A man had his bandages removed a few days after undergoing surgery to manage a skin condition, only to discover an unexpected outcome – he had been circumcised against his wishes.

The man, in his 50s, told his doctor and an operating theatre full of medical professionals he did not consent to a “full” circumcision.

As a result of the unexpected procedure, he suffered adverse symptoms such as physical irritation, discomfort, and “a significant reduction in sexual contact with his partner due to increased sensitivity on the penis”.

Today, Deputy Health and Disability Commissioner (HDC) Dr Vanessa Caldwell released findings from her investigation into a complaint from the man about the services provided to him by Health New Zealand-Te Whatu Ora.

She found the public healthcare provider breached the Code of Health and Disability Services Consumers’ Rights after the man, who is not named, was circumcised without his consent.

The report stated he was seen by a consultant urologist, via a telehealth appointment, about the condition balanitis xerotica obliterans (BXO) he had been diagnosed with in early 2021. BXO is a thin, white, scaly and inflammatory patch that appears on the foreskin of the penis.

In explaining the surgical procedure required to treat the condition, the consultant told the man, who had been a patient of the urology service since 2008, that there was a chance circumcision would be required once the surgery started, and could involve a full or partial circumcision.

The man expressly told the doctor he would not consent to a “full” circumcision. He was not provided with written information about the procedure, nor was he provided with a copy of the consultation documentation.

On the day of the September 2021 surgery, the man met with the operating surgeon, who was a different doctor from the earlier consultant urologist he had seen.

According to the surgeon, the usual treatment for BXO was circumcision, so he noted this on the consent form and discussed the procedure with the man.

Although the man said he was confused by the terminology used, he continued to sign the consent form because he assumed the removal of scar tissue on the frenulum was a form of partial circumcision, but did not knowingly consent to a full circumcision.

The man told the HDC he had been confused to see a “random” doctor discussing the procedure with him and became concerned when circumcision was mentioned.

He said that he stopped the preoperative briefing and explained to the surgeon the scope of work that had been agreed upon with the consultant urologist.

“[I told the surgeon] directly to his face that I hadn’t come in for a full circumcision.”

Deputy Health and Disability Commissioner Dr Vanessa Caldwell investigated the complaint.

But the surgeon told the HDC he could not recall the man saying he did not want a circumcision and that he had not seen any clinical notes indicating he was not happy for one to be performed.

“[The surgeon] reiterated that he would not perform surgery without informing a patient of exactly what was to be performed and any risks associated with the procedure.”

The man said it was “obvious” to him that the doctor was confused so when entering the operating theatre he “vigorously” raised his concerns to everyone present, which did not include the surgeon.

Health NZ told HDC that a consultant anaesthetist confirmed the man did state that he did not want a circumcision.

However, as no one raised concerns to the operating surgeon, a full circumcision was completed.

Health NZ told the HDC that when the man was later discharged he was advised that circumcision had been performed as part of the procedure, and voiced no concerns in that regard.

But the report stated the man later told ACC that there were bandages on the postoperative site, so he did not realise that a full circumcision had been undertaken until a few days later.

The report found the man’s understanding of the procedure differed from what was listed on the consent form and departed from the expected standard of care.

He was not provided with adequate information before his surgery. In particular, there was a lack of clarity about the extent of the procedure, he was not provided with written information, and he was not advised that a different person may be operating on him.

In addition, it was found that consenting took place in an inappropriate place and there was a lack of mutual understanding among the providers, resulting from ineffective communication processes, which contributed to the man’s unexpected surgical outcome.

Caldwell recommended Health NZ provide a formal written apology to the man, provide an update to HDC on its implementation of a new system that supports the sharing of clinical appointment letters with its patients, and remind staff that patients should be given adequate time and opportunities to ask questions about the proposed surgery.

Since the incident, Health NZ has made several changes, including that the Theatre Operational Leadership Team continue regular audits of consent forms of patients presenting for elective surgery.

Tara Shaskey joined NZME in 2022 as a news director and Open Justice reporter. She has been a reporter since 2014 and previously worked at Stuff covering crime and justice, arts and entertainment, and Māori issues.