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Day Three

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Day Three

Prosecuting attorney is questioning a local unnamed (Nurse)

Question: Do you agree that it is not advisable to speak to a woman about sterilization while she is experiencing labour related contractions

Answer: ‘If you were a nurse would you worry about taking records and counselling or saving the unborn child’s life?’

Question: Please answer the question

Answer: I wanted to save the child’s life because a C-section is an emergency operation and this is why I did not take records.

Question: As a nurse you have the responsibility of making sure that you are conducting your duties and following all of the correct procedures

Answer: Yes

Question: Is that why you considered that counselling the patient and taking notes was not important?

Answer: All the things are important, but I put the life of the child as more important as the counselling is a long process. So I concentrated on the consent form; which is more important than the counselling and taking of records

Question: So you do consider all of those things important…?

Answer: Yes

Question: It is clear that your priority was to take the patient for the operation

Answer: Yes

Question: I accept that your primary focus was on the unborn baby, but I will not ignore that you did ignore the other things I questioned you about

Answer: Why are you asking about them then?

Question: Your only concern was about the child’s life

Answer: The primary focus was ion the child, but we also touched on the counselling and record keeping

Question: I know you were under pressure and there was no time to counsel and explain the sterilization procedure to the patient

Answer: As I told you before, I said I explained to the patient that she was going to be sterilized and I told her that this was a permanent thing

Question: Since you have indicated that you were more concerned with saving the child’s life, I am going to have to disagree with that

Answer: I have given an explanation that if a patient is in need of an immediate operation there will not always be time to note everything

Question: The sterilization on that day was not an immediate operation that had nothing to do with saving the child’s life?

Answer: Yes

Question: There was no reason to do the sterilization immediately; she could have come back for the sterilization after 6 months?

Answer: I don’t think it’s possible

Question: On the sterilization consent form, it requires that the Doctor to sign that an explanation was given to the patient regarding the pending sterilization procedure

Answer: Yes

Question: Would it not be better to tell the patient to come back after some time so that you can explain the procedure to them and give them comprehensive counselling?

Answer: Sterilization can be done anytime

Question: It is not advisable for sterilization to be done to a person in her 20’s

Answer: I understand, but I do not know about that

Question: Do you recommend that HIV + women be sterilized?

Answer: No

Question: A complainant has said that she was told by a nurse that HIV + women must be sterilized

Answer: I never said that because there is no such policy

Question: Even if there is no such policy would you tell a HIV + patient that they should be sterilized?

Answer: No

Question: Did you discuss this case with Dr. Mowatale

Answer: Since this case started? I saw him but we did not discuss about this case

Question: You are all involved in this case; and you did not discuss with him at all?

Answer: No I didn’t

Question: In you statement, you did not discuss you had a standing order?

Answer: I already told you I did not discuss with him

Question: So you did not discuss this with your lawyer?

Answer: I can speak with my lawyer

CASE ADJOURNS for LUNCH

Case resumes with questioning of a new Medical Doctor. The name of the doctor was inaudible

Question: Where are you working as a Medical Doctor?

Answer: Central Hospital

Question: When was the first time you came in contact with the two patients?

Answer: March 2005

Question: What did you explain to her about the sterilization process?

Answer: I told her that sterilization is when you don’t want to get pregnant again and it is a permanent thing

Question: What information did you give to the patient about family planning?

Answer: I discuss every type of contraceptives available; injections, condoms, pills, etc

Question: Why was sterilization recommended?

Answer: Because the contraceptives are not reliable

Question: How do you make sure your patients understand?

Answer: I try to speak in languages that they understand – English, Afrikaans; if they can’t understand then I call a nurse who can translate in their language

Question: How do you know that the patient needs to be sterilized?

Answer: It is indicated on the health passport with an exclamation point

Question: Do you know Dr. Kimberly?

Answer: Yes

Question: Do you know that he is giving testimony in this case?

Answer: Yes

Question: The decision of sterilization can be avoided during an operation?

Answer: Yes

Question: Do you counsel whole groups together and tell them about sterilization?

Answer: Yes

Question: It is advisable that patients be recommended to go for sterilization?

Answer: Patients have to decide for themselves

Question: Do you think she asked to be sterilized because she had problems with her last pregnancy and because she is HIV +

Answer: Yes

Question: Do you agree that there is no record of this patient requesting to be sterilized?

Answer: Yes

Written by Admin

January 28, 2011 at 8:34 am

Posted in Uncategorized

Court Proceedings Day Two

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Trial Day Two

QUESTIONING BY THE PROSECUTING ATTORNEY; WITNESS BEING QUESTIONED IS THE NURSE FROM OSHIKOTI HOSPITAL WHO WAS ON DUTY WHEN PATIENT WAS STERILIZED

Question: Once the doctor decides on the operating procedure, does the patient go from the delivery room to the preparation area?

Answer: No, the patient that needs to be operated is prepared in the delivery room and it depends…

Question: The student nurse signed the consent form; does she work where they prepare operations?

Answer: The term preparation can refer to the preparation area, the delivery room or the operating area.

Question: Once the decision is made that the patient must undergo an operation, she is prepared for the operation in the room that she is in, correct?

Answer: That is correct

Question: Then the patient is taken to theatre (operating room)

Answer: As I explained yesterday, we are not the ones that take the patient to theatre

Question: The theatre is far from the delivery room; is that correct?

Answer: Yes

Question: The consent form that was signed in your presence was it in the delivery room, where she was prepared for operation?

