Doctor breached suspected bowel cancer patient's rights by failing to order tests

By Martin Johnston

The Health and Disability Commissioner says the doctor should have ordered tests to rule out his suspicions of bowel cancer. Photo / iStock
The Health and Disability Commissioner says the doctor should have ordered tests to rule out his suspicions of bowel cancer. Photo / iStock

A doctor who suspected an elderly woman with tummy pain might have have bowel cancer prescribed a laxative but did not order lab tests.

She did, in fact, have cancer. Despite treatment, however, the disease progressed and the woman died around 18 months later.

In a decision made public today, the unnamed GP has been found by Health and Disability Commissioner Anthony Hill to have breached the code of patients' rights.

This is because he did not act with reasonable care and skill in his management of the woman's case. The failure to order tests fell short of accepted standards.

"Ms A" was 74 when she saw "Dr B" on May 19, 2014 for abdominal pain. The GP said bowel cancer may be the cause.

"He told Ms A that a colonoscopy would help to confirm his clinical suspicion but, given the lack of other contributing symptoms, Ms A would not meet the criteria for a public [hospital] referral. Dr B suggested a private referral for a colonoscopy, which Ms A declined," Mr Hill said.

"Dr B did not conduct any laboratory investigations regarding the cause of Ms A's pain, and instead prescribed medication in case her symptoms were caused by constipation."

On June 13, 2014, the woman went through a very similar consultation with the GP, with the addition that he asked her to report any rectal bleeding.

In severe pain on July 9, 2014, she tried -- unsuccessfully -- to get a same-day appointment at an accident and medical centre as she did not want to see Dr B again.

Two days later, now in extreme pain, she called Dr B's practice but he was away and she saw Dr C, who ordered lab tests. Upon learning of the results, Dr C phoned Ms A, who was vomiting and feeling cold and shaky. Dr C told her to go to a hospital emergency department.

The following day, the woman had surgery to remove her appendix. During surgery a tumour, suspected to have originated from the appendix, was found growing outside of the bowel wall. It was confirmed as colon cancer and was surgically removed. Ms A was referred to the oncology department, where it was recommended she start chemotherapy.

"Sadly, despite treatment, Ms A's cancer progressed and she died in early 2016."

The commissioner said Dr B should have ordered lab tests at the consultations on May 19 and June 13, 2014 to rule out his clinical suspicion of bowel cancer. The results could have provided evidence whether or not the patient needed to be referred for a colonoscopy and/or to a specialist.

Dr B told the commissioner's investigation he had discussed the case with colleagues and, if faced with a similar scenario, in which he had a clinical suspicion but an absence of grounds for a referral to be accepted, he would now do a rectal examination, order blood tests, phone a specialist for advice, and invite the patient back for review.


Bowel cancer symptoms

See a GP if concerned about any of these:

• Bleeding from the bottom without any obvious reason

• A persistent change in bowel habit

• Abdominal pain especially if severe

• Any lumps or mass in your tummy

• Weight loss and tiredness

- NZ Herald

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