The woman returned on August 19, 2016 saying she no longer had the itch, but that she had noticed blood on the toilet paper. A perianal examination was carried out where Dr C concluded she had haemorrhoids and prescribed suppositories.
But three months later the woman attended an appointment with a different doctor, Dr D, at the same medical centre saying she had been experiencing intermittent bleeding from her rectum. She declined a rectal examination.
In February 2017, she had another appointment with Dr C where she told him she was still bleeding from her rectum and her bowel habits had changed. The clinical notes showed she was still having "trouble with haemorrhoids, blood most times, goes up to 3 x a day".
Dr C said he didn't carry out an internal examination because he believed she had haemorrhoids and it would not change the treatment plan. He ordered a blood test which showed her liver function was abnormal prompting him to refer her to the hospital.
However, in his findings Health and Disability Commissioner Anthony Hill found Dr C's failure to perform an internal examination in February was a breach of the code and did not provide services with reasonable care and skill.
An internal examination would have revealed a rectal tumour and increased the urgency and priority of the woman being seen by the hospital, the report found. The woman was finally seen in April 2017 where she was diagnosed with rectal cancer.
The woman has since died and the commissioner recommended Dr C write an apology to her daughter.
Dr C has also included bowel cancer as part of his practice development plan with the Royal New Zealand College of General Practitioners.
The medical centre was not found to have breached the code.