Answer: Yes

Question: Now, you would have consulted the doctor and made inscriptions on B3 (referring to the patient’s medical record/chart)

Answer: Yes

Question: At the time that the doctor was there, he spoke in English, would you disagree that a student nurse was there

Answer: Yes…

Question: Have a look at the doctor’s notes and make out what was written and what the abbreviations stand for, since you have worked in the maternity ward for over 10 years

Answer: Ok, (starts to read medical terminology related to the patients weeks of pregnancy etc)

Question: These notes that the doctor wrote are a result of a detailed exam, correct?

Answer: Yes

Question: After the examination, the decision was made that the baby had to be delivered by C-section because it could not pass through a normal vaginal delivery – correct?

Answer: Yes

Question: You would have prepared the patient for the operation, correct?

Answer: After the doctor examines the patient, he informs the patient of his findings and he informed the patient for the need of a C-section

Question: That would have been needed to be translated, because he was speaking in English, correct?

Answer: (I was translating for the doctor.

Question: There were no notes indicating that you were in fact translating to the patient

Answer: I did not indicate on the patients records – but I was in fact translating

Question: But we are dealing with what the doctor was explaining to the patient?

Answer: I interpreted for the patient and I was the only one where with the doctor

Question: But there are other signatures on the page during the time that you said that you were the only one in the room with the doctor

Answer: I am answering what you asked

Question: You would have written down notes after the doctor left?

Answer: I prepared the patient for the operation; I did research and went to the delegation to establish what I did that day

Question: When did you do the research?

Answer: a long time ago

Question: After the case was brought you went back to research what happened?

Answer: I went to all registers to see how many of us were in the maternity ward.

Question: After the case was brought, you engaged in investigations, is that correct?

Answer: (I went to our duty station to establish if I was involved with this case

Question – BY JUDGE: When did you do this?

Answer: at the time we were requested to make a statement

Question – by JUDGE and Prosecuting Attorney: WHEN!

Answer: I can’t answer that question

Question – by JUDGE: Why did you go to the register?

Answer: I went to the register t9o see if I was on duty

Question – by JUDGE: surely you don’t do that everyday; what prompted you to do that?

Answer: it was after I was requested to make a statement

Question: Who requested you to make that statement?

Answer: We were requested

Question: Who requested?

Answer: The supervisor of the ward

Question: Who is the supervisor of the ward?

Answer: he is no longer there

Question – by JUDGE: What is his name?

Answer: I cannot recall his name

Question: You cannot remember who asked you to make a statement?

Answer: I’m snot here to answer who asked me to make a statement!

Questions: No madam! You are here to answer all of the questions that you are asked. You indicated that you made a statement in 2008, why did we have to wait so long t9o get that answer from you?

Answer: You have been confusing me by your questions

Question: No we are being quite clear. It was in 2008 that there was a summons to court; so as a result of this case you were asked to make a statement. Is that correct?

Answer: Yes

Question: And you are aware that the patient has made a legal case against the state?

Answer: Yes

Question: How is it that after this woman went through sterilization – several years later you went back to the records to investigate your involvement in this?

Answer: I followed procedures

Question: What procedures?

Answer: If a doctors examines a patient the nurse must be present; if doctor says anything about the procedure I must interpret; I must explain to the patient and the doctor must be satisfied with my explanation; if the patient agrees about the sterilization – a patient must request it; and when they request the procedure, the doctor explains again and then I call another witness and then I explain again, the consequences, etc

Question: So that is the procedure you are required to follow?

Answer: Yes

Question: So, in 2008 – you were requested to make a statement about a medical procedure that was done in 2005, so in 2008 you researched the procedures you were supposed to follow?

Answer: Yes

Question: When you were requested to make a statement, you then had to read the procedures you were supposed to follow in 2005?

Answer: Yes

Question: With this procedure in mind you had to look at the maternity records to confirm what you did?

Answer: Yes, I went even further to establish that on that day I was working

Question: Have you reconstructed what happened on that day to suit your purpose?

Answer: No I didn’t

Question: You would not be able to remember (in 2008) what happened 3 years prior. You looked at the hospital registry and saw the names of the other people that were working and involved with this case – then you spoke with them to reconstruct the events of the day.

Answer: It was not necessary for me to go to my colleagues

Question: You knew that you would have to say that you followed the procedure by the MoH because you could get in trouble if you did not follow the procedure

Answer: Yes

Question: Did a student nurse speak with the patient about sterilization – this is what I suspect

Answer: No

Question: Do you understand that the MoH requires that there be a record of conversations to a patient in cases of sterilization?

Answer: You can’t write details of everything

Question: Everything related to the merits of this case are important two write

Answer: All of this is important – but I did not write everything because she is not the only patient in the ward!

Questions: You have agreed that the important things must be noted, correct?

Answer: Yes

Question: Is it important to write down if a person is going to be sterilized that all notes are taken properly?

Answer: Yes, but I didn’t

Question: You accept that you cannot FORCE people to be sterilized AGAINST the will?

Answer: Yes

Question: When it comes to sterilization it must be by patient request, correct?

Answer: Yes, this patient requested to be sterilized

Question: The REQUEST for sterilization is one of the most important aspects of the process – correct?

Answer: Yes

Question: I’m sure you will accept this because sterilization is an invasive and fa4r reaching procedure…

Answer: This sis very important; it is noted on the consent form that it was…

Question: We will come to the consent form…; does not being sterilized have important impact on socio-cultural issues: standing sin community, decrease prospects of marriage, etc?

Answer: I would not agree with you

Question: The community from where this patient is from, does being sterilized diminish marriage prospects?

Answer: Is this a question or a statement? I would not agree; if a person wants to marry you they will marry you rather you are sterilized or not. That’s why I can’t agree with you.

