Health NZ Waikato And Surgeon Breach Code In Care Of Woman Who Developed Metastatic Cancer 20HDC01217

In a report released today, the Deputy Health and
Disability Commissioner has found Health New Zealand Waikato
and a surgeon breached the Code of Health and Disability
Services Consumers’ Rights (the Code) after the surgeon
failed to perform a physical examination on a woman when it
was indicated, and Health NZ did not adhere to guidelines
when it advised the woman of the wait times for a
colonoscopy.

The woman had a family history of
colorectal cancer and was experiencing rectal bleeding and
changed bowel habits. A consultant general and colorectal
surgeon performed a sigmoidoscopy (examination of the lower
third of intestine) at Thames Hospital which was reported as
normal and referred her back to her GP.

The bleeding
continued, so the woman was referred back to the surgeon who
referred her to Waikato Hospital, triaging the referral to
be seen within five-six months because of the normal earlier
results.

Four months later, the woman was seen by a
second general and colorectal surgeon. He did not physically
examine her, or perform a proctoscopy or sigmoidoscopy,
telling HDC this decision was probably because there was a
possible diagnosis of inflammatory bowel disease and she had
a previous normal colonoscopy. He referred her back to
Thames Hospital for a colonoscopy to be undertaken within
six weeks.

The hospital, however, advised her she
could expect to wait four months so she undertook a private
colonoscopy which found a malignant lesion. The lesion was
removed five months later, but seven months later she was
advised the cancer had spread to her lungs.

Of the
surgeon, Dr Vanessa Caldwell said, “The Code provides that
every consumer has the right to have services provided with
reasonable care and skill. I consider the surgeons rationale
for not conducting a physical examination to be insufficient
in the circumstances, and I am concerned that he did not
document the reasons for not undertaking a physical
examination, particularly as this comprises part of his
usual practice.”

Dr Caldwell was critical of Health NZ
for advising the woman that she was likely to wait four
months. “The Ministry of Health guidelines indicate a
priority 3 referral should mean a wait of six weeks and
Health NZ Waikato failed to adhere to these
guidelines”.

The Deputy Commissioner recommended that
Health NZ Waikato and the second surgeon apologise to the
woman. She also recommended the surgeon undertake an audit
of clinical appointments for investigation of rectal
bleeding to check physical examinations took place and were
documented.

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