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A public health nurse failed to check a 12-year-old still had consent for a vaccine after the girl expressed concern.
In a recently released health and disability commissioner report, the nurse was found in breach of a health code for not checking that consent to give the young student the human papillomavirus (HPV) vaccine was still current.
The girl told the nurse that her mother no longer consented to her getting the HPV vaccine, but the nurse was unable to contact the mother and went ahead with the injection.
The student's mother had previously provided written consent for the HPV vaccine but after she received the first dose at school, the mother decided she did not want her daughter to receive the second dose at school.
When it came to giving the second dose, the vaccinating nurse said she believed the student's concerns related to a different vaccine, and proceeded with the vaccination after reassuring the student and her father (by telephone) that the vaccine was for HPV.
The father's recollection of the phone call was that he told the nurse he did not "have anything to do with it" and they should contact the girl's mother.
The nuse said the girl "seemed calm, was not distressed and she gave her verbal consent to have the vaccination".
According to the student's mother, the girl experienced undesirable long-term symptoms following the vaccination.
Deputy Health and Disability Commissioner Vanessa Caldwell found the nurse breached the Code of Health and Disability Service Consumers' Rights.
She found the nurse in breach of Right 7(1) of the Code which stipulates that services may be provided only if the consumer makes an informed choice and gives informed consent.
"It is imperative that providers take appropriate steps to obtain informed consent."
Caldwell said it was the responsibility of the nurse to ensure she had appropriate permission from the consenting parent.
Given the student's vulnerability as a young consumer and the fact that her consenting parent was not present, the report considered the threshold for questioning whether the parental consent was still valid needed to be low.
Caldwell said she was concerned that the nurse did not make contact with the mother to discuss the consent further.
"To be clear, I do not consider that the nurse meant any harm to the student in administering HPV2 or that this was an assertion of the nurse's views or beliefs over those of the student or her mother.''
"But I do consider that the nurse was on notice that the student's mother had withdrawn consent for her daughter to receive HPV2."
The nurse also breached Right 7(7) of the Code, which ensures that consumers have the right to refuse services and to withdraw consent to services.
Caldwell recommended the nurse make a written apology to the student and her family, and undertake online training on informed consent.
She also recommended that Te Whatu Ora:
- Review the SBVP Policy Manual with regard to confirming parental consent and arranging "catch-up" clinics.
- Communicate to the Public Health Nursing Service (PHNS) the expectation that the process for informing parents/caregivers when a student misses the initial vaccination be followed.
- Use an anonymised version of this case for wider education of the PHNS.