Systems at Te Whatu Ora Southern for obtaining consent have been found to be “demonstrably lacking” after a woman had an IUD inserted under anaesthesia with the non-consented involvement of medical students.
It comes after a woman in her 20s, who had a mild intellectual disability, had a mirena intrauterine device (IUD) inserted under general anaesthetic with the non-consented involvement of medical students, at Te Whatu Ora Southern, previously known as the Southern District Health Board.
Health and Disability Commissioner Morag McDowell found Te Whatu Ora Southern in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for providing services involving teaching without first notifying the woman involved, and failing to obtain her informed consent.
McDowell also said in her report, released today, that systems for obtaining consent were “demonstrably lacking”.
She was critical of a registrar, who had been delegated responsibility for the procedure by a consultant doctor and had permitted the student’s involvement, for not reviewing the consent form to ensure consent to student involvement had been obtained.
She was also critical of an anaesthetist for not acting on another anaesthetist’s concern about the woman’s capacity to consent to her anaesthesia.
While McDowell acknowledged “the importance of medical education, and that students training to become doctors need to learn how to perform sensitive examinations and procedures", there is also a “clear expectation” that sensitive medical examinations must be “conducted only with unequivocal informed consent, given the vulnerability of the person being examined”.
“It is at the heart of patient-centred care.”
She made multiple recommendations Te Whatu Ora Southern, including that an audit of cases involving medical students observing or performing sensitive procedures within Obstetrics & Gynaecology be carried out to check whether consent was given and recorded.
McDowell also recommended further training be provided to staff within Obstetrics & Gynaecology on informed consent, clinician communication, and the requirement to review clinical records; and apologise to the woman involved.
She further recommended that the registrar undertake training on informed consent, and the registrar and anaesthetist provide a written apology to the woman.
Te Whatu Ora Southern has since reviewed its policies, process and forms around student involvement following the incident.
McDowell said “clear ethical leadership is required to embed a culture of vigilance around informed consent”.
“This requires positive and ethical role modelling, and students must feel empowered to question any examination if a patient has not given informed consent.”
Following the events, McDowell has written to all DHBs, medical schools and Te Whatu Ora – Health New Zealand to “reinforce the message that informed consent must be sought for student involvement in sensitive examinations”.
"I will continue to monitor this issue closely, and I encourage anyone who has knowledge of, or is concerned about sensitive examinations having taken place without informed consent to report their concerns to my office directly at 0800 112233 or to make a complaint at www.hdc.org.nz.”
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