Question: This plaintiff/patient stated that if a woman of child bearing age cannot have children, it reduces her chances of getting married – do you agree?

Answer: I still do not agree

Question: I am asking these questions so you might come to realize how this procedure has impacted this woman’s life…you have emphasized procedures, policies etc in your earlier testimony; and you would agree that it is important to reflect in records t6hat the patient has requested to be sterilized correct?

Answer: Yes

Question: It is important to note that you advised the patient of the alternatives and consequences of sterilization and risks associated with the procedure

Answer: I did not write it down but I explained it to the patient before she signed the consent form.

Question: You would agree that there is no reference to a request by this patient to be sterilized.

Answer: Yes, it is not noted

Question: And there is nothing noted that you explained the procedure to the patient?

Answer: It’s not noted, but the most important- is the consent form

Question: We are talking about your record keeping in respect to this patient; nothing in the records reflect any explanation being given to her about this invasive procedure.

Answer: The consent and maternity ward works together.

Question: You know that there is an obligation to keep proper records on a patient?

Answer: You are right, but we did not do it because there were many patients in the ward and people can make mistakes

Question: That is what this case is all about … mistakes

Answer: It is not a BIG mistake that was made by us, because we explained to the patient

Question: Can you remember that patient today?

Answer: No

Question: There is no way that you can say under oath that you followed orders because there is no where in the records that indicate that you followed orders

Answer: I think that the most important thing was my explanation to her.

Question: There is nothing in these records that prove you explained anything to her; except the signed consent form.

Answer: Yes

Question: When you prepare a patient for surgery do you provide anaesthia, and when you gave her the consent form she had been provided with anaesthesia?

Answer: No

Question: I’m putting to you that preparing that patient for surgery simply meant giving her pain medication.

Answer: I would not agree

Question: Please look at the original maternity records form; on the back on the 4th line is pre-medication that was signed/filled by you. Can you tell the judge that time that you administered the medication?

Answer: The time sis showing 1:15

Question: Is that your handwriting?

Answer: Yes

Question: At 1:20 you wrote (inaudible)

Answer: Yes

Question: At 1:20 this is the time the consent form was signed?

Answer: I just wrote 1:20 on both forms

Question: Are you saying that the time you wrote on this form was knowingly incorrect?

Answer: The time I made the entry was not the exact time. I do not know what you want me to say?

Question: If you put a time down indicating that you did something the time should be a true reflection of your actions

Answer: The time on the consent and maternity form is the same because I just put one time on both forms.

Question: When you talk about standard Operating Procedures for with sterilization, there is a rule for ‘unhurried and skilled counselling,’ do you agree?

Answer: Yes I agree

Question: (attorney refers again to the maternity handbook, pg 34) reads: information about counselling session time should be recorded in patient’s records. There is no record you counselled this patient

Answer: Counselling starts with the pre-maternity ward, this is where the counselling happens

Question: This is what you are assuming

Answer: Now that is what happened

Question: There are no records proving that is what happened

Answer: The papers of the antenatal clinic (ANC) do provide this. I did not do the counselling it was done at the ANC

Question: Do you know what counselling is?

Answer: Yes

Question: Would you agree that proper sterilization counselling should be done 1 on 1 and not in group sessions?

Answers: It is very difficult, it is not just one woman it is over 100 women in the ANC

Question: That’s why counselling such as this should be done at the hospital, with ‘unhurried and skilled counselling’ prior to undergoing the sterilization procedure.

Answer: It is impossible for me to do this. They (the women) get it (counselling). I am in the labour ward – I can not give counselling on sterilization.

Question: So you did not provide counselling to this patient about sterilization when the procedure was done on 13 June 2005?

Answer: The patient requested the procedure. I told her it was permanent
Question: But there is no record of any requests by her to be sterilized

Answer: It was on her request. If she did not request it, we would not have done it, because it would have been against out rules

Question: I am not asking about your rules. There is no record of the counselling and you have already said that you don’t recall this specific patient

Answer: It is not in the patient’s records but it is what happened

Question: It would be a mistake to sterilize someone without their consent, correct?

Answer: If the patient did not ask for it, it will not happen

Question: If a patient received sterilization without requesting it, it would be wrong correct?

Answer: What mistake did we make?

Question: For the second time, is it a mistake if sterilization is done if a patient does not request it?

Answer: There is not a mistake since the consent form was signed

Question: Don not confuses consent with request. You cannot have consent for sterilization before requesting it

Answer: If the patient says that she requests sterilization and then she says no; we will cancel it

CASE ADJOURNED UNTIL AFTER¬LUNCH

CASE RESUMES

Question: When patients are in a group session at the antenatal clinic, sterilization is presented as a contraceptive option to them?

Answer: Yes

Question: This is considering part of counselling in this context?

Answer: Yes

Question: Is it just the woman or are their partners present during this session?

Answer: It depends

Question: You testified that you have participated in some of these sessions, do women’s partners’ cone?

Answer: Most of the time me are not present

Question: This counselling (from mid wives book) does not talk about group counselling at an antenatal clinic It talks about specific 1-1 counselling.

Answer: It is impossible because there are too many patients. 1-1 counselling can be done if a patient wants to be counselled on HIV

Question: When obtaining informed consent there should be records slept, yes?

Answer: In this case I was not the person who counselled the patient; she was counselled in the ANC

Question: Would you agree that group counselling for sterilization is not adequate?

