KEY POINTS:
A registrar needs to apologise to a United States tourist after twice misdiagnosing her acute appendicitis as a stomach bug, a report by the Health and Disability Commissioner says.
Commissioner Ron Paterson said the 27-year-old woman (Ms A), who was in New Zealand on a two year working visa, was taken to the emergency department of an unnamed district health board (DHB) hospital with severe stomach pains on May 14 last year.
Because she had no travel insurance she was referred to a medical centre, where the doctor diagnosed her with acute appendicitis and sent her back to the emergency department.
The commissioner's report said Ms A was given morphine while waiting for the duty registrar, which considerably lessened her pain.
The registrar was not told Ms A had been given the morphine and, as her pain had decreased, diagnosed her as suffering gastroenteritis and discharged her.
After Ms A returned home that evening, she collapsed and was rushed back to the hospital by an ambulance. She was again given morphine and assessed by the same registrar who had seen her earlier that day.
The registrar again failed to realise Ms A had been given morphine and diagnosed her with gastoenteritis or atypical appendicitis.
Ms A was eventually operated on the following afternoon, after her appendix had ruptured, which resulted in a "stormy recovery", Mr Paterson said.
The registrar, Dr B, said it was unfortunate Ms A had a prolonged and complicated illness.
"I am very sorry this happened and regret that we were not able to make the diagnosis of appendicitis earlier."
But he was concerned at the retrospective analysis, which found someone at fault rather than "accepting that humans are not cars and do not present with a flat battery or a punctured tyre but rather a complex series of symptoms that is often compatible with a variety of different illnesses".
Mr Paterson said while Dr B said he had not been informed by either Ms A or other staff she had been given morphine for her pain, the doses had been clearly documented in her medical records and it was Dr B's responsibility to read them.
He also criticised Dr B's failure to appreciate that Ms A's pain, which had recurred over a period of time, was failing to ease.
"This should have prompted him to reconsider his diagnosis of gastroenteritis."
He said Dr B did not meet the standard of reasonable care and skill expected of a surgical registrar and was hasty in discharging Ms A.
"Dr B made an innocent mistake, at a time when he was tired, but as a professional he should be willing to accept responsibility for a deficiency in his care on this single occasion."
Mr Paterson recommended Dr B apologise to Ms A in writing and review his practice in light of the report.
- NZPA
