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Death of young woman prescribed second-generation contraceptive pill despite history of superficial thrombosis (03HDC00837)

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(03HDC00837, 2 December 2003)

General practitioner ~ Standard of care ~ Prescription of oral contraceptive ~ Risk factors ~ Missed diagnosis of pulmonary embolism ~ Rights 4(1), 6(2)

A father complained about the services provided to his daughter by a general practitioner who: (1) prescribed oral contraceptives even though the woman had a recent history of thrombophlebitis; and (2) did not diagnose that she was suffering from pulmonary emboli. The woman, aged 39 years, died as a result of a lung infarction caused by pulmonary emboli from a deep vein thrombosis.

The Commissioner reasoned that: (1) superficial thrombosis with thrombophlebitis, although not an absolute contraindication, is associated with increased risk of thromboembolism, and is listed as a risk factor for oral contraceptives; and (2) the possible increased risk should have been disclosed and increased care was needed in follow-up.

It was held that the GP breached Right 4(1) because he did not act with reasonable care and skill when he prescribed the second-generation contraceptive pill, in that he did not address the woman's personal risk when he failed to: (a) take a comprehensive personal and family history to exclude contraindications; (b) review her personal risk factors prior to prescribing, including her varicose veins and recent thrombophlebitis; (c) discuss alternative management options; and (d) document his findings and the discussion.

However, the GP did not breach Right 4(1) by failing to diagnose the patient's pulmonary embolism, because his assessment and management of the patient's chest complaints was consistent with the standards of a competent doctor. There was no reason to believe that the patient was suffering from a life-threatening condition because: (1) even though she had symptoms of pulmonary emboli, the symptoms were equally consistent with asthma secondary to a chest infection, which the patient had suffered in the past; and (2) the patient did not report any leg swelling, which would have made the diagnosis of pulmonary emboli significantly easier.

The Commissioner commented that a prudent medical practitioner should inform a patient of the risks associated with taking the oral contraceptive, and discuss any personal risk factors.