A doctor exposed a woman, who has been left permanently disabled, to unnecessary risk by failing to ensure she was seen immediately by a specialist, the Health and Disability Commissioner has ruled.
The case was an example of how patients should have "justified confidence" that their doctors will refer them in a timely manner so that their condition does not worsen.
That was not the case when the woman visited her GP in 2009, commissioner Anthony Hill said in a ruling released today.
If the woman had been seen by a specialist immediately after presenting to her doctor, then she would have had a greater chance of recovery and might not have been permanently disabled due to a prolapsed disc, Hill said.
The names of the women, doctor, specialist, medical centre, and district health board were not published.
The woman was 29-years-old when she saw her GP in November, 2009. She had slipped in the shower three weeks earlier, but had been experiencing severe pain in her sciatic nerve and in her right foot for the four days prior to her appointment.
The doctor diagnosed a disc prolapsed, referred her for a CT scan and prescribed her pain relief. But she returned the following day after losing control of her bladder.
Urinary incontinence was a "red flag" that she could possibly have cauda equina syndrome, something which every doctor should be aware of, Hill said in his ruling.
The syndrome affects the nerve tissue and time is of the essence in treating it.
However, while the doctor was aware of the possibility of the woman having the syndrome, and contacted a surgeon and the emergency department, he understood that he could not directly refer his patient to the ED, something which the district health board says is in contrast to its expectation.
The doctor left a message on the surgeon’s phone on a Friday afternoon asking him to bring her CT scan forward, and said he instructed the woman to go to the hospital emergency department (ED) over the weekend if she did not hear from the on-call orthopaedic surgeon, or if her symptoms worsened.
He has been criticised for not being more aggressive in his referral by making sure she was seen that day. The doctor has said on reflection, he should have sent her straight to the ED.
However, the specialist who listened to the phone message and tried to find the woman in ED, also should have been more active in making sure she was seen as soon as possible, Hill said.
The woman said she her doctor told her to take more pain killers and rest until Monday, when she was due to have a CT scan.
"He left it at that," she said.
"I went home and had the worst weekend of my life with the pain and the worry that I might over dose on the pain killers as they weren't doing anything."
She was in so much pain she could barely stand or sit.
After she had the scan on Monday she received a phone call telling her to return to the hospital to meet with the surgeon straight away.
He told her that her situation was a medical emergency and she had 48 hours after the onset of the bladder incontinence to have surgery to have the best chance of recovery.
She had surgery later that day and has had two more surgeries since.
While the medical centre has since taken steps to improve its procedures, Hill said he was concerned that effective procedures weren’t in place to start with and recommended that it send him a progress report later this year.
He found the doctor breached his responsibility of appropriately referring his patient and minimising potential harm to her, and recommended the doctor apologise.
- © Fairfax NZ News
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