Health board breached standards

Hywel Lloyd. Photo: ODT files
Hywel Lloyd. Photo: ODT files
The former Southern District Health Board has been found to have breached standards after a man with terminal colon cancer had to wait 12 weeks for a colonoscopy.

The health and disability commissioner’s decision, released yesterday, said the SDHB (now Te Whatu Ora Health New Zealand Southern) would have to write an apology to the man and his family and reform their checklist procedures after they breached the code of health and disability services consumers’ rights.

The decision said 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.

"SDHB accepted that in relation to the guidelines in operation at the time, the colonoscopy should have been completed within two weeks, as the man fulfilled the criteria for an urgent colonoscopy," the decision said.

The commissioner’s decision said the man’s colonoscopy wait time exceeded SDHB’s own recommended timeframe and the Ministry of Health’s guidelines by at least six weeks.

"I am, of course, aware of the pressure faced by colonoscopy services at a national level due to an increase in demand paired with workforce shortages and recruitment challenges," the decision said.

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

The commissioner also noted the man told the commission that in May 2020 he received a telephone call from a nurse informing him that his cancer was terminal and that he had between six to 12 months to live.

"SDHB said that normally, this sort of information is delivered in person, but it occurred in this way to reduce the number of patients attending hospital because of the risk of Covid-19.

"In the unique and unprecedented circumstances of the pandemic, I accept SDHB’s response."

The commissioner also criticised the concurrent use of anticoagulant medication and the lack of clarity in the discharge advice about anticoagulants.

HNZ Southern must provide a written apology for the deficiency in the care provided.

They must also consider a standardised checklist and format for the provision of anticoagulants advice on discharge, and provide the commission with an update on wait times for colonoscopy services, including any actions being taken to address delays.

HNZ Southern quality and clinical governance solutions director Dr Hywel Lloyd said it accepted the report and recommendations.

"We sincerely apologise to the patient and their whānau for the distress caused during this time," Dr Lloyd said.

"Any delay in healthcare is very concerning for any patient."

Dr Lloyd said it was implementing a standardised checklist and format for the provision of anticoagulant advice on discharge.

"The improvements are to ensure all discharge advice [is] presented in a manner that can be readily understood by the patient and their whānau," he said.

Dr Lloyd said it had also provided the commission with an update on waiting times for colonoscopy service.