A nurse has been found in breach of the Code of Health and Disability Services Consumers' Rights after vaccinating a 12-year-old when the question of consent was murky. Photo / NZME
A school nurse gave a 12-year-old student the Human Papillomavirus [HPV] vaccine despite the girl telling the nurse her mother no longer consented to it.
The mother of the child later claimed the vaccination resulted in long-term adverse symptoms, including mental health issues that led to her daughter being home-schooled.
The nurse has been found in breach of the Code of Health and Disability Consumers’ Services Consumers Rights by the Health and Disability Commissioner [HDC].
The name of the student, nurse, school, and region where the events occurred is not detailed by the HDC.
According to the decision released today, the student received her first dose on April 15, 2021, with no adverse reactions recorded. Weeks earlier, her mother had signed a consent form allowing her daughter to be vaccinated.
The HPV vaccine, aimed at protecting against a virus that causes several cancers that can affect women and men including cervical cancer, involves two doses, separated months apart.
When it came time for the second dose later in November, the mother decided she wanted a longer period between vaccines so her daughter’s immune system was not “overstimulated”.
Not knowing how to withdraw her consent, she decided to keep her daughter home on the date of the second in-school vaccination clinic, November 4.
The principal of the school told Deputy Commissioner Dr Vanessa Caldwell the mother said her daughter was sick that day, but had made no mention of the absence being related to the vaccine.
Eleven days later, nurses attended the school for a “catch-up clinic” where students who missed their second dose on November 4 would be vaccinated.
Recollections differ at this point, according to the decision.
Called to the school library where vaccinations were happening, the student recalled that she told her teacher she didn’t want the vaccine. She said the school’s office manager told her to tell the nurses directly.
The student said she told the nurse her mother had said she wasn’t to be vaccinated.
The nurse attempted to call the child’s mother to clarify. The mother didn’t pick up, so she rang the child’s father.
The father told the Deputy Commissioner that he told the nurse as far as he knew the vaccination was not to go ahead. He said he told the nurse he “[doesn’t] have anything to do with it” and to call the child’s mother.
The nurse, however, said the student had been under the impression the vaccine was for Covid-19. When it was explained it wasn’t, she gave her consent to be vaccinated.
The student told the Deputy Commissioner she made no mention of the Covid-19 vaccine, denying she was confused, or that she gave consent.
“On the basis that we had a consent form from [the mother] for HPV and had no notice that consent was withdrawn, I thought the issue of which vaccine was being given had been cleared up,” the nurse said.
The vaccination was administered.
The nurse said there was no impression that the student didn’t want the HPV vaccine, or that her mother had withdrawn consent. Had that been the case, “I would not have administered the vaccine,” she said.
Another nurse at the school on the day had largely the same recollection as the vaccinating nurse, although this nurse said the student “wasn’t sure” if her mother wanted her vaccinated.
After concerns were raised, a meeting was later held with the student, her mother and father, and the vaccinating nurse at the school.
The nurse told the parents her recollection, denying wrongdoing and stating there had been no harm to the student.
The student’s father alleged the nurse lied about his daughter having given consent. The nurse denied any dishonesty.
The mother further told the Deputy Commissioner that the same day as the vaccination was given, the student experienced “several reactions” including rash, headaches, and dizziness.
She claimed her daughter now experiences poor mental health and other symptoms as a result of the vaccine, and felt unable to return to school. The girl is now homeschooled.
The nurse later accepted she misunderstood the student’s withdrawn consent and apologised.
“I appreciate though with the benefit of having all of the HDC material, that there was a misunderstanding in my conversation with [the student] and with her father and given that [the student] had raised concerns from her mother, I should have stopped until I could confirm the position with her mother.”
Caldwell found the nurse breached 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.
She said the nurse should have spoken to the mother before administering the vaccine.
“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,” Caldwell said.
“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.
“When uncertainty about the mother’s consent was raised, this cast doubt on the validity of the consent that was held,” Caldwell said.
“As the registered nurse administering the vaccine it was her responsibility to ensure she had appropriate consent before doing so.”
She recommended the school-based vaccination plan was reviewed as it pertained to “catch-up clinics” and that it be reinforced to the public health nursing team that contact should be made when vaccination is missed.
