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Insertion of IUCD without removing existing contraceptive device (13HDC01212)

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(13HDC01212, 16 June 2015)

General practitioner ~ Medical centre ~ Gynaecology ~ Women's health ~ Mirena ~ IUCD ~ Contraception ~ Rights 4(1), 4(2)

A woman had a copper intrauterine contraceptive device (IUCD) inserted by a family planning clinic. Around five months before the IUCD was due to be removed, the woman presented to her GP medical centre. She received treatment for bacterial vaginosis (BV), and advised the nurse that she had an IUCD in place, which was due to be removed. The nurse recorded this in the woman's clinical notes.

The woman saw her GP at the medical centre about a month later. She recalls telling the GP that she had an IUCD in place. The GP said she did not ask the woman about contraceptive use and history, and was not aware the woman had an IUCD in place. The woman enquired with the medical centre about Mirena (a different type of intrauterine system) as an option for management of heavy menstrual bleeding. Her GP arranged special authority for a Mirena.

The woman attended an appointment with her GP to have the Mirena inserted. The GP performed pelvic and speculum examinations, and told HDC the results of these assessments were normal and there were no strings from an existing IUCD visible. The GP did not remove the existing IUCD before inserting the Mirena.

The woman attended a follow-up appointment and her GP performed a vaginal examination and noted the Mirena was in place. The woman attended a further follow-up appointment with another GP at the medical centre who performed a vaginal examination and noted the Mirena was in place. The woman had recurring BV which was treated with antibiotics.

The following year, an X-ray was taken of the woman's back following a fall. This revealed two contraceptive devices in her uterine cavity. The woman returned to her GP who removed both devices and noted that the strings from two contraceptive devices were seen on examination.

It was held that the GP breached Right 4(1) as she did not adequately assess the woman's contraceptive history prior to inserting the Mirena. Further, the GP failed to read the nurse's note stating that the woman had an IUCD in place, and failed to consider alternative causes of the woman's heavy menstrual bleeding and BV. The GP breached Right 4(2) for failing to keep adequate clinical records. The GP's failures were matters of individual clinical judgement and the medical centre was not responsible for them.

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