Doctor failed patient with spinal infection

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A health board and one of its emergency doctors breached the code of patients' rights in their care of a woman with a spinal infection who went on to suffer paraplegia.

Health and Disability Commissioner Anthony Hill, in a report made public today, says the doctor, whom he does not name but is a locum specialist in the Palmerston North Hospital emergency department, is no longer practising medicine in New Zealand.

He recommended that if the doctor applies for an annual practising certificate, the Medical Council conduct a review of his competence.

In mid-2011, the woman, then aged 59 years, who was physically active, had osteoarthritis of the spine, high blood pressure and was obese, experienced back pain for several days after lifting a heavy weight, leading to a series of visits to her family doctor's clinic, a physiotherapist, a sports physician and the public hospital ED.

Six days after a bone scan ordered by the sports physician, she went to the hospital ED. An x-ray suggested a compression fracture had occurred in her spine. She was observed overnight and in the morning was assessed by the locum specialist who assumed her blood-test abnormalities were due to the fracture.

He did not request a review by the hospital's orthopaedic doctors, nor discuss her case with them, despite a draft policy which indicated that a referral was warranted.

The woman was discharged but returned to the ED a fortnight later. An MRI scan indicated fractures on two vertebrae and infection. The scan doctor phoned the ED specialist to discuss the results, the commissioner's office said.

"The ED consultant did not make notes of his conversation with the radiologist, did not relay all of the MRI findings to the orthopaedic team, and did not make notes of his conversation with the orthopaedic registrar."

The woman developed "profound paraplegia", which the commissioner's orthopaedics adviser said was probably caused by a "vascular event". She was transferred to another hospital where she was found to have suffered the collapse of two vertebrae and the compromise of her spinal cord. She had several rounds of major surgery on her spine her and chest, where the infection had spread to. She was later transferred to a spinal unit.

Mr Hill said the woman's care was characterised by missed opportunities for her vertebral infection to have been considered, and an early referral for specialist orthopaedic review to have been initiated.

The failures in the woman's care resulted mainly from deficiencies on the part of some individual clinicians, coupled with an organisational deficiencies at the Mid-Central District Health Board that did not facilitate continuity of care between the hospital's emergency department and orthopaedic teams, Mr Hill said.

The case had led to the DHB implementing a number of system and policy changes.

The DHB said it had apologised to the woman for the inadequacies in its systems and processes that contributed to the shortcomings in care that was provided.

Chief medical officer Dr Kenneth Clark and chief executive Kathryn Cook said in a written statement: "We accept that this is a significant shortcoming against both the expected standards of care and this patient's expectations.

"We have confirmed to the commissioner the steps we have taken to ensure that the systems and processes at MDHB are improved both now and into the future as a result of this patient's experience.

"We have unreservedly apologised to the patient and her family for the impact of our care for her health and wellbeing both now and into the future."