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Claims of gynaecology patients' consent breaches

Health board says it's made improvements since claims of gynaecology patients' rights breaches
Phil Pennington, Reporter

The Waitematā District Health Board admits it's dealt with several cases of inadequate patient consent last year but none in the past six months.

North Shore Hospital across Lake Pupuke. Photo: Karora, Wikimedia Commons

The Nurses Organisation has accused North Shore Hospital of breaching women patients' rights in its women health theatres, and has asked the Health and Disability Commissioner to investigate.

The accusation centres on junior doctors, midwives and paramedics observing or participating in procedures in a teaching situation.

But the board said it had taken a lot of action to improve its procedures and policies, and the union's complaints were outdated.

"It's difficult to respond to their concern about the practice [being] ongoing because they have not provided - and no member of staff actually has provided - to us specific concerns since June," said chief medical officer Dr Jonathan Christiansen.

A union claim of 10 problem cases of inadequate consent being recorded since last year was incorrect, he said.

"Prior to that [June 2019] we did fully investigate the small number they raised," Dr Christiansen said.

"Our investigations found that there were incomplete conversations with the team members on several occasions, and those were followed up very closely.

"I would note that I personally investigated three cases in April and May of this year and found that the conversations that were had were appropriate, and that the concerns were not sustained," he said.

The board at first did not provide information to RNZ about these other cases, or say anything about the interaction with the union, saying the other cases were out of scope of an Official Information Act request.

The DHB had not been notified by the Health and Disability Commissioner so Dr Christiansen did not believe it was being investigated.

The board and the union were fundamentally on the same page, that teaching situations - such as where a senior doctor conducted a vaginal examination then asked a junior doctor to do one too - required a patient's full knowledge and consent, he said.

The Nurses Organisation said it had become increasingly frustrated since meeting in April 2019 with senior medical staff and board members, including women's health advocate Sandra Coney, at which point action had looked likely.

Ms Coney in 1987 co-wrote a magazine article, An Unfortunate Experiment, which helped expose scandals around cervical cancer and lack of consent.

She told RNZ to speak to the board chair, and that she would not comment because she "did not have to". She then hung up.

Dr Christiansen said it had taken years to improve informed consent practices partly because staff moved around a lot.

"You actually have to provide a continuous constant reinforcement of individual policies in your DHB to that workforce, which we are now doing with much more focus," he said.

Consent was a two-way street, he said.

He stressed that women needed to be proactive and ask more questions if they felt they did not have enough information.

"It's not simply a one-way street where clinicians tell the patient what's going to happen, the patient is an active participant in in the informed consent process. And there are often choices about how a procedure is undertaken."

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