The Health and Disability Commissioner today released a report finding a district health board (DHB) and a urologist in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failures in the care of a man with lower urinary tract symptoms.
The man, in his fifties, was referred to a Urology Clinic because he was experiencing pain when passing urine, difficulty with bladder control, and a frequent urge to urinate. The referral letter from the man’s GP mentioned issues including inflammation of the prostate gland, and the presence of blood and abnormal cells in the urine. The referral contained the man’s medical history, and the copies of four urine cytology reports, the results of which were all abnormal. These reports contained information regarding potential causes of the abnormal results, including possible neoplasia (cancer).
When the man first saw the urologist, highly relevant information from his referral, particularly the cytology reports, was not made available to the urologist, and the urologist did not conduct a thorough investigation of his symptoms.
Over a year after the original referral, the man’s symptoms had failed to resolve and he returned to the urologist as a private patient. The specialist clinic did not identify the man’s status accurately when he changed from a public to a private patient, and this resulted in confusion and miscommunication.
Eventually, the man’s pain worsened and he attended the public hospital’s Emergency Department. The man was left waiting in a car outside the Emergency Department in severe pain with no medical assistance.
After requesting a referral to a different urologist, the man was diagnosed with a high-grade bladder cancer and carcinoma in situ.
Former Commissioner Anthony Hill found that relevant information about the man’s condition was not available to the urologist owing to poor systems. He also found that the urologist breached the Code by failing to obtain the man’s referral letter and cytology results (at least after the first appointment), to note the absence of urine cytology results in a letter to the man’s GP, to consider and rule out alternative explanations for the man’s symptoms, and to carry out appropriate investigations.
"Overall I consider that [the man’s] treatment was poor, and caused him considerable unnecessary distress," said Mr Hill. "District health boards have a responsibility for the actions of their staff, and an organisational duty to facilitate continuity of care. This includes ensuring that appropriate resources are available, and that all staff communicate effectively. It also requires that appropriate systems are in place for ensuring that patients are triaged appropriately, necessary tests are undertaken, and patients are treated with respect, even in circumstances in which workloads are high."
Mr Hill recommended that the DHB and the urologist prepare a case study for staff training, and apologise to the man. He also recommended that the DHB conduct communication training for Urology Service staff, review aspects of the Urology Service’s referral triage system, audit the priority levels given to referrals, and develop a policy on the information that should be shared with patients about their public or private urology treatment options.
The full report for case 17HDC02166 can be found on the HDC website.