Answer: I talked and explained to the patient about the sterilization procedure

Question: You have no record of that conversation/explanation; this book sets up standards for counselling in cases of sterilization

Answer: Yes

Question: You did not do the following: obtain informed written consent because a record must be kept of what was told to the patient

Answer:  I did not write it down but the patient was informed

Question: Is it a mistake that you did not write down notes and comply you is your requirements as a midwife?

Answer: That is not a mistake and I will not admit to that because the patient gave her consent

Question: Consent is not enough. A record must be kept of what was told to the patient; and you did not meet that requirement

Answer: You will say that because you were not in my position

Question: So there are reasons why you did nit comply with the rules?

Answer: Yes. I can not write everything in detail.

Question: Do you accept that you should have wrote something?

Answer: There is nothing that indicates that we did not explain to the patient

Question: It is your duty as a midwife to keep a record of what’s told to your patient

Answer: Yes, but I still have evidence of her consent that she agreed to be sterilized

Question: (Hands nurse the Midwives book/manual) please read… (Interrupted)

Answer: You can’t force me with one thing the whole day…lets move on, you are taking too much time!

Question: What’s taking time is that you aren’t answering the questions

Answer: Your questions are not straight

Question: In addition to obtaining written co9nsent, you have to keep a record of your communication with the patient. You did not meet the government policy that’s why you do not want to answer the questions

Answer: Why must you keep repeating if I admitted it?

Question: Do you know what unhurried and without pressure counselling is? (Referring to an entrance in the midwife manual that speaks to this)

Answer: Yes

Question: It is preferable that counselling about sterilization should not take place during labour…

Answer: I did not read that

Question: When it comes to sterilization, consent should not be obtained during the height of labour.

Answer: Why?

Question: It is painful and difficult period for a woman, are you not aware of that?

Answer: Labour is not a mental disease.

Question: When your pain is so severe it can impact your ability to make rational choices?

Answer: Labour pains are not for a long time it come and goes…

Question: Surely you have experienced that in you’re your years of experience as a midwife?

Answer: I have 3 children and I know labour pains. The labour pain of this patient come and went, it was not abnormal

Question: Are you aware that she had been in labour for sometime? She first went to the clinic on the 9th. She had been having contractions for a long time before the C section was performed. On the 12th do you accept that she went into labour?

Answer: Her contractions were not so severe that she could not make decisions

Question: That is not what I’m saying. Based on the literature, a woman should not make sterilization decisions while she is in labour. Do you understand?

Answer: I don’t have aright to refuse a patient’s request

Question: Do you accept that you were in a hurry?

Answer: In not going to repeat myself again

Question: The patient gave evidence that her labour was prolonged and difficult and she was exhausted from the four day process.

Answer: Yes

Question: That is the evidence and it’s all supported by her medical records

Answer: There are no notes that the patient was tired

Question: There are many omissions in your notes

Answer: I can’t answer if the patient was tired

Question: the evidence says that the patient went to the hospital for a natural birth; there are no indications that she requested to be sterilized

Answer: Although it is not evident on the medical report, she signed the consent form

Question: Where is it recorded nthat she requested to be sterilized?

Answer: All I can say is that we cant sterilize a patient without their consent

Question: There is no rcord that she requested sterilization. Do you agree; if not point out in the records where she requested the procedure?

Answer: I did not say that it was written somewhere

Questsion: the patient says that there were no options to sterilization that were explained to her by the doctor or yourself

Answer: All those things are discussed in she group counselling

Question: Did you discuss the procedure that would be used, consequences, or was this raised in the group discussions

Answer: The consequences I explained to her

Question: Patient says that she was never asked if she wanted to have children in the future

Answer: She would not have requested to be sterilized if she wanted to have children in the future; she can say that

Question: She did under oath. She also said that the doctor did not mention the word sterilization; but she was told she had to have a C section because she was having a protracted labour

Answer: Now, she did not know about being sterilized? So she did not have any knowledge about the sterilization?

Question: The patient just thought the operation was a C section

Answer: she signed the consent form after I explained to her

Question: She did not know what the abbreviation BDL meant

Answer: Yes, I would agree that she would not know what BDL meant

Question: She signed the consent form just thinking that she was going to have the baby removed via C section

Answer: I explained everything to her including the C section and the sterilization

Question: You only say that because you see the consent form; you don’t remember what you said to her.

Answer: Although I can’t recall the patient this is what I do everyday

Question: Your entire evidence is about what you believe happened, not what really happened.

Answer: No. Do you want me to remember from 2005? Before I ask a patient to sign, I explain to them everything

Question: You are supposed to explain…

Answer: That is what I did

Question: If you don’t explain properly you could get in trouble with your employer. This whole reconstruction that you are giving to the court today comes from you looking at the hospital registry. You had to go to the hospital records and research the requirements; and then you developed a story about what you did.

Answer: No I just went to the register to see what time I worked and who witnessed the signing of the consent form. I did not say I went through the rules and registry

Question: But that’s what you told the court earlier

Answer: I never told the court that

Question: You based your statement today and in 2008 on what were supposed to happen, not what really happened. It cannot be too much work for you to spell out sterilization on the consent form, so the patient can see what it is all about.

Answer:  I followed the hospital procedure; I did not create it myself.

Question: Most people would not understand what is meant by BDL

Answer: Rather I wrote BDL or sterilization, it does not matter, I could explain to them

Question: That is if you are asked a question. What you have pieced together today, I will prove that it did not happen

Answer: It happened

Question: According to the records, you looked at the patients health records at 1:00. You looked through them – it would take some time to look through them, correct?

Answer: It would take time if you’re not knowledgeable

Question: It would have taken at least a few minutes, and then you had to call the doctor, which would have taken some time, correct?

