Deputy Health and Disability Commissioner Dr Vanessa Caldwell. Photo / James Gilberd Photography Ltd
In a decision released today, Deputy Health and Disability Commissioner Vanessa Caldwell found the doctor had breached a section of the health consumers’ code by failing to provide services with reasonable care and skill, largely through his failure to refer the woman in a timely manner.
Caldwell was also critical of how the doctor had taken the woman to the clinic’s front desk and discussed the details of the process required for a planned termination with the receptionist in the busy waiting area.
She said more suitable options might have been a brief written note to the receptionist about what was required, or going to the reception area first to discuss next steps with the reception staff.
Investigation followed complaint referral
The HDC investigated the complaint following a referral from the Health and Disability Advocacy Service, with whom the GP clinic refused to engage, despite five attempts, Caldwell said.
She said the GP clinic finally responded to the HDC’s request for information about 18 months after its initial request.
There was a further seven-month delay before the investigation began, Caldwell said.
The incident when matters were discussed at reception happened during an initial consultation with the GP, when the woman requested a referral for a termination of the unexpected first trimester pregnancy.
At the same time she was told her visa status meant the relevant services would not be publicly funded.
She was advised to return for a second consultation once preliminary investigations had been completed.
The doctor said it was common practise for him to manage such matters through two consultations to ascertain a patient’s wishes whether to continue or terminate a pregnancy.
Consultation ‘disputed’
The doctor told the HDC he did not carry out a consultation in the reception area. However, he acknowledged he took the woman to the front desk and told staff that “she needed a TOP (termination of pregnancy) workout” in the full reception and waiting area.
He claimed this was necessary for the reception staff to co-ordinate the next steps.
He also said his reason for going to the reception area with her, after consultation, was “purely an act of doing a favour” for the woman who he said seemed unsure about what to do next.
Caldwell said regardless of the intent, in her view, the doctor had a responsibility to consider the sensitivity of the matter and respect the woman’s privacy.
“I remain critical that other options available for having this conversation more privately were not utilised,” she said.
Told to return after Covid lockdown
About 10 days after the initial consultation, when Auckland had just entered Covid lockdown, the doctor phoned the woman and advised her to return to the clinic for a second consultation, after lockdown.
The doctor said because the woman was an international student, with very limited English, he felt a greater need to explain the referral process and therefore a second consultation was warranted.
She was also told that no (termination) services were available during alert Level 4 lockdown.
The advice was later found to be incorrect.
The doctor acknowledged his mistake in not knowing that a private sector pregnancy termination service was always available, even during Level 4 lockdown.
He said had he known, he would have asked the woman to come straight to the clinic for a referral.
The doctor said he did not carry out a consultation in the reception area, but acknowledged that he took the woman to the front desk where he spoke about the process. Photo / 123RF
He said it was an “unprecedented and chaotic time” of the Covid pandemic and as a working GP, he had limited information about which hospital or specialist services were available during lockdown.
Caldwell said that could have been resolved by a simple query from him, or a practice staff member.
She said HDC in-house clinical adviser, David Maplesden, advised the most appropriate management would have been for the doctor to refer the woman immediately to the private provider, or to have advised her to self-refer straight after the first consultation while waiting for initial investigation results.
Maplesden considered the doctor’s intention to have a second consultation with the woman before formalising the referral was “probably reasonable” at the time.
However, it was “unreasonable and inconsistent” with accepted practise for the doctor to advise the woman 10 days after the initial consultation to make an appointment after lockdown when the duration of lockdown could not be anticipated.
Failure to refer in timely manner
Caldwell said it was her view that the doctor failed to refer the woman in a timely manner.
“I accept that, in general, it is reasonable to offer a second consultation to people who remain unsure or who indicate that further time is needed to consider options.”
However, Caldwell agreed with Maplesden the second consultation was unnecessary from a clinical perspective and when it was a time-critical matter.
“I acknowledge the unprecedented time of Covid-19 lockdowns but consider that to postpone the second consultation during the uncertain lockdown period potentially hindered Ms A’s ability to exercise autonomy in her health care.
“I note that a virtual or telephone consultation could also have been considered,” Caldwell said.
Along with the recommended training in privacy around patients requesting a termination, the doctor was also asked to apologise to the woman.
Caldwell also recommended that the GP clinic review its complaint management processes or policies to ensure they aligned with the HDC’s Code of Rights, and make changes as appropriate.
The woman said it had been a “deeply painful and personal memory for her”.
The HDC told NZME it did not hold information on whether the woman had been able to proceed with the pregnancy termination as that information was not relevant to the complaint.
Tracy Neal is a Nelson-based Open Justice reporter at NZME. She was previously RNZ’s regional reporter in Nelson-Marlborough and has covered general news, including court and local government for the Nelson Mail.