The decision of Health and Disability Commissioner Morag McDowell released today detailed the 2018 insertion under general anaesthetic of a Mirena intrauterine device (IUD) by a student and a registrar, while other students observed.
The patient, a woman in her 20s with a mild intellectual disability, was "distressed" that medical students had been involved, in spite of an earlier refusal of consent on a form she had completed.
The form had not been included in the patient’s file, one factor behind Ms McDowell’s description of the system for obtaining consent at what was then the Southern District Health Board (SDHB) as "demonstrably lacking".
Ms McDowell found Te Whatu Ora Southern in breach of the Code of Health and Disability Services Consumers Rights for providing services involving teaching to the woman without first notifying her, and not obtaining her informed consent.
Rights contained in the code were partly informed by the 1998 Cartwright Cervical Cancer Inquiry, which criticised the practice of students, under supervision, undertaking internal vaginal examinations on anaesthetised women without their consent.
Ms McDowell recommended an audit over a three-month period of cases with Obstetrics & Gynaecology in which students had been observers or participants in sensitive procedures, "to check from the patient’s clinical records whether consent was given and recorded".
Further training on consent was also recommended.
Medical education was important, the decision said.
"However, there is a clear expectation that such examinations can be conducted only with unequivocal informed consent, given the vulnerability of the person being examined."
Following these events SDHB reviewed its policies, process, and forms concerning student involvement, she noted.
"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."
She had written to all district health boards, medical schools, and Te Whatu Ora to reinforce the message and would continue to monitor the situation, she said.
