Standards breached in terminal cancer case

Dunedin Hospital. Photo: RNZ
Dunedin Hospital. Photo: RNZ
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 decision, released today, said the board 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.

SDHB stated that the possible reason he was scheduled for lower urgency was in reliance on the CT colonography (CTC) undertaken in June 2018.

SDHB said that as the June 2018 CTC did not pick up the lesion, the delay of "about 10 weeks" for the colonoscopy was "unfortunate and too long".

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,’’ it 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 decision said a timely diagnosis could be particularly important for reducing morbidity and mortality for cancer patients, and often it was 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,’’ it said.

The commissioner also noted the man told HDC 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.

‘‘I acknowledge that receiving a terminal diagnosis over the telephone is not what one would expect, but in the unique and unprecedented circumstances of the pandemic I accept SDHB’s response that there were limited options for providing this distressing but important information.’’

No breaches of the Code in relation to other aspects of the man’s care were identified.

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

As a result of the decision, Te Whatu Ora 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, to ensure that all relevant aspects of advice are covered and presented in a manner that can be readily understood by the patient, and 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.

Te Whatu Ora Southern director quality and clinical governance solutions Dr Hywel Lloyd said it accepted the HDC report and recommendations in relation to this patient’s care at Dunedin Hospital.

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

 ‘‘Any delay in health care is very concerning for any patient. We have taken significant actions to improve access to colonoscopy services for the Southern community.’’

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

‘‘The improvements are to ensure all discharge advice are 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 HDC with an update on wait times for colonoscopy service.