at birth in female babies. When news of the neonatal study broke during the Inquiry, there was a public furore, as no provision for parental knowledge or consent had been made. Judge Cartwright heard evidence, also, of disrespectful teaching practices, such as the insertion and removal of intrauterine devices on patients under general anaesthetic for other purposes, and vaginal examinations performed by undergraduates on anaesthetised women, in both cases without their prior knowledge or consent. The Report condemned such practices. Report Recommendations, Resulting Legal Reforms and Other Changes Recommendations in the Report of the Cervical Cancer Inquiry 1988 contributed to sweeping changes in law and practice around health and disability services’ consumers' rights in the 1990s and beyond. An independent patient advocate was to be appointed at National Women’s Hospital, whose duty was to protect the patient and ensure that she received full information and the opportunity to consent to all procedures in which she might participate. In 1989 Lynda Williams was appointed to the position, becoming New Zealand’s first patient advocate. The recommendation for patient advocacy has since been applied generally with a free nationwide health and disability advocacy service, The Cartwright Report recommended that the Human Rights Commission Act 1977 be amended to provide for a statement of patients’ rights, and the appointment of a Health Commissioner. The Code of Health and Disability Services Consumers’ Rights, stating ten rights of health and disability services consumers and correlative duties owed to them by providers, was passed into law in regulations in 1996. The first Health and Disability Commissioner was appointed in 1994. The complaints regime became operational in July 1996. The Cartwright Report recommended setting in place a system of regional ethics committees, focused on the protection of patients, independent of hospitals, of which half the members would be lay people. New Zealand now has a national system of ethics committees, to which research involving health and disability services consumers must be submitted for ethical approval before it can proceed. The Judge recommended the urgent implementation of a nationally organised population-based cervical screening programme, which became operational nationally in 1991. Legal Consequences Attempts to bring Green before medical disciplinary authorities failed because he was deemed, at 74, to be not mentally or physically fit enough to be charged. In 1990 the Medical Council of New Zealand found Professor Denis Bonham (Green's head of department and head of the Postgraduate