12 Oct 2015

Doctor failed bowel cancer victim

5:47 pm on 12 October 2015

A GP and a District Health Board (DHB) have been heavily criticised for the delay in specialist treatment for a man with rectal bleeding who died of advanced bowel cancer.

Health and Disability Commissioner Anthony Hill.

Health and Disability Commissioner Anthony Hill. Photo: Supplied

Health and Disability Commissioner Anthony Hill said the man, in his early 50s, complained to his GP in April 2012 about weight loss, bleeding and needing to use the toilet up to 40 times a day.

He was referred to gastroenterologists at the Waitemata DHB but it never received the referral and the GP failed follow up.

After a visit to a hospital emergency department, another referral was made, this time to general surgeons at the DHB over a suspected hernia. This referral resulted in a message to the man's GP saying the referral was declined for being below the DHB's access criteria for the surgery.

The GP mistakenly thought this communication concerned the referral for a specialist gastronterologist assessment. A new referral was sent in early July after a locum GP realised the error.

The DHB received this referral the next day and gave the man a P2 grading, meaning he should receive a specialist assessment within six weeks over the rectal bleeding and other problems.

However, the DHB also said the length of wait was unknown, because of waiting list pressures for colonoscopies.

Within two months and following another visit to a hospital emergency department, the man was diagnosed with bowel cancer which had spread and died in a hospice.

Mr Hill said the unnamed GP failed his patient by not classifying his initial referral as urgent, for not providing the man with a scheduled follow-up or advice about what to do if symptoms persisted, and for failing to set up an electronic reminder at his GP practice over the referral.

Mr Hill said the GP made other errors, too, including failing to advocate effectively for his patient by contacting the DHB to query its message declining an appointment for the man.

The DHB's delays in processing the GP referrals were substandard, and Mr Hill also criticised it for failing to give the man clear information about an estimnated timeframe for his specialist assessment.

Both the GP and the DHB have apologised to the man's family.

Waitemata DHB chief medical officer Dr Andrew Brant said it accepted the findings and had since switched to an electronic referral system.

"The great advantage of that is that when a general practitioner sends a referral to the hospital, the general practitioner would immediately get a response back from us so they can get an assurance we have actually received that referral."

Dr Brant said the DHB had also shortened waiting times when cancer was strongly suspected.

It also now provided clarity to patients and their GPs about the expected timeframe in which patients would be seen, as well as advice on what patients should do if their condition changed or if they had worries.