Northland DHB apologises for treatment of urology patient who developed cancer

NDHB has apologised for the care it provided to a urology patient who was first treated at Whangārei Hospital before he was transferred to private practice where it was later discovered he had cancer.

Health officials have apologised to a Northland man who later developed cancer for the care provided by Northland District Health Board's urology outpatient services.

The Health and Disability Commission (HDC) yesterday released a report into the care provided by NDHB's urology outpatient services to a man who was then in his 50s when he first presented to Whangārei Hospital on February 11, 2016.

The man was experiencing pain when passing urine, and difficulty with bladder control, with a frequent urge to urinate and often needing to urinate several times throughout the night.

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.

The man was later diagnosed with a high-grade bladder cancer and carcinoma in situ.
The HDC report concerned the care provided by NDHB's urology outpatient services and said this case highlights the importance of having robust processes for sharing patient information, so that appropriate treatment can be provided.

It found that the unnamed urologist breached the Health and Disability Code by failing to obtain the man's referral letter and cytology results (at least after his first appointment), note the absence of urine cytology results in a letter to the man's GP, consider and rule out alternative explanations for the man's symptoms, and carry out appropriate investigations.

The commissioner found that highly relevant information about the man's condition was not available to the urologist, owing to poor systems. As well, the specialist clinic did not identify the man's status accurately when he changed from a public to a private patient, which led to confusion and miscommunication.

HDC recommended that NDHB and the urologist apologise to the man and prepare a case study for the purpose of staff training, and that NDHB 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.

NDHB Chief Medical Officer Dr Michael Roberts said the DHB profoundly regrets the harm caused to this patient from not having robust processes for sharing patient information which resulted in a delay to his treatment.

''We sincerely offer our apology to the man and his whānau for not conducting a thorough investigation of his symptoms that caused him considerable unnecessary distress,'' Dr Roberts said.

''To safeguard that this doesn't happen again NDHB have improved our processes to ensure all patient notes and results are available to the clinicians caring for the patient.

''The case study for staff training has been prepared, and new processes have been implemented in the emergency department to ensure patients outside the department (in a private car) can receive pain relief promptly. The remaining actions are under way and will be completed in a timely manner.''

For the full decision go to: https://www.hdc.org.nz/media/5590/17hdc02166.pdf