DHB breached patient's rights

A 59-year-old woman whose surgery for acute appendicitis was delayed for two days had to wait too long and was kept inadequately informed, the Health and Disability Commissioner has found.

The woman was admitted to Whangarei Hospital on the morning of March 30, 2008, and was quickly diagnosed with acute appendicitis and booked in for surgery that day.

She was told the surgery would take place at 3pm, but was informed at 8pm the operation would be delayed until the next day "as a consequence of other emergencies".

The next day the surgery was repeatedly deferred until it was again postponed until the following day. She was not informed of the reason for the delays.

When the operation went ahead on the morning of April 1, the planned keyhole surgery was scrapped in favour of open surgery after doctors discovered a perforated appendix and peritonitis, an inflammation of the membrane of the abdominal cavity.

The woman was told the surgery had been considerably more difficult than anticipated, but was not informed she had also been treated for peritonitis. She required an antibiotic drip and was not discharged from hospital for another six days.

The woman laid a complaint in February last year, after which she received an apology from the Northland District Health Board (DHB).

The letter emphasised the high caseload of acute patