A locum ophthalmologist was not in breach of the Code of Rights for referring a patient for a semi-urgent MRI that didn't happen because of Christmas. Photo / 123RF
A locum ophthalmologist was not in breach of the Code of Rights for referring a patient for a semi-urgent MRI that didn't happen because of Christmas. Photo / 123RF
A man in his 50s went blind in his right eye after he was referred for a semi-urgent MRI scan that didn't happen because it was Christmas.
The Health and Disability Commissioner has found Southern District Health Board in breach of the man's rights to services of an appropriate standard, under the Code of Patient Rights.
However, the locum ophthalmologist who referred the man for the semi-urgent scan only received an adverse comment from Health and Disability Commissioner Anthony Hill, in a decision released this week.
The patient told the HDC he and his partner did not blame the eye doctor but felt the DHB "severely let down" both him and the locum.
"My vision loss has changed my life and I feel aggrieved and disappointed about what has occurred," the man said. "I am now permanently blind in my right eye."
The man, known as Mr A, was referred to the Ophthalmology Outpatient Department for a specialist opinion.
On December 18, Mr A underwent a visual field test and three days later the results showed a blind spot. The man's referral was marked urgent.
On Christmas Eve, Mr A was reviewed by a locum ophthalmologist, Dr B, who found the man could see only hand movements in the right eye, had reduced colour vision, and had total loss of the right visual field.
Dr B told HDC he believed the right eye problem was a chronic one and was sufficiently serious to merit a semi-urgent MRI, which he expected to be performed prior to a follow-up clinic two weeks later.
Mr A told HDC that he was assured that he would receive an MRI "inside two weeks".
But what Dr B did not know was that over the Christmas holidays MRI availability was limited to on-call only until December 28, urgent referrals only after that to New Years Eve, with radiology closed from January 1 to 10, 2016.
Southern DHB had communicated this to its staff but because Dr B was a locum, he did not receive the information and told the HDC if he had known, he would have offered the patient the opportunity to go private.
Mr A told HDC that he would have paid for a private scan but never received this option.
He said between December 24 and January 12, his GP contacted the first hospital numerous times on his behalf to obtain an appointment date for an MRI but did not receive an adequate response.
On January 12, Mr A went back to the emergency department where a nurse noted redness and swelling around his right eye and that his vision had been poor for the last five weeks.
On January 18 the man's GP referred him to the ED, now with a loss of vision in his left eye.
"... Mr A stated that he had blurred vision and was concerned, 'as this is how [his right] eye started'."
Health and Disability Commissioner Anthony Hill was critical of Southern District Health Board for its poor communication over available services. Photo / Supplied
On January 19, an MRI was attempted at a second hospital but was unsuccessful. An urgent request was instead made for a CT scan.
The next day a CT scan showed a small 9mm lesion at the right orbital apex, but the cause of the lesion could not be defined.
On the same day another hospital doctor wrote to a second DHB requesting an urgent MRI, asking for it to be done before the weekend.
On January 22, three-and-a-half weeks after the semi-urgent MRI was requested, one was done.
The MRI confirmed a small lesion at the right orbital apex but excluded damage around that area.
Because of the delay in receiving an MRI, Mr A did not receive the two-week follow-up review after his consultation with Dr B on December 24.
On January 24, Mr A was discharged from the second hospital without a diagnosis.
Subsequently, a diagnosis of presumed sarcoid inflammatory ocular disease was made.
The Clinical Director of Ophthalmology at the time said Mr A was seen by Dr B within an appropriate time frame and he considered Dr B's referral for blood tests and a semi-urgent MRI on Christmas Even was appropriate.
The HDC's expert, ophthalmologist Professor Charles McGhee, said he would have expected Mr A to receive an urgent MRI scan within a few days, "and certainly not delayed until late January".
He advised the delay represented a "major" departure from accepted standards and the HDC agreed.
"I am critical of Southern DHB's poor communication and guidance to Dr B about the availability of MRIs during the Christmas and New Year period.
"Southern DHB's failure to ensure that all relevant staff were provided with such information meant that Mr A experienced an unacceptable delay in obtaining imaging — the next diagnostic step in his care.
"Further, had Dr B been informed of this key information, he may have taken further steps to ensure that Mr A received timely imaging and follow-up assessment."
Southern DHB apologised for any of its actions that may have contributed to the effect of vision loss on Mr A.
Since the events Southern DHB had made changes to its service included making improvements to induction of locum and new staff, such as ensuring radiology waiting times and processes were highlighted.
