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Manchester physician reprimanded for performing hysterectomy on girl without judge’s concent

New Hampshire Union Leader

February 18. 2014 5:20PM

MANCHESTER — A city physician was reprimanded by the state Board of Medicine for performing a hysterectomy on a 12-year-old, severely autistic girl without first obtaining a probate judge’s approval.

Dr. Mary J. Montanarella, who has her own obstetrics and gynecology practice on Canton Street and enjoys privileges at Elliot Hospital, performed the surgery after obtaining the consent of the child’s parents and with the recommendation of the child’s primary care physician.

Attorney Bradley D. Holt, who represents Montanarella, said there was nothing inappropriate about Montanarella’s medical care of the patient, and the patient suffered no complications from the procedure.

Montanarella, he said, was unaware about a matter of law and was up front about that with both the Medical Board and Elliot Hospital.

According to a settlement agreement, the child was referred to Montanarella by her primary care physician. The child’s parents wanted to discuss methods to control their daughter’s menstruation so it would not adversely impact her.

The primary care physician discussed the case with Montanarella and sent her a letter supporting a hysterectomy.

Montanarella met with the child and her parents on Jan. 28, 2013, to discuss possible interventions. Montanarella recommended a hysterectomy, permanently addressing the child’s menstruation, but which also would result in permanent loss of fertility.

The child’s parents, her legal guardians, supported the hysterectomy and understood its implications. They signed a consent form for surgery, but the form they signed was a general consent form that did not expressly reference all of the implications of hysterectomy.

Under state law, a guardian can only give consent for sterilization if it is first approved by a probate court judge. Montanarella performed the hysterectomy on March 14, 2013, without obtaining a probate court order.

According to the settlement, both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics emphasize that physicians contemplating sterilization/hysterectomy in a female patient with disabilities must be familiar with the applicable local law. Montanarella acknowledged she was not familiar with state law.

Montanarella’s medical staff privileges at Elliot Hospital were temporarily suspended in May 2013 on a precautionary basis. Holt said the suspension was a matter of weeks, while the case was reviewed by a hospital committee and the state board. Her privileges subsequently were restored.

Montanarella, he said, is a skilled and caring physician who has practiced in New Hampshire for many years. She earned her medical degree from the University of Rochester (N.Y.) School of Medicine in 1986 and completed residency at Strong Memorial Hospital in 1990.

The board found that Montanarella displayed medical practice incompatible with the basic knowledge and competence expected of a person licensed to practice medicine, specifically obstetrics and gynecology, violating the Medical Practice Act.

Montanarella and the board, in settling the case, agreed to the reprimand to avoid delay and expense of further board proceedings and to promote the best interests of the public and the practice of medicine.

The investigation was opened after Elliot Hospital Chief Medical Officer W. Gregory Baxter sent a letter on May 28, 2013, to the board’s investigator reporting the Elliot Health System had imposed a temporary, precautionary suspension of Montanarella’s privileges while it investigated her care of the autistic patient.

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