Hospital sends woman home with broken back

Julia Zuccani. Photo / Herald on Sunday

A woman discharged from North Shore Hospital discovered nine days later that she had a broken back.

Julia Zuccani, 59, was taken by ambulance to North Shore Hospital's emergency department after falling in her Birkenhead home at 4am on January 10. She was discharged two hours later with painkillers and was told to see her doctor if problems persisted.

No X-rays were taken and her discharge sheet states: "nil concerning feature for fracture/disk injury".

Nine days later, she had X-rays done through her family doctor that showed she had a compression fracture in her spine.

The hospital has since completed an investigation into the case and said the emergency department doctor who treated Zuccani followed the correct procedure.

North Shore Hospital emergency department clinical director Bhavani Peddinti said similar cases happened regularly but it did not affect patients due to the type of injury.

"At the time clinically it was deemed that an X-ray wasn't warranted, which happens to us all the time. It's not unusual." He said even if it was diagnosed at the time, the outcome would be no different.

"Even if the fracture had been picked up, we would have still discharged her. It is a stable injury."

If the doctor had chosen not to X-ray after finding a lump or swelling or other symptoms, Peddinti said he would be worried but there were no signs of serious injury.

The alternative would be to X-ray every back that came through the hospital - an expensive procedure, which would increase the risk of cancer.

"If communities are upset about the erection of cellphone towers and transmitters because of the risk of tumours, they should be aware of the high risks of having radiation [from X-rays]."

Figures released by the Ministry of Health last November show just 61 per cent of patients going through emergency departments in the Waitemata District Health Board area were out within six hours - the lowest rate in the country.

A Health and Disability Commissioner inquiry last year found North Shore Hospital had failed in its care of five elderly patients in 2007. Three of them were found to be treated in a "disrespectful and undignified manner" in the emergency care clinic.

Peddinti said staff shortages and overcrowding were not an issue at the time Zuccani came to hospital.

Zuccani said staff were friendly but she felt they were trying to rush her through.

"I was in agony and kept vomiting from the pain killers. They left me for ages but I didn't like having to keep ringing the bell.

"The doctor pressed spots on my back and said nothing was broken and sent me home."

She spent several days in pain at her home, and was unable to sit down. She went to her family doctor who ordered the X-rays.

In a letter to the Herald on Sunday, the emergency department doctor's lawyer said the doctor had done everything right and had not been negligent.

There were no clinical signs of a compression fracture, said the lawyer.

Greg Finch an orthopaedic spine surgeon based in Greenlane, Auckland, said ideally every spinal injury would be diagnosed immediately but that was not always possible.

He said he had dealt with several more serious cases of mis-diagnoses in the last few weeks.

"However, I hope it is not happening as often as Bhavani suggests."

Cameron Green, a specialist back physiotherapist from Spinal Care Clinic in Auckland, said a lower compression fraction could be easily missed as other sore back complaints can have the same signs.

"The fact they missed it on day one won't have made a difference in her long-term recovery."

He sympathised with the staff and said emergency departments were typically underfunded, understaffed and regularly hammered with serious trauma cases.