Southern District Health Board Breached The Code Over Delayed Colonoscopy 20HDC02382

A report released today by Health and Disability
Commissioner Morag McDowell found Southern District Health
Board (SDHB) (now Te Whatu Ora Southern) breached the Code
of Health and Disability Services Consumers’ Rights (the
Code) over a delayed colonoscopy for a man with colon
cancer.

The man, who had a family history of colon
cancer, had four admissions to Dunedin Hospital between
April 2018 and October 2019. On the second admission, he was
scheduled for an outpatient colonoscopy in just over 12
weeks. The colonoscopy, and subsequent biopsy, revealed
colon cancer.

The man’s symptoms and history
fulfilled the SDHB criteria and Manatū Hauora/Ministry of
Health (MOH) referral guidelines for an urgent colonoscopy
(within two weeks). A possible reason for the lower urgency
was due to reliance on a normal result from a previous
colonography (CTC). In light of this, the Commissioner’s
independent surgical advisor commented that the request
could have been prioritised under a six-week
timeframe.

In any event, Ms McDowell noted that, “the
12 week wait exceeded SDHB’s own recommended timeframe and
the MoH’s guidelines by at least six
weeks.”

Accordingly, she found SDHB breached Right
4(1) of the Code which gives consumers the right to services
provided with reasonable care and skill.

In the
report, Ms McDowell, acknowledged, “the pressures faced by
colonoscopy services at a national level, due to an increase
in demand, paired with workforce shortages and recruitment
challenges.”

“However, it is my view that when
investigations are clinically indicated as urgent, or
semi-urgent, healthcare consumers have the right to expect
them to be scheduled sooner than occurred in this
case.

“A timely diagnosis can be particularly
important for reducing morbidity and mortality for cancer
patients, and often it is a key factor in survivability.
Long waits for diagnostic procedures can also have a
significant psychological impact on patients and their
whānau who may be concerned that they have cancer,” she
said.

No breaches of the Code in relation to other
aspects of the man’s care were identified. However, Ms
McDowell made an adverse comment about the concurrent use of
anticoagulant medication and the lack of clarity in the
discharge advice about anticoagulation.

Ms McDowell
noted that the report should be viewed in the context of
SDHB’s previous actions to address issues relating to
restricted access to colonoscopy services, including
commissioned external reviews.

“On assessment of the
information provided to me, I am satisfied that Te Whatu Ora
Southern has shown a commitment to implementing the
recommendations of the reviews and many of the issues
identified have been addressed,” Ms McDowell said.

“I
will continue to take a close interest in the quality of
this service and maintain a watching brief over the pattern
of complaints in this area.”

Ms McDowell recommended
that Te Whatu Ora Southern:

– Provide the man and his
family with a written apology for the deficiency in the care
provided.

– Consider a standardised checklist and
format for the provision of anticoagulation advice on
discharge, to ensure that all relevant aspects of advice are
covered and presented in a manner that can be readily
understood by the patient.

– Provide HDC with an
update on current wait times for colonoscopy services,
including any actions being taken to address delays where
wait times are outside expected timeframes.

Health and
disability service users can now access an animated
video to help them understand their health and
disability service rights under the
Code.

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