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A doctor who appeared to be amused and laughing while carrying out a circumcision on a teen has apologised to the boy and his family for being insensitive.

The apology came after the boy’s mother complained to the health watchdog, claiming the doctor was “culturally insensitive” and didn’t ask for consent to examine her son’s genitals following the procedure.

She also complained that the doctor was hurtful with the way he told her son to lose weight.

Now, Deputy Health and Disability Commissioner (HDC) Dr Vanessa Caldwell has criticised the doctor for not asking for consent before lifting the boy’s sarong, something she described as “unacceptable”, in a report released today.

In October 2020, the teen, who was 15 at the time, his father and his grandmother went to a consultation with the doctor, identified in the report as Dr B, to discuss circumcision for cultural reasons.

The teen was asked to remove his underwear and lie on the table, at which point Dr B demonstrated to the boy and his family how the procedure would occur.

Dr B indicated where the boy would receive local anaesthetic and said stitches would be required.

He then advised that the boy should shave his pubic hair and lose some weight as the procedure is more difficult with overweight children.

An appointment for the procedure was made for the following month, and the family was given an information sheet outlining the procedure and postoperative care required and consent form for signing.

Deputy Health and Disability Commissioner Dr Vanessa Caldwell said the fact that the doctor lifted the boy's sarong to examine his genitals without consent was "unacceptable". Photo / supplied

The following month, the boy, his parents and grandmother arrived at the medical centre for the procedure. The signed consent form was given to Dr B.

The boy was then asked to lie on the table to receive the local anaesthetic. The boy’s parents told the HDC they heard Dr B say the boy had not shaved his pubic hair and asked him if he had lost any weight.

The boy responded that he had forgotten to shave and thought he had lost some weight. The boy’s mother stated that he was “very shy” and felt nervous about the procedure and sad after being told to lose weight.

The boy’s mother told the HDC that she felt the doctor’s overall manner was “disrespectful” and he was “inconsiderate” to the sensitivity of the procedure and the whānau’s cultural values.

Dr B apologised if his comments about the boy’s weight and shaving were insensitive and stated that they were not intended to be.

The boy and his family were asked to wait in the main reception area for 40 minutes until the anaesthetic became effective.

When the boy was called back into the treatment room a nurse began to trim his pubic hair with consent from the boy’s father.

Dr B then asked the boy’s whānau to leave the treatment room, later telling the HDC that he does not permit family to be in the room during the procedure due to recent episodes of fathers fainting.

During the procedure, the boy’s mother said she could hear her son grunting and Dr B and the nurse telling him to relax. The boy’s mother said she had to call out to reassure her son twice.

She also told the HDC that Dr B and the nurse appeared to be “amused” and said there was laughter while she and her husband remained concerned that their son was not settling.

Dr B later told the HDC that he had attempted to use humour to settle the boy, who was very “anxious” but acknowledged that it would have been better to invite his parents into the room to help settle him instead.

After the procedure, the boy’s mother asked Dr B why it had taken so long to which he replied: “Because [the boy’s] thighs are so big and [the boy] kept freezing up it took longer than usual, which is why I advised him to lose weight.”

As the boy recovered from the procedure his whānau rejoined him in the treatment room.

His mother told the HDC that Dr B reached out and opened the boy’s sarong without any explanation or asking for consent to examine his penis.

The teen's mother said the doctor and nurse appeared to be amused during her son's circumcision and she heard laughter. Photo / Thinkstock

Dr B then played an audio recording from his phone setting out the postoperative instructions for the boy to follow, using hand motions to point at the boy’s penis.

When questioned by the boy’s mother on why he could not explain the instructions himself, Dr B responded that the audio clip meant he wouldn’t have to repeat himself.

Dr B later apologised for appearing abrupt or rude following the procedure and apologised to the boy for any hurt or disrespect he felt because of his conduct, which he acknowledged fell below the standards of care he usually sets for himself.

He also apologised for not asking for consent before examining the “operation site” following the procedure.

Dr Caldwell found that Dr B breached the boy’s right to information and his right to make a choice and give consent.

“Given the teenager’s vulnerability as a young person, the intimate nature of the post operative examination and the presence of the teenager’s whānau in the room at the time, I find the GP opening the teenager’s sarong without consent unacceptable,” Dr Caldwell said.

“In my view, although the teenager had consented to undergo circumcision, this did not mean the GP could continue further physical examinations without explicitly gaining consent for each follow-up examination.”

Dr Caldwell also encouraged Dr B to use more sympathetic and thoughtful language in the future when advising patients on matters including weight loss.

Since the complaint, Dr B has made several changes including abandoning the audio clip outlining the postoperative care instructions, adding more information to the forms provided to patients and being more mindful of how he communicates.

Emily Moorhouse is a Christchurch-based Open Justice journalist at ��һ�ǿ�����. She joined ��һ�ǿ����� in 2022. Before that, she was at the Christchurch Star.