HDC: Missed opportunities in diagnosis linked to middle-aged man's death from rectal cancer

RNZ News

3 days ago

By Tracy Neal, Open Justice reporter of
The man complained of a list of symptoms including pain and bleeding, but gaps in diagnosis and care failed to pick up his cancer.
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Doctors failed to detect a man's cancer in a series of missed opportunities that started when he first began getting symptoms in his late 30s.
The man was aged 39 when the first signs appeared in 2016 and he was referred to a public hospital in the lower North Island.
Surgery to remove haemorrhoids was carried out the following year, but three years later he sought help for ongoing abdominal pain and diarrhoea. However, no further detailed investigations were undertaken at this time.
Instead, he was encouraged to enrol with a GP for a follow-up.
In January 2021, the man, who is only referred to as "Mr A" in a decision released on Monday, was diagnosed with advanced rectal cancer.
He died last year.
Deputy Health and Disability Commissioner Vanessa Caldwell said in her findings that deficiencies in the care provided by Health New Zealand Te Whatu Ora Capital, Coast and Hutt Valley contributed to the delay in the man's diagnosis.
"I accept that multiple individuals were involved with Mr A over this time and, in my view, the responsibility for the deficiencies in care lay with Health NZ," Caldwell said.
She ruled that Health NZ breached a section of the Health and Disability Services consumers' rights code in relation to the man's care.
She extended her sincere condolences to the man's whānau for their loss and acknowledged other struggles the man had faced while managing his illness.
Caldwell said that when the man was treated for haemorrhoids in 2016, his history of rectal bleeding was documented but closer internal examination through a sigmoidoscopy was not done.
Expert advice was that such a procedure would be an essential part of a patient assessment, even when a prolapsing haemorrhoid was identified.
The possibility of a rectal mass was also included in the reason for the referral, Caldwell noted.
In late 2017, the man was scheduled for a haemorrhoidectomy after experiencing ongoing rectal bleeding and occasional spontaneous blood loss.
Again, a sigmoidoscopy was not performed at either of two consultations.
Colorectal surgeon professor Ian Bissett said it would have been standard practice in the context of the second referral.
Caldwell said while it was speculative as to whether a sigmoidoscopy might have changed Mr A's clinical management, she was concerned that there were several missed opportunities to carry out the procedure.
By May 2020, the man's symptoms included abdominal pain and diarrhoea. A medical centre doctor diagnosed irritable bowel syndrome. He later told the Health and Disability Commissioner (HDC) his differential diagnosis was coeliac disease.
The doctor considered a stool sample was not appropriate, but the expert evidence was that it should have been taken.
Caldwell acknowledged the doctor advised the man to follow up with a GP, but the doctor was limited in the further investigations that could be arranged because of the medical centre's policies at the time around blood testing, which set out they could only be requested in certain circumstances.
The man attended a second appointment at the medical centre in November 2020 because of ongoing abdominal pain and diarrhoea.
He was seen by a different doctor, who did not examine him but prescribed a short course of codeine and again advised him to enrol with a GP for a follow-up.
Caldwell accepted difficulties with following up results for patients at a medical centre facility, but it had a responsibility to instigate some tests based on the clinical picture.
Therefore the centre needed a system in place to ensure a follow-up, particularly in the context of patients with no GP, she said.
"I note that the centre has since made changes to address these issues," Caldwell said.
Health NZ Capital, Coast and Hutt Valley told the HDC that there had since been a change of practice at the centre. Doctors and nurse practitioners now had a lower threshold for starting investigations in patients with chronic symptoms, particularly those without a GP and in cases where serious pathology was considered.
The centre's blood-testing policy had also been updated.
Changes had also been made in relation to general surgery, including the establishment of a rectal bleeding clinic led by a nurse practitioner.
Caldwell noted the improvements and recommended that Health NZ provide a written apology to Mr A's family related to the care provided in 2016 and 2017.
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This story originally appeared in the
New Zealand Herald
.