Doctor censured for providing 'abortion drug'

A doctor who gave rural women stomach ulcer medication to induce abortions considered it a necessary service, a health disciplinary tribunal was told.

In one case, a patient later had to have a fallopian tube removed when an ectopic pregnancy ruptured, according to a decision from the Health Practitioners Disciplinary Tribunal (HPDT).

The doctor, who was not named in the decision, was suspended from practising for six months by the tribunal.

The GP, known as Dr N, was found guilty of professional misconduct for giving the four women who wanted to terminate their pregnancies the drug misoprostol.

She hid her actions by not updating the patients' records.

The medication, prescribed under the brand name Cytotec, is commonly used to treat stomach ulcers, but cannot be given to pregnant women as it can cause miscarriages or damage to the fetus.

Dr N, who had more than 30 years' experience and worked at an unnamed rural clinic, was reported to a conduct committee after a fifth year medical student named Dr L witnessed her giving a woman named as Patient A misoprostol pills in an envelope and telling her: "I think you are having a miscarriage and this will help it along".

"It was clear to Dr L that it was 'very understood' by Patient A that she had been given an abortion drug," the HPDT decision said.

However, the patient was not warned of the effects of the drug and no clinical examination was carried out.

When Dr L questioned Dr N about the medication, she said that while it was an off-licence use of the drug, it would save the patient "a massive ordeal associated with a trip ... for an abortion".

She considered it was a "necessary service and she felt justified in her decision to use it in Patient A's situation", Dr L told the tribunal.

"Dr N said that she would defend her decision in this regard in a court of law."

On another occasion, a nurse at the clinic refused to give a pregnant woman misoprostol when Dr N told her over the phone to get some of the pills out of the cupboard in her office to give to Patient B who wanted to terminate her pregnancy.

When Dr N returned to the clinic she was "angry" that Nurse E had not done so.

"Dr N told Nurse E that it was unfair not to give the patient these pills ... that if Patient B had to wait it would be too late; and that [Nurse E] would be denying the patient the right to choose if she denied her the pills."

Dr N wrote a prescription of the drug for Patient B, who later suffered a ruptured ectopic pregnancy and underwent surgery to remove a fallopian tube.

Dr N was also found to have inappropriately given two more patients misoprostol.

In all cases she failed to record the details on the patient's medical notes, or pass on the information where necessary to other doctors.

The tribunal said there were dangers in administering the drug for the purpose of inducing an abortion because it "may not have the desired result and a viable pregnancy may continue with a potential risk of fetal abnormality; or that if a miscarriage did occur, it would not be complete."

Doctor N was charged with breaking the provisions of the Contraception Sterilisation and Abortion Act 1977, as well as failing to undertake proper clinical assessments and provide adequate support to the patients who were given the drug.

The tribunal was "satisfied that this pattern of illegal and inappropriate care constitutes serious negligence, malpractice and brings discredit to the medical profession".

"Dr N was acting contrary to all relevant guidelines especially as to safe prescribing," it said.

In her defence to the tribunal, Dr N said she was stressed and "allowed herself to become overwhelmed by the need to help those desperately seeking her help".

The tribunal found her guilty of professional misconduct and suspended her for six months from May 27, 2013.

A number of restrictions were imposed on her for three years and a recommendation was made to the Ministry of Health that she be banned from prescribing or supplying misoprostol for three years.

She was also ordered to pay costs totalling $38,310.

The Medical Council and New Zealand Medical Association declined to comment and the Ministry of Health did not respond to requests for comment.


The law

Abortion in New Zealand is governed by the Contraception, Sterilisation and Abortion Act 1977 and certain provisions in the Crimes Act 1961.

Both medical and surgical abortions are available.

Abortion must be authorised by two medically qualified and specially approved certifying consultants who are satisfied that one of the grounds justifying abortion exists - either, the pregnancy would result in serious danger to the life, or to the physical or mental health, of the woman, or there is a substantial risk to the child, if born.

There is also a legal requirement to offer counselling to the person seeking the abortion.

The accepted practice for a woman who requests a termination is:

- Discussion regarding pregnancy options and if the woman is clear she does not wish to continue the pregnancy and has grounds for referral for a termination of pregnancy then she should be referred for termination of pregnancy.

- The CSA Act requires referral to a licensed institution and for the woman to see two certifying consultants.

- A referral to a licensed clinic requires a referral letter from the patient's doctor, an antenatal blood test, a pregnancy ultrasound scan, and swabs taken to exclude infection.

- Discussion with the woman regarding contraception after the abortion.

Misoprostol

Medsafe guidelines state: "Misoprostol induces uterine contractions and is associated with abortion, premature birth and fetal death. Miscarriages caused by misoprostol may be incomplete, which could lead to potentially dangerous bleeding, hospitalisation, surgery, infertility or death. Use of misoprostol has been associated with birth defects."

It is not approved for obstetric or gynaecological use, but can be used as a secondary drug for medical abortions in licensed facilities. However, because it is not registered for use in abortion, patients must sign an consent form.

Source: Health Practitioners Disciplinary Tribunal


 

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