Doctors blasted for surgical delay
The Health and Disability Commissioner (HDC) wants a review of the competence of two surgeons who failed to recognise a 79-year-old man in severe pain needed emergency surgery.
The patient, with a history of multiple medical complaints, had a sudden onset of abdominal pain after his evening meal in October 2009.
He was given morphine by ambulance staff and in the emergency department of the hospital he was taken to.
Paramedics with the ambulance, which was called just before 7pm, found the man "lying in bed in obvious pain, pale, cold".
He had been nauseated, and complained of severe abdominal pain rated 10/10.
One of the surgeons - identified as Dr B - saw the patient about two hours after the pain started and diagnosed a painful hernia that needed surgery, but not as an emergency.
The surgeon admitted the patient for observation overnight, and during the night the man continued to report severe pain, requiring morphine, commissioner Anthony Hill said in a report published today.
The case was handed over to on-call surgeon, Dr C, the next morning, who agreed with Dr B's diagnosis and operated at 3.40pm, 20 hours after the pain started.
The man was found to have a small bowel volvulus - a bowel obstruction caused by abnormal twisting of a loop of small bowel - and more than 2 metres of small bowel was removed.
A nursing note at 8.45am the day of the operation had recorded: "[P]atient writhing in pain."
Although the volvulus may not have been expected, doctors should have recognised that the patient needed emergency surgery, Hill said.
He found both surgeons breached the Code of Health and Disability Services Consumers' Rights.
The commissioner recommended the Medical Council consider reviewing the competence of the two surgeons. He also recommended the surgeons write letters of apology to the patient's daughter. The patient had died since the incident.