Woman felt 'like body on a table' after surgeries performed without consent

Woman 'gobsmacked' after Sydney doctor asked to write reflection letter on unwanted surgeries In short: Catherine Shakespeare was treated for a uterine prolapse but later learnt gynaecologist Alan Lam carried out three further operations without her consent. After complaining to the NSW Health regulator she was left "gobsmacked" that Dr Lam was only required to write a reflection letter. Dr Lam has categorically denied Ms Shakespeare's allegations. A woman who blames unwanted surgeries for drastically impacting her quality of life says she is "gobsmacked and furious" that the NSW health regulator chose only to ask the surgeon who performed them to write a reflection letter on his "learnings" from her complaint. Catherine Shakespeare saw gynaecologist Alan Lam in 2013 for surgery to treat a uterine prolapse, a condition that affects as many as half of women who have had a baby. The active social tennis player from Sydney's south hoped the surgery would reduce symptoms of incontinence. Documents show the pair agreed on a series of surgeries to treat the prolapse. But after the surgery, Dr Lam told her he was unable to complete all of the agreed procedures because he had discovered and decided to remove previously undiagnosed, asymptomatic endometriosis. It was not until later, when she sought answers while suffering from a "soul-destroying" recto-vaginal fistula, that Ms Shakespeare learned another two surgeries had been performed without prior agreement. "He had also performed a posterior repair to my vaginal wall and also repair of my rectal walls," Ms Shakespeare said. "I never knew about it. It was not written on the invoice that I received." Ms Shakespeare said she was left feeling like "a body on a table". "Every surgery that I had, and I've had over 20 general anaesthetics since that particular surgery, I've felt extremely vulnerable, extremely anxious to the point of tears every time I get put under because I'm left there wondering what is the next doctor going to do to me," Ms Shakespeare said. 'I didn't agree to these surgeries' Dr Lam categorically denied Ms Shakespeare's allegations. "If you are in the shoe of doctors and surgeons, you will understand there are conditions and circumstances we find where we have to make a clinical judgement on the risk of harm versus benefits, and in the case of this lady, everything done was explained to this lady," Dr Lam said. While Dr Lam wrote in a 2014 referral to Ms Shakespeare's GP that she may have developed an "uncommonly late, tiny fistula" related to the surgeries, he later maintained any potential complications were the result of "a suspected genetic predisposition to poor wound healing". Ms Shakespeare said that was not the point. "It does not take away from the fact that I didn't agree to these surgeries to begin with," she said. After further procedures with other surgeons to repair the fistula, including time living with a colostomy bag, she complained to the NSW Health Care Complaints Commission (HCCC) in October 2021. The HCCC wrote to Ms Shakespeare about seven months later noting an expert peer had been critical of Dr Lam's decision to perform the posterior repair and endometriosis excision without her consent. The HCCC letter noted that while posterior repair was mentioned during her initial consultation, it was not raised at a subsequent appointment or listed on her signed consent form. "The peer refers to … assessments at your initial consultation with Dr Lam and also intra-operatively that would indicate a well-supported posterior vaginal wall … which did not require surgical repair," the letter said. "The peer is also critical of Dr Lam's decision to excise your extensive endometriosis without consent … it would have been reasonable to avoid extensive excision of endometriosis in this situation until Dr Lam had informed you of your options." The HCCC referred the complaint to the Medical Council for further consideration. The Medical Council later wrote that while its Case Management Committee was critical of Dr Lam's consent process and communication, due to the passage of time and lack of "other evidence suggestive of an immediate risk to the public", the surgeon had been asked to write a reflection exercise. The Medical Council noted Dr Lam had already implemented changes related to communication and informed consent, and had engaged with colleagues and peers to "better manage unexpected pathologies". The search for answers Ms Shakespeare said she felt unsupported during the more than year-long HCCC and Medical Council processes and that the regulatory bodies had not put enough weight on the expert peer opinion that one of the additional surgeries had not been clinically necessary. "I was absolutely gobsmacked and furious," Ms Shakespeare said. "I was seeking and I guess I was expecting from the Medical Council for him to be at least directed to give me an apology for his actions, that he should never have performed surgery without my consent and certainly when it wasn't needed." The Medical Council had told Ms Shakespeare in previous correspondence it could direct doctors to provide a written apology. She said she was later told this was incorrect. "The outcome that they decided, this reflection letter, was not even one of the decisions they said could be made," she said. A Medical Council spokesperson said a doctor could "undertake" to send a written apology. "There are many possible outcomes to a complaint because every case is different," the spokesperson said. "Self-reflection gives practitioners an opportunity to consider the events or incidents that led to a complaint being made … a self-reflection exercise focuses on how they have reflected on the incident since then." An HCCC spokesperson said the commission was unable to comment on individual matters, but that it tried to assess complaints within 60 days. "Historical matters, involving health services provided some time ago, can involve added complexity in gathering information and retrieving records," the spokesperson said. "We recognise that a matter taking longer than our standard time frames can be frustrating for everyone involved." Dr Lam said he had assisted with the HCCC and Medical Council inquiries. "The HCCC and Medical Council has received my feedback and assistance on this matter … and in response no further action was taken," he said. Dr Lam did apologise to Ms Shakespeare via his insurer in 2023, writing "I am sorry to hear … of your distressing experience in requiring multiple surgeries", and "I apologise for the misunderstanding that led you to believe that the posterior vaginal repair was not part of the overall surgical management of pelvic organ prolapse". Ms Shakespeare is now preparing for another surgery to deal with ongoing complications from the 2013 procedures. She said she was speaking out now to encourage women to be fully informed before any medical procedure. "Every doctor that I see now, I take notes in any consultation that I have and I confirm exactly what they're wanting to do to me," she said.