Gynaecologist cleared in hysterectomy case

BMJ 2000; 320 doi: (Published 26 February 2000) Cite this as: BMJ 2000;320:535
  1. Clare Dyer, legal correspondent
  1. BMJ

    A consultant gynaecologist was cleared last week of serious professional misconduct after he admitted removing a patient's ovaries without her consent. Ian Fergusson, a consultant at Guy's and St Thomas's Hospital in London, admitted performing an oophorectomy and salpingectomy on Caroline Richmond without consent but denied that he operated without consent or unnecessarily in carrying out a hysterectomy.

    Rodney Yates, chairman of the General Medical Council's professional conduct committee, said the case was one of the most difficult the committee had encountered. It had to balance the right of a patient to be involved in decisions about her care with what Mr Fergusson found once he had started the procedure that Ms Richmond had chosen to undergo—a trans-cervical resection of the endometrium to control heavy bleeding.

    Mr Yates told Mr Fergusson that the process of counselling the patient and obtaining her consent “left a lot to be desired.” The committee held, however, that the surgeon was justified in performing the hysterectomy when he found a swelling. This proved to be adenomyosis, a bulky condition of the uterus. After the hearing Ms Richmond, aged 58, a medical journalist, said: “I had been counselled that if the uterus was perforated I might need an emergency hysterectomy but that this had never happened at St Thomas's. This was used to justify performing cold surgery. I think it means that women have no rights and no protection against marauding surgeons doing pretty much what they want.”

    She said that a registrar had noted that she had a bulky uterus on her first visit to the hospital. Ms Richmond, who underwent the operation in 1992, told the GMC that she regarded hysterectomy as mutilation. She won a £50000 settlement, but no admission of liability, in a civil action three years ago against the Guy's and St Thomas's Hospital NHS Trust. Mr Yates noted that the operation had taken place eight years ago and “fortunately” the consent procedure had now “been improved.” A BMA working party is reviewing the system for informed consent.

    Mr Fergusson acknowledged that Ms Richmond had experienced “enormous hurt,” adding: “I feel huge compassion for her, and I want to apologise publicly for the distress I have caused her.”

    The GMC is considering a second complaint against Mr Fergusson. Sally McLachlan, has complained that he ignored her warnings that she had a life threatening allergy to catgut when he performed a hysterectomy on her in 1997.

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    Ian Fergusson: cleared of serious professional misconduct after removing Caroline Richmond's ovaries without consent


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