Health and Disability Commissioner Morag McDowell did not make a finding on this allegation, but said if it was “recording consent that had not been given” it would “clearly be inappropriate”.

Another example described a registrar proposing to involve a house officer in an intimate examination of a woman under general anaesthesia.

“[The nurse] told HDC that she intervened, saying that no consent had been gained.”

As a result, the examination did not go ahead.

The report pointed to “systems weaknesses” in the procedures, however, did not breach the Code of Health and Disability Services Consumers’ Rights (the Code).

Mcdowell said, “Clinicians must be mindful that informed consent is more than just a tick box exercise, and they must be alive to individual patient circumstances.

“The wording of Health NZ’s 2018 consent form and apparent reliance on it to justify all medical student involvement beyond observation was a significant weakness in Health NZ’s consent practices,” she said.

“Basic courtesy and respect for patients apply and, wherever practicable, consumers should know who is to be providing their care and what they will be doing. This is information that a reasonable consumer can expect to receive.

“Consumers undergoing sensitive/intimate examinations should know beforehand who will be involved and what their role will be, including any observers. Explicit consent is required.”

The report also noted that “national practices for the obtaining of informed consent to teaching are inconsistent”.

Health NZ Te Whatu Ora told Stuff it accepted the investigation’s findings.

“While the Commissioner found Health NZ did not breach the Code … we want to reassure the public that we take our obligations and responsibilities very seriously,” Te Whatu Ora Waitematā Chief Medical Officer Jonathan Christiansen said.

“The Commissioner acknowledged and commended Health NZ for undertaking a careful, ongoing review and improving the informed consent policy and practice.

“Work is ongoing to develop a nationally consistent approach to informed consent. Health NZ will be using the findings from this report to inform these policies and processes,” he said.

College of Nurses Aotearoa executive director Kate Weston said the organisation welcomed the findings of the Health & Disability Commissioner report.

“Informed consent is a key right under the Health and Disability Sector Code of Consumers rights – which was developed as a direct response to major concerns about practice in women’s health and gynaecology services at National Women’s Hospital. It is almost 30 years since the Code was released and made into law in Aotearoa,” she said.

“Informed consent applies to all patients – irrespective of where the services are being provided, whether the patient is paying for the service or whether the services are being provided at a teaching hospital or facility.

“The rights of the patient to be informed about what treatment is being proposed and knowledge of who the team caring for them is and their role, especially in teaching, is protected. The need for health practitioners to learn is acknowledged, however patient rights must take precedence.”

Weston said the College of Nurses considered that there is a responsibility for nurses to act and to advocate for patients to uphold their rights – especially for patients and whanau who are vulnerable, such as the women who were the patients in this investigation.

“It is not okay for nurses or other health professionals to stand by and fail to challenge colleagues who may not be considering people’s rights as patients,” she said.

“We applaud the brave actions of the registered nurse who raised concerns within the team and initially with the District Health Board, before escalating these further to the Health and Disability Commissioner.”

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