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IUCD inserted without consent (13HDC00594)
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(13HDC00594, 21 November
Obstetrician/gynaecologist ~ District health board ~
Termination of pregnancy ~ Contraception ~ IUCD ~ Consent ~ Systems
~ Rights 4(1), 7(1)
A woman underwent a termination of pregnancy (TOP) at a public
hospital's clinic. When the woman presented at the clinic she was
seen by at least eight staff members, including an
obstetrician/gynaecologist, many of whom recorded in the woman's
records that she planned to use condoms for on-going contraception.
The woman did not consent to having an intrauterine contraceptive
device (IUCD) inserted.
The obstetrician/gynaecologist performed the TOP and then
inserted an IUCD into the woman's uterus. The
obstetrician/gynaecologist said that the nurse placed an IUCD on
the instrument trolley and he inserted it assuming that the woman
had consented for this to take place. The
obstetrician/gynaecologist said that the error was caused by staff,
and the systems within the clinic.
Over two years later the woman attempted to become pregnant
without success. After six months of trying, she visited her GP and
underwent various tests, including a smear test. Her GP identified
and removed the IUCD.
The district health board told the woman that the insertion of
the IUCD was a human error. A district health board staff member
said that she would write an apology letter to the woman, but did
not do so.
It was held that it was the obstetrician/gynaecologist's
responsibility to ensure that the woman had consented to the
insertion of the IUCD before he inserted it. The systems issues do
not excuse this failing. By inserting an IUCD into the woman's
uterus without first obtaining her informed consent, the
obstetrician/gynaecologist breached Right 7(1).
The systems in existence at the clinic at the time of these
events also failed the woman. Providing services with reasonable
care includes the provision of the right service, at the right
time, to the right patient. For a district health board, it means
operating a system that ensures that patients do not receive
treatment that they have elected not to receive. The woman left the
clinic with no knowledge of the IUCD having been inserted, which
was clearly unsatisfactory. The systems operating at the clinic for
the checking of consent prior to the insertion of IUCDs were
The district health board therefore failed to provide services
to the woman with reasonable care and skill and breached Right
4(1). It also failed to take reasonable steps to prevent the
obstetrician/gynaecologist's error and, accordingly, the district
health board was vicariously liable for the
obstetrician/gynaecologist's breach of Right 7(1).
Adverse comment was made about the manner in which the district
health board dealt with the woman's complaint.