A junior doctor allowed a medical student to surgically insert a contraceptive device into a patient's vagina without her consent. Other students observed the procedure. Photo /123rf
A junior doctor allowed a medical student to surgically insert a contraceptive device into a patient's vagina without her consent. Other students observed the procedure. Photo /123rf
A junior doctor is being forced to apologise to a intellectually disabled woman for allowing a medical student to surgically insert a contraceptive device into her vagina without her consent.
After the surgery, the woman in her 20s suffered severe abdominal pain and went to her GP where she discovered the Mirena had not been implanted by a obstetrician, as she and her mum understood would be the case.
"We were horrified to see that a fifth year medical student had done the operation... I said 'No Students' and broke down in tears. [The GP] was also very shocked and said this is serious and should go straight to Medical Council," the mum of the woman in her 20s said.
The procedure was also observed by other medical students without the patient knowing.
Today, Health and Disability Commissioner Morag McDowell released a decision on the case, finding Te Whatu Ora Southern in breach of patient rights for providing teaching without first notifying the patient and obtaining informed consent.
The decision comes after similar cases were found in a study published in the New Zealand Medical Journal in 2015.
In May, the Commissioner wrote to all public hospitals, medical schools and Health New Zealand to reinforce the message that informed consent must be sought for students to perform sensitive examinations.
"It is particularly disappointing that this issue is continuing...I will continue to monitor this issue closely and will follow up with Te Whatu Ora — Health New Zealand," McDowell said.
In February 2018, the woman had surgery to insert of a Mirena intrauterine device (IUD) under general anaesthetic.
Explicit consent to the involvement of medical students in this sensitive procedure was not obtained, the HDC report said.
During pre-op, the woman's mum told HDC that they were never asked by the obstetrician if students could be present.
"The whole meeting was sloppy and casual. At no stage did [the obstetrician] say that anyone else, other than her, would be doing the procedure."
"At the end of [the obstetrician's] meeting she smiled and said she would see [her daughter] in the operating theatre."
HDC found the patient consent form for medical students to be involved was left blank.
The Commissioner acknowledged the importance of medical education, but emphasised that there was a clear expectation that the presence or involvement of students in sensitive examinations or procedures could only take place with unequivocal informed consent, given the vulnerability of the person being examined.
"It is at the heart of patient-centred care," McDowell said.
She also pointed to the 1988 Cartwright Cervical Cancer Inquiry which was critical of practices at that time where students, under supervision, undertook internal vaginal examinations on anaesthetised women without their consent.
Among other things, this informed the rights contained in the Health and Disability's Code, McDowell said.
The Commissioner recommended that Te Whatu Ora Southern conduct an audit of cases within Obstetrics & Gynaecology in which students had observed or performed sensitive procedures. She asked the hospital to check whether consent was given and recorded.
McDowell also advised the hospital provided further training to staff within Obstetrics & Gynaecology on informed consent, capacity, communication between clinicians, and the requirement to review clinical records.
The hospital and junior doctor were also ordered to apologise to the woman for the identified breaches.
This story also follows an investigation by the Herald into claims surgeons have been implanting mesh into women's bodies without their informed consent, leaving them with severe injuries.
The Health and Disability Commission (HDC) is scrutinising the claims three years after a Victoria University report for the Ministry of Health, which included women describing their trauma from surgical mesh as "medical rape".
Merrissa Haa, 47, told the Herald she pleaded for mesh not to be inserted into her pelvis but, she claimed, that her surgeon insisted it was tape, which was different and therefore safe.
Her medical records showed she and a doctor at her local DHB clearly stated in writing that she did not want mesh used in her operation.
Haa said she was left disabled after the surgery, and medical records show she received an ACC payout for being injured by mesh treatment.
"I remember waking up screaming, 'I've had four children and I would rather give birth to them all now than be in this pain'," Haa said.
Other HDC decisions released today:
• A pharmacist is being forced to apologise for giving a cancer patient the wrong medication, which she took for two months.
• A woman who died of colorectal cancer could potentially have been saved if a GP had investigated her serious symptoms further.
• A dentist is being forced to apologise to an 8-year-old girl who was rushed to the emergency department with a haemorrhage weeks after a dental procedure.
In Her Head is a Herald campaign for better women's health services. Health reporter Emma Russell investigates what's wrong with our current system and talks to wāhine who have been made to feel their serious illness is a figment of their imagination or "just part of being a woman".
