Doctor in short-staffed Hastings radiology department missed lesion on woman's lung

A radiologist under "tremendous pressure" in a short-staffed department at Hawke's Bay Hospital missed a lesion on a woman's lung in a CT scan. Photo NZME

A radiologist under "tremendous pressure" in a short-staffed department at Hawke's Bay Hospital missed a lesion on a woman's lung in a CT scan, which was later diagnosed as cancer.

The doctor says he was "heartbroken" to have been informed of two missed opportunities to spot the lesion on the woman's lung – from the CT scan in 2016 and an X-ray in 2018.

The woman was diagnosed with lung cancer in February 2020.

Deputy Health and Disability Commissioner Vanessa Caldwell, in an inquiry report released on Monday, found the radiologist and the Hawke's Bay District Health Board (HBDHB) had breached patient rights.

The radiologist breached the Code of Health and Disability Services Consumers' Rights because he failed to report the lesion in 2016.

The health board breached the code because it failed to maintain standards while increasing demands were made on its services.

The doctor's standard of care when he failed to spot the lesion on the 2018 X-ray, when it was not clearly identifiable, was deemed "reasonable in the circumstances".

Caldwell said the radiologist's 2016 error indicated broader "systems and organisational issues" at the health board, which has since become part of the national Te Whatu Ora health agency.

"HBDHB has an obligation to provide services to consumers with reasonable care and skill, and ensure employees have the conditions necessary to perform their work to an appropriate standard," she said.

"I consider the HBDHB's response to increasing radiology workloads was insufficient to support the team to maintain standards in the face of increasing demands on the service," she said.

The patient, Mrs A, and the radiologist, Dr B, were not identified in Caldwell's report.

It said Dr B is no longer practising in New Zealand and is in private practice overseas, where he can "demand the ability to work at a slower more reasonable pace without undue pressure".

He told the inquiry that he was upset and "personally heartbroken" to be told he had twice missed opportunities to spot Mrs A's irregularities on test results. He asked for an apology to be conveyed to her.

"My role as a doctor is always to protect my patients and help them in any way possible and I regret that I missed opportunities to do so in this case," he said.

The inquiry noted that the CT scan in 2016 had been to screen for bowel cancer, but it included the bases of the woman's lungs.

The HBDHB acknowledged that its Radiology Department was under-resourced in 2016.

The report said the HBDHB response to increasing radiology workload was "insufficient to support the team to maintain standards in the face of increasing demands on the service".

The report recommended that Te Whatu Ora and the radiologist provide written apologies to the woman and her family.

The inquiry was told that the hospital is now fully staffed with radiologists.