, which included injecting a chemical into the vein while under local anaesthetic (ultrasound-guided foam sclerotherapy), were discussed at the January appointment and covered the risk of inadvertent intra-arterial injection, which Dr B described as a “very rare complication”.

After suspecting he might have mistakenly injected the main artery in his patient’s right foot, while carrying out the procedure on February 19, Dr B examined both feet but did not notice a difference.

However, that night the patient reported pain and colour blotches in her feet when the doctor called to monitor her progress, he realised the issue affected both sides and arranged a review appointment.

She continued to complain of high pain levels in both feet, which had a mottled appearance, the following day at the review, prompting her doctor to apologise for the complication and explain, using diagrams, what may have happened.

While the patient was advised the outcome would not be known for six weeks, she was admitted to hospital less than a week later, on February 25, suffering painful and discoloured feet.

As a result, she was transferred on March 2 to a larger facility where four days later both legs were amputated below-the-knee due to tissue death from a lack of adequate blood flow to the affected areas.

An independent opinion given to the HDC stated although there was no clear consensus on how to approach such a complication, described as one of the most devastating, it was considered appropriate to seek emergency care.

“In my opinion, the patient should have been referred immediately to an emergency facility upon recognition of an arterial event of such significance.

“Not doing so, may be considered a significant departure from standard practice.”

Dr B stated to the HDC he did not refer the patient to a vascular surgeon immediately when the complication occurred because he was not certain what had happened until it was too late for a referral to make a difference to the outcome.

The independent doctor told the HDC it was difficult to make an assessment of whether Dr B did the sclerotherapy procedure appropriately, and he could not directly comment on his technique without observing it.

Cooper said Mrs A believed Dr B should have been aware of all the possible outcomes of the procedure and instead of adopting a ‘watch and see’ approach, any steps that could have been taken, should have been taken.

“Mrs A realises that other treatments may not have worked but stated that she will never know what the outcome would have been with the earlier assistance of a vascular specialist.”

Dr B has since closed his practice and no longer performs any vein procedures.

He told HDC he is truly sorry for the ‘devastating complication’ under his care and wrote a letter of apology to the woman.

Leighton Keith joined NZME as an Open Justice reporter based in Whanganui in 2022. He’s been a journalist for 20 years covering a variety of topics and rounds.