In a decision released today, Commissioner Morag McDowell acknowledged the “serious implications” of tissue being returned without testing, but said only the patient had the mana to decide whether their whare tangata was to be returned.
Whare tangata was described as a concept that extended deeply into several key areas of Māori culture and health.
A hospital and a surgeon have breached a patient’s rights over the improper return of a body part following surgery, the Health & Disability Commissioner has found. Photo / 123rf
“As the whare tangata carries deep and significant meaning for Māori, clinicians working with whare tangata have a responsibility to protect it and its sacredness,” McDowell said.
However, this was not reflected in the care provided to the patient, who identifies as a Māori wahine in ao Māori (Māori worldview) and they/them in ao Pākehā (Western worldview).
Ao Māori practices a normal way of life
In October 2024, the patient went to an appointment at the unnamed public hospital to discuss an upcoming hysterectomy.
Health NZ confirmed that a doctor discussed this with the patient and whether their ovaries would also be removed.
The appointment was an opportunity for the potential risks and benefits of the surgery to be discussed and for the patient to ask any questions, Health NZ said.
The patient was raised following the principles of core Māori concepts, where ao Māori practices were the norm and a natural way of life for them.
They made it clear to hospital staff they wanted their whare tangata returned whole, without testing, for cultural reasons.
The patient filled out the “return of tissue” form, but their whare tangata was sent to the laboratory for testing.
The complaint to the HDC a month later focused on its improper return, when histological analysis had not been consented to.
Concerns were also raised about how the error was communicated to the patient and the care they received from staff after the error was identified.
McDowall said it was important to note the doctor attending the preoperative appointment disputed being told the patient would like their whare tangata returned whole without testing.
Health NZ said the section of the form pertaining to the return of tissues was “incorrectly” ticked “yes” by the patient.
However, the doctor accepted that he knew the patient wanted their tissue returned.
He agreed that he asked the patient to remind the surgical team about this request.
Matter of cultural integrity
The patient understood there was a chance their whare tangata might get cut during surgery, because of the presence of a cyst and potential bowel lesions, but requested it be returned as “whole” or as “untouched” as possible.
“As a Māori woman, I whakapapa to Māori heritage, which holds the whare tangata as sacred.
The patient said in their culture, “this organ symbolises our connection to ancestors, our land, and future generations”.
“Returning it whole after surgery is a sign of respect for whenua, and it honours my cultural and spiritual beliefs.
“This request was not simply a preference; it was a matter of cultural and spiritual integrity.”
On the day of the surgery, they arrived early and filled out the patient information and admission forms.
They also filled in a “return of tissue” form and verbally re-stated the request to the different staff involved.
Mixed messages
McDowall said surgery went without complications. Afterwards, the patient asked if their whare tangata had been removed intact and was told that it had been taken out whole.
The next day the patient was told to pick it up from the laboratory in two weeks.
McDowall said the patient was confused because of the request for no testing or cutting.
Later that day another doctor said the whare tangata had not been altered and that no “cutting or dying” (staining, to make cells visible) had occurred.
However, days later the same doctor then said the laboratory had done exactly that, which contradicted the previous assurances given.
‘Wires crossed’
The patient said the doctors apologised and that they had “got their wires crossed”.
McDowall said the patient was upset and felt “lied to”.
The patient then had to sign a second “return of tissue” form before their whare tangata could be returned, which stated they understood the implications of it not being tested and that consent was never given for testing.
McDowall said the patient received their whare tangata from the hospital mortuary, then left.
She said because of the tapu nature of whare tangata and the patient’s “explicit and numerous requests” to have their whare tangata returned whole, the experience has caused immense distress for the patient and their whānau.
Health NZ told the HDC that had the patient wanted their whare tangata returned without testing, they should have selected the option “temporary storage required”.
Health NZ apologised that its staff did not help the patient fill out this form, or explain the different processes for the return of their whare tangata.
The hospital’s “human tissue, management and handling” policy noted that the different processes of tissue return should be explained to patients.
Doctor acknowledged hurt caused
The doctor who had seen the patient at the pre-operative appointment, said in a statement to the HDC he acknowledged the hurt experienced by the patient and apologised for the breach of tikanga.
He offered to take part in tikanga to help resolve the grievance if the patient felt that was appropriate.
He also acknowledged that tikanga had not been respected, through miscommunication rather than neglect.
Health and Disability Commissioner Morag McDowell acknowledged the “serious implications” of tissue being returned without testing, but only the patient had the mana to decide whether their whare tangata was to be returned.
McDowall said in finding the doctor had breached a section of the health consumer’s code, that regrettably, however well-intentioned the doctor seemed, he had proceeded on an assumption that tissue return would occur after testing.
She was also “mildly critical” that the doctor had not documented that the patient had requested the return of their whare tangata.
McDowall acknowledged he had expressed his “deep sadness for what occurred” and had “unhesitatingly apologised for the upset and distress caused”.
He had also changed his practice to ensure patients requesting return of tissue were engaged on the limits and extent of testing they would agree to.
In relation to Māori consumers, he planned to further emphasise what would happen to tissue to ensure that tikanga was respected.
McDowall found Health NZ breached the code by the testing of the patient’s whare tangata without their explicit consent.
Neither had it provided the patient with culturally appropriate care.
Tracy Neal is a Nelson-based Open Justice reporter at NZME. She was previously RNZ’s regional reporter in Nelson-Marlborough and has covered general news, including court and local government for the Nelson Mail.