Death sparks review of junior doctors

Wellington Hospital is being urged to review its procedures after a 19-year-old student died of pneumonia which was undiagnosed by junior doctors despite three visits to its emergency department.

Wellington coroner Garry Evans has released his findings into the death of Cassandra Ann Laurent, who was found dead in her bed by a flatmate on the evening of July 25, 2003. Her boyfriend had found her snoring that morning but decided not to wake her.

Mr Evans said he was disappointed to be conducting the inquest after a 2001 inquiry into the case of Te Arri Bland, who died of an aneurysm after being examined by a junior doctor who was working unsupervised.

Ms Laurent had suffered from flu-like symptoms and stiffness in her limbs and neck in the weeks before she died.

She went to the emergency department at Wellington Hospital six days before her death, where a senior doctor ruled out meningitis but suspected pneumonia and ordered a chest x-ray.

With no radiographer on duty, the doctor examined the x-ray, which he determined to be normal, and told Ms Laurent it was likely she had a viral infection.

The chest x-ray was read by a radiologist four days later but a report was not available to emergency department staff until the day Ms Laurent died.

She returned to the hospital twice with worsening symptoms and was examined separately by three junior doctors.

She was kept overnight on July 23 before deciding she was feeling better and being discharged the following morning.

She died the next day.

The last junior doctor to see her told the inquest she understood junior medical staff were not meant to discharge patients without speaking to a senior doctor but that did not happen in practice. It was not unusual for a radiology report to take four or five days.

Experts who gave evidence at the inquest raised concerns that despite Ms Laurent's deteriorating condition a repeat chest x-ray was not considered by the junior doctors. They also found Ms Laurent's pneumonia was likely to have been picked up by more experienced doctors.

The district health board's acting CEO, Martin Hefford, said the changes identified by the coroner had already been in place for some time. Other improvements had been implemented, including boosting the number of senior medical officers in the emergency department from three to eight.

There were also now more experienced junior doctors among the staff, and training for them had been improved, he said.

He extended the health board's sympathy to Ms Laurent's family over their loss.

The family declined to comment.

Recommendations

The coroner made the following recommendations to the Capital and Coast District Health Board:

* Junior emergency department doctors be supervised and supported by senior doctors who provide clinical oversight of their work
* Clear clinical management protocols and guidelines for when junior staff should refer patients or seek guidance from their seniors be established
* An urgent review of protocols and guidelines be carried out to ensure all patients returning to the emergency department are seen by a senior doctor
* All x-ray results be reviewed by a senior medical officer
* All emergency department x-rays be read within one working day, and
* A radiology alert system be established.