20 May 2024

Woman's cancer diagnosis delayed after Waikato Hospital failed to follow up on X-ray

3:54 pm on 20 May 2024
Chest, X-ray. (Photo by NICK VEASEY/SCIENCE PHOTO LIBRAR / NVY / Science Photo Library via AFP)

The patient was told she would need another lung x-ray but this was never followed up. (File photo) Photo: NICK VEASEY/SCIENCE PHOTO LIBRARY

A woman in her 60s died of cancer after doctors at a Waikato hospital emergency department failed to tell her and her medical centre about a worrying chest X-ray that showed nodules on both lungs.

Deputy Health and Disability Commissioner Vanessa Caldwell found Te Whatu Ora Waikato breached the woman's right to information about her condition and as a result her diagnosis of metastasised lung cancer was delayed.

Although Caldwell said an earlier diagnosis may not have changed the trajectory of the disease, the patient would have been able to manage her condition and treatment.

The woman, identified as Ms A in a report by Caldwell released today, first went to her medical centre on 7 February 2020 with a lump on her neck and a cough.

She saw a locum GP who was not her regular doctor, who suspected breast cancer and conducted an exam and took bloods, which were found to be normal.

The doctor recommended a mammogram but the woman refused and the GP, Dr C, did not record this.

She also did not document other checks on Ms A including her blood pressure and temperature.

Instead Dr C, who was concerned the enlarged lymph node in the neck indicated cancer, made an ultrasound referral.

That report three days later identified a cluster of abnormal lymph nodes and a chest X-ray that same day noted density.

Dr C discussed the X-ray results with Ms A on 14 February and advised her she would need a follow-up X-ray in six weeks.

She made a reminder to herself but never followed up with Ms A when the six weeks was up.

Ms B, a friend of Ms A's, told the Health and Disability Commissioner doctors at the medical centre repeatedly diagnosed Ms A with bronchitis and gave her antibiotics with little effect.

On 17 February Ms A complained to Dr C of upper back pain and further blood tests were ordered.

Dr C told the HDC she was concerned Ms A had cancer that had spread to her bones and Ms A was advised to return once she had completed the course of antibiotics.

By 21 February the lump had gone and cough cleared up and Ms A reported feeling better with no fever, night sweats or weight loss, however, the back pain persisted.

Five days later, Ms A was admitted to a public hospital emergency department with back, lower chest and abdominal pain, reduced appetite, nausea and passing smaller amounts of urine.

A chest X-ray was interpreted as showing a right lung nodule with no acute changes and Ms A was discharged with pain relief and anti-nausea medication.

However, a radiologist reviewed the X-ray on 5 March and reported there were "some nodules on both lungs, larger on the right, which [were] concerning" and that cross-sectional imaging should be considered.

That report was acknowledged by an ED doctor 12 March and although the discharge summary from 26 February was sent to the medical centre, the radiologist's findings and recommendation was not sent to either the medical centre or Ms A.

In May 2020, following a further admission to hospital, Ms A was diagnosed with metastatic cancer of her lungs, lymph nodes, liver, and bones (spine and pelvis), and died a few weeks later.

Deputy Health and Disability Commissioner Dr Vanessa Caldwell.

Photo: James Gilberd Photography Ltd

Caldwell found the delay in the chest X-ray result being reported by radiology to the ED on 5 March, in addition to the report only being acknowledged by the ED a week later on 12 March, was "less than ideal".

She agreed with her expert the lack of follow-up from Te Whatu Ora after receiving the report was a serious departure from the accepted standard of care, and found Te Whatu Ora Waikato failed to inform the medical centre and Ms A of the chest X-ray result that recommended further cross-sectional imaging.

She was also critical that Ms A was not reviewed adequately by a senior doctor during the 26 February admission, given her condition and earlier unclear diagnosis.

Te Whatu Ora said it was short-staffed due to sickness and unplanned leave but Caldwell said a senior doctor's input might have led to an earlier diagnosis.

She was also critical of Dr C for not ensuring Ms A underwent a repeat chest X-ray after six weeks, which she said was a significant contributor to the delayed diagnosis.

Dr C said at that point New Zealand was in the middle of its first Covid-19 lockdown and her working hours had reduced, but Caldwell said despite this she was concerned Dr C did not follow up on her own task reminder.

However, she did not find the doctor in breach of the Code of Health and Disability Services Consumers' Rights.

She recommended Dr C and Te Whatu Ora Waikato send written apologies to Ms B.

Te Whatu Ora Waikato should also review its electronic results policy and provide training to ED staff on it.

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