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
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
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
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
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
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
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.
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
- 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
- Discussion with the woman regarding contraception after the
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