Answer: I can’t recall this patient

Question: According to you, the doctor spoke in English to the patient, and the patient needed translation. It would have taken you some time to translate, correct?

Answer: Inaudible

Question: You stated that you also had to give explanations to the patient. That would have taken some time, correct?

Answer: Yes…What is this about the time?

Question: I’m saying that it would take time to explain to the patient. After explaining the procedure the doctor would then go away; and before we goes away, he would have to write his notes, which reflect his detailed examination of the patient; and then after he leaves, you prepare the patient for the operation.

Answer: To prepare a patient there are many things to be done. I can prepare while the doctor is doing the notes

Question: You administered medicine to the patient. Was this after the doctor examined the patient?

Answer:  I would not wait for the doctor

Question: But you would not be doing anything while you are translating to the patient?

Answer: Your questions are confusing

Question: Just listen. You say that at 1:00 you went through the records and then you called the doctor

Answer: Yes

Question: And the doctor looked at the records, spoke to the patient and then examined the patient

Answer: That is correct

Question: Does all of that take some time?

Answer: Yes, but not too much time. You can’t walk slowly. She’s not the only patient in the world.

Question: But the doctor does examine one patient at a tine?

Answer: Anything that we are doing takes time – why do you keep asking, this is taking too much time?

Question: You are evading my questions, that’s why we are taking time… (Witness interrupts but is inaudible) just answer my questions. He supposed explains to the patient in English?

Answer: Yes

Question: This takes time (translating from Oshiwambo to English)?

Answer: Yes

Question: You’re in a hospital setting with serious issues and it takes time to explain properly…

Answer: I have answered all the questions about this. I won’t answer more.

Question: At 1:15 you administered medicine and I put it to you that that you could not have transported prepared and administered medicine in 15 minutes

Answer: The medicine I gave at 1:15 and at 1:20 she signed the consent form

Question: So you did all this in 5 minutes?

Answer: I am not alone in the ward; maybe the student nurse gave the medication

Question: Maybe she was also the one that does the translation about the sterilization?

Answer: Student does not have that right

Question:  So things like that don’t happen in your standing orders?

Answer: Like what?

Question: Keeping proper records

Answer: I can’t keep repeating

Question: The patient says that the nurse did all of the translating

Answer: Maybe she does not know the difference between the nurse and the student

Question: She said that the nurse did the translating

Answer: I just said that is not allowed

Question: But the patient said that the student nurse did the translating

Answer: The student nurse was not translating

Question: I submit that that was another irregularity that occurred

 

COURT ADJOURNED UNTIL NEXT DAY

Written by Admin

January 21, 2011 at 1:16 pm

Posted in Uncategorized

Court Proceedings: DAY 1 – Complete

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As Recorded by: Brian Wheeler NWHN Volunteer

Court Proceedings Day 1: Trial begins at 10.03 am. The judge and lawyers begin the proceedings advising that the names of the plaintiffs are not to be disclosed in court; the women are to be referred to as patient or plaintiff. A witness for the defence a medical doctor (name withheld) at Katatura hospital in Windhoek provided medical services to the plaintiff and according to his notes, he saw the woman in regards to her breeched fetous at 39 weeks of her pregnancy.

According to the doctors explanation, he advised the woman of the ramifications of a C-section, and why it what important for her to deliver the baby in this manner; additionally according to the doctors testimony he explained the surgical and post operation procedures to the patient. Upon being asked by the defence attorney if he knew the patient was HIV positive, he said that at the time he did not and if he was aware he would have noted this in his notes, which he did not. The Prosecutor was next to ask the doctor questions; and he started by asking the doctor is he was familiar with the patients medical passport (a document that the patient is given detailing their medical history)? The doctor informed the court that he was not aware of what the acronym PMTCT means.

The Prosecutor informs the doctor of the meaning of the acronym and the questioning proceeds. The doctor was asked if he discusses options with his patients in regards to a C-section; as there is no such indication in the patient’s files. The doctor indicates that he does discuss these options with patients; however they were not noted in the patient file. The Prosecutor continued by asking if the doctor was aware that the patient had already had a C-section; the doctor rep-lied that he was aware.

The questioning continued by the Prosecutor asking the doctor if he mentioned sterilization options to the patient; the doctor replied that he did mention this to the patient. The Prosecutor then countered that if it was mentioned to the patient, why is it not then reflected in the patient’s medical records and the doctors’ notes? The doctor then replied that ‘the patient agreed to the procedure but I did not indicate this in my notes.’ Prosecutor then asked the doctor ‘since your notes are obviously incomplete can you confirm that you advised the woman completely about the sterilization procedure?’ At this point, the doctor’s response was inaudible.

END OF QUESTION OF 1st WITNESS

Questioning by Prosecuting attorney: The witness is a Zimbabwean medical doctor who specializes in gynaecology at Oshikoti Hospital in Northern Namibia. He qualified as a medical doctor in 1995 and as a doctor specializing in gynaecology in 2000. He has worked for the Ministry of Health for over 10 years and has his own limited private practice. Question: The Prosecutor gives the health records and medical passport to the doctor. He then asks, what are the series of events on the patient’s medical records?

Answer: I discharged the patient and recorded information o her records in June 2005. I prescribed her medication and recorded diagnosis. She was operated on and received a C-section and BDL

Question: Why not use the word sterilization on the patient records and not BDL? Answer: We have high workload and no time to write long words

Question: Ok, now please look at the patient’s maternity records; when did you consult with the patient, and please indicate what the notes state?

Answer: ‘Called by nurse to review patient; on examination I found that the patient was full term, but the head of the baby could not fit into the pelvis of the mother for normal deliver. After talking to the patient I found out that she was on ART and PMTCT.

Question: You did not indicate in the notes exactly why the C-section and BDL was performed. What did you explain to the patient?

Answer: A nurse was translating… (Interrupted)

Question: Why? Answer: I speak Oshiwambo, but there is still always a nurse who serves as a translator.

Question: What was explained?

Answer: I explained that she could not deliver the baby on her own, and after explaining this to her she said that she wanted to be ‘closed,’ and after she said this I explained that this procedure is irreversible.

Question: All I se is the words BDL, there are no notes which indicate that she requested to be sterilized.

Answer: We checked the situation and found out that she has one baby at home

Question: What did you explain to her?

Answer: That she is going to be closed and that ‘you will have no babies in the future’.

Question: What else did you tell her?

Answer: It is a permanent decision and that BDL is irreversible, and BDL is a contraceptive procedure; we also assume that she knows what it means’.

Question: Is it not highly undesirable to obtain consent when the patient is in the height of labour; did you consider that you should wait to obtain consent?

Answer: She was not in sincere pain, she did not look confused to us, and we do not talk about sterilization unless a patient asks.

Question: Are there any notes that indicate this?

Answer: Because of the shortage of our work force – we do not always write and give details.

Question: Regarding the consent form; is your handwriting on the form?

Answer: They are signed by the patient and a registered nurse.

Question: I take it was not signed in your presence?

Answer: No

Question: There is a specific consent form for sterilization issued by the Ministry of Health, but there is not one in the patient’s records, why?

Answer: We thought the general consent one that she signed was enough. Question: Who provides the sterilization consent form?

Answer: The Ministry of Health, but we only use the general surgical consent form for all medical procedures.

Question: Do you use acronyms on the consent form?

Answer: Yes, but I did not operate on her.

Question: At state facilities, staff deals with many patients; resulting in pressure, is that a fair assessment?

Answer: Yes

Question: The sterilization occurred in 2005, do you have a specific recollection of the patient?

Answer: No

Question: When you give testimony about what happened, is it from your notes and what ‘you believe should have happened?

Answer: I know my work

Question: Do you agree that you need to rely heavily on your notes and it is your ethical duty as a doctor to take good notes? Is it also true that sterilization is a very invasive procedure?

Answer: yes

Question: You are aware that socio-culturally that being able to deliver babies is a very important aspect of a woman’s life?

Answer: Yes

Question: The patient indicates that she gave evidence that she went to the clinic several days before she was referred to the hospital. Patient was seen first by a doctor who is not a gynaecologist. There is evidence that the woman was in high levels of pain even before she was admitted into the hospital.

Answer: Inaudible

Question: According to the patient there was never any mention of the word sterilization; until it was raised by a nursing assistant after the procedure had already been completed; and you are the medical doctor in charge of this patient?

Answer: Yes

Question: You have indicated that the use of acronyms on medical reports is for the use of your medical colleagues; but you use the same justification on the use of medical related acronyms on the consent form?

Answer: The forms are for the health staff

Question: Is not the consent form for the patient and medical staff?  Is it not the patient’s consent that the form is for?

Answer: Yes

Question: Is it not advisable to have a consent form with the acronym BDL on it?

Answer: Yes, but we work in abnormal circumstances at the government hospital

Question: The only consent form in this patient’s case (exhibit B) refers to CBD and BDL; do you accept that most people do not know what these acronyms mean?

Answer: Yes

Question: The patient states that she did not know what the acronym CBD and BDL means.

Answer: It is explained to them

Question: Would they know if it was not explained?

Answer: No

Question: Was the patient English speaking?

Answer: No, ‘but this is 20 years after independence and most speak English’

Question: is it not possible to have on the consent form the full spelling of the words so people would understand ; using words like ‘Sterilization’ instead of BDL, because there are important issues such as ‘informed consent’

Answer: All those things are explained at the antenatal clinic even before they come to the hospital.

Question: Is this not an assumption?

Answer: Yes

Question: So she understands because she went to an antenatal clinic; but there is nothing on her health passport that reflects that she requested a BDL/sterilization?

Answer: Correct, we explain but we don’t lecture; in this case I cannot confirm that she was told.

Question: Did you see the summary by Dr. Kimbu (sp) prepared by your medial colleague in his evidence summary that stressed the different components of informed consent?

Answer: Because of these cases, we now even have the partners sign the form if possible.

Question: At the time of this case the Ministry of Health was using a comprehensive sterilization consent form, but at Oshikati hospital the form was not being used, why?

Answer: I would not fully agree with you (reads verbatim the form that Oshikati hospital used.) This form is adequate but we are now using the one from the Ministry of Health.

Question: If the form was adequate, why did you have to change it?

Answer: We wanted a better one

Question: Lets have a look at the other consent form – now this form has a heading ‘Consent Form for Sterilization;’ there is no mention of BDL (this is another form the MoH uses, but is not used at Oshikoti Hospital). The other form that you use Doctor is a general consent form for any surgical procedure?

Answer: Yes

Question: Do you accept that the form was inadequate; and this is why you introduced the new form?

Answer: We introduced the form because of the outcry from the public.

Question: Do you accept today that the new consent form is how the form should be done?

Answer: Yes

Question: Why at Oshikoti hospital are there no notes taken with explanations of the actions taken with patients

Answer: Instructions are given to patients but we do not always write them down

Question: There is no record in your notes that indicate informed consent by this patient

Answer: Yes, we have Standard Operating Procedures, but they are just not in my notes

Question: Do you understand why it is important to have proper notes and detailed notes when interacting with your patients?

Answer: Yes

Question: You know that at the height of labour that people may agree to a sterilization, but regret later….do you agree that the patient was only 26 years old at the time of the procedure; and that it is not advisable to do such a procedure on a patient this young.

Answer: There are many young women who request this procedure. Now we refuse to do it directly after labour. Now it is done later on its own.

Question: The patient says that the doctor was speaking to her in English; and according to her, her understanding was she was ‘having a caesarean section because labour had been long and she was exhausted.’ Would you agree that an additional form (consent) should be used in sterilization procedures; and full notes are necessary in this situation? Do you agree that your notes we inadequate?

Answer: No. The patient receives an explanation. My colleagues understand, because of our situation at the hospital. Because of our situation long explanations are not possible because of patient demands and shortage of staff.

Question: It does not appear in your notes that this patient requested a sterilization procedure?

Answer: No but our system is adequate. We give full explanations to all patients.

Question: The NOTES and FORMS (emphasis) does NOT represent adequacy; by medical or ethical standards! Why would the government hospital have had to make changes if it was adequate!? Your notes make NO reference that the patient requested to be sterilized. Should not such a serious procedure have been present in your notes?  I will argue at the end of this case that this patient NEVER requested to be sterilized! I will also argue that your statement that the patient ‘requested’ to be sterilized is a self serving statement, that you have made up because if it is found out you acted negligently, you can face disciplinary actions by both your employer; the government and your governing professional medical body

Answer: Yes…but there is no reason for us to sterilize someone without their consent. Why would we want to perform an extra surgery – it is more work!

Question: Maybe you and your colleagues hold a view that HIV positive women need to be sterilized?

Answer: No… I don’t hold that view

Question: Doctor, there is NO indication that the woman came to the hospital with the intention to be sterilized.

Answer: She requested.

Question: Do you agree that sterilization should be performed in a way that it may be reversible? The fibria (sp) was badly damaged on this patient. The surgery was done in such a way that it is irreversible; the tubes were severed. In this woman’s case the prognosis of reversal is very poor.

Answer: agreed. But the patient can get IVF at only N $40-50000 in Cape Town (South Africa).

Question: Is that very expensive, and not even available in Namibia?

Answer: Many people in the North can sell 10 cattle and raise the money to go to Cape Town. The patient never came back to the hospital and asked for help.

Question: The reason we are in court today is because the patient did not want this procedure done and because she is seeking justice!

End of Questioning with this witness (Doctor from Oshikoti Hospital)

Lunch Break

NEW WITNESS NURSE WHO ASSISTED THE DR. AT OSHIKOTI HOSPITAL – WITNESS IS BEING QUESTSIONED BY THE GOVERNMENTS’ DEFENSE ATTORNEY

Question: (Had begun prior to my re-entering the courtroom)

Answer: After the doctor examined the patient, the doctor requested that the patient be prepared fro surgery. The doctor explained that the patient was going to have a C-section and he also told her that she was going to be sterilized. After the doctor explained this to the patient, he left. All during the explanation, I was interpreting for him in Oshiwambo (this nurse who is testifying that she was translating from English to Oshiwambo has a translator herself at court who is translating the lawyers questions from English to Oshiwambo so she can understand)

Question: How do you know that the patient requested to be sterilized?

Answer: She was explained the procedure before signing (the consent form)

Question: Was this sterilization procedure indicated in your notes?

Answer: I did not put it in the notes but I know I explained it to her

Question: What is the methodology that you apply to your work? What procedures do you follow to obtain consent from this patient?

Answer: The doctor explains to the patient, and we (nurses/midwife) translate to the patient, and there is always a witness during the procedure

Question: Whose signature appears on the consent form?

Answer: The name of the patient, the nurse and a student nurse (note: doctor’s; signature is supposed to be present on the consent form)

Question: Have you ever provided antenatal counselling at the Oshikoti hospital?

Answer: Yes, the 14 nurses who work at the antenatal clinic provide antenatal and family planning counselling

Question: What language is the counselling give in; and what does the counselling consist of?

Answer: Oshiwambo; nutrition, exercising while pregnant and various problems that women face while they are pregnant.

Question: When you inform a woman about sterilization – what do you tell them?

Answer: It is an irreversible medical procedure

Question: Do you use the word sterilization? Is there any additional information that you give to an HIV positive patient?

Answer: Yes…

Question: Do you understand PMTCT

Answer: Yes

Question: Was this patient on any treatment to prevent MTCT

Answer: Yes

END OF DEFENSE QUESTIONING

QUESTIONING NOW IS BY PROSECUTING ATTORNEY

Question: You don’t remember this specific case do you?

Answer: Yes

Question: When you provide your testimony you refer to notes?

Answer: Yes

Question: When the then Ministry of Health was asked to provide documentation to provided a book called ‘Midwifery (holds book in air). Does this book provide the standards and treatment of care for mid-wives?

Answer: Yes

Question: Quotes from book ‘unhurried and skilled counselling is necessary prior to sterilization procedure’

Answer: Yes…I explained to the patient and she was aware of the process

ATTORNEY ASKS FOR COURT TO BE ADJOURNED UNTIL NEXT MORNING (WEDNESDAY) – JUDGE AGREES. COURT ENDS AT 4:08 PM

Writers OPINION/ANALYSIS: The prosecutor was very effective in proving that neither the attending doctor nor the nurse fulfilled their medical and ethical duty to document the process of explaining the sterilization procedure to the patient. Further, the prosecutor was equally effective in proving that their was no evidence that the patient requested to be sterilized, which in my onion is an integral aspect of the case.

 

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January 20, 2011 at 9:38 am

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Sister Site

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Same Focus

Same Aim

One Goal

END FORCED STERILIZATION OF WOMEN

http://endforcedsterilisation.wordpress.com/

Written by Admin

January 19, 2011 at 2:34 pm

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Trial Proceedings Day ONE

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Court Proceedings Day 1:

Trial begins at 10.03 am. The judge and lawyers begin the proceedings advising that the names of the plaintiffs are not to be disclosed in court; the women are to be referred to as patient or plaintiff. A witness for the defense a medical doctor (name withheld) at Katatura hospital in Windhoek provided medical services to the plaintiff and according to his notes, he saw the woman in regards to her breeched fetus at 39 weeks of her pregnancy.

According to the doctors explanation, he advised the woman of the ramifications of a C-section, and why it what important for her to deliver the baby in this manner; additionally according to the doctors testimony he explained the surgical and post operation procedures to the patient. Upon being asked by the defence attorney if he knew the patient was HIV positive, he said that at the time he did not and if he was aware he would have noted this in his notes, which he did not.

The Prosecutor was next to ask the doctor questions; and he started by asking the doctor is he was familiar with the patients medical passport (a document that the patient is given detailing their medical history)?

The doctor informed the court that he was not aware of what the acronym PMTCT means. The Prosecutor informs the doctor of the meaning of the acronym and the questioning proceeds.

The doctor was asked if he discusses options with his patients in regards to a C-section; as there is ni such indication in the patients files. The doctor indicates that he does discuss these options with patients; however they were not noted in the patient file. The Prosecutor continued by asking if the doctor was aware that the patient had already had a C-section; the doctor replied that he was aware.

The questioning continued by the Prosecutor asking the doctor if he mentioned sterilization options to the patient; the doctor replied that he did mention this to the patient. The Prosecutor then countered that if it was mentioned to the patient, why is it not then reflected in the patient’s medical records and the doctors’ notes? The doctor then replied that ‘the patient agreed to the procedure but I did not indicate this in my notes.’

Prosecutor then asked the doctor ‘since your notes are obviously incomplete can you confirm that you advised the woman completely about the sterilization procedure?’ At this point, the doctor’s response was inaudible.

END OF QUESTION OF 1st WITNESS

The witness is a Zimbabwean medical doctor who specializes in gynaecology at Oshikoti Hospital in Northern Namibia. He qualified as a medical doctor in 1995 and as a doctor specializing in gynaecology in 2000. He has worked for the Ministry of Health for over 10 years and has his own limited private practice.

Question: The Prosecutor gives the health records and medical passport to the doctor. He then asks, what are the series of events on the patient’s medical records?

Answer: I didischared the patient and and recorded information o her records in June 2005. I prescribed her medication and recorded diagnosis. She was operated on an received a C-section and BDL

Question: Why not use the word sterilization on the patient records and not BDL?

Answer: We have high workload and no time to write long words

Question: Ok, now please look at the patient’s maternity records; when did you consult with the patient, and please indicate what the notes state? 

Answer: ‘Called by nurse to review patient; on examination I found that the patient was full term, but the head of the baby could not fit into the pelvis of the mother for normal deliver. After talking to the patient I found out that she was on ART and PMTCT.

Question: You did not indicate in the notes exactly why the C-section and BDL was performed. What did you explain to the patient?

Answer: A nurse was translating… (Interrupted)

Question: Why?

Answer: I speak Oshiwambo, but there is still always a nurse who serves as a translator.

Question: What was explained?

Answer: I explained that she could not deliver the babay on her own, and after explaining this to her she said that she wanted to be ‘closed,’ and after she said this I explained that this procedure is irreversible.

Question: All I se is the words BDL, there are no notes which indicatge that she requested to be sterilized.

Answer: We checked the situation and found out that she has one baby atg home

Question: What did you explain to her?

Answer: That she is going to be closed and that ‘you will have no babies in the future’.

Question: What else did you tell her?

Answer: It is a permanent decision and that BDL is irreversible, and BDL is a contraceptive procedure; we also assume that she knows what it means’.

Question: Is it not highly undesirable to obtain consent when the patient is in the height of labour; did you consider that you should wait to obtain consent?

Answer: She was not in sincere pain, she did not look confused to us, and we do not talk about sterilization unless a patient asks.

Question: Are there any notes that indicate this?

Answer: Because of the shortage of our work force – we do not always write and give details.

Question: Regarding the consent form; is your handwriting on the form?

Answer: They are signed by the patient and a registered nurse.

Question: I take it was not signed in your presence?

Answer: No

Question: There is a specific consent form for sterilization issued by the Ministry of Health, but there is not one in the patient’s records, why?

Answer: We thought the general consent one that she signed was enough.

Question: Who provides the sterilization consent form?

Answer: The Ministry of Health, but we only use the general surgical consent form for all medical procedures. Question: Do you use acronyms on the consent form?

Answer: Yes, but I did not operate on her.

…to be continued

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January 19, 2011 at 7:42 am

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Trial Updates

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Court began at approximately9am in Namibia. Representatives form NWHN and various other women’s group were in attendance to give their full support to the women. Updates on the trials proceeding will be updated on the web tomorrow.

Written by Admin

January 18, 2011 at 6:37 pm

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Strategic meeting

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Court Cases begin at 9am tomorrow. Today was a planning day with AIDS and Rights Alliance for Southern Africa (ARASA) and Legal Assistance Centre representatives (LAC) to determine a strategy to mobilize the women plaintiffs and get them to court in a show of solidarity.

Written by Admin

January 17, 2011 at 2:56 pm

Posted in Ongoing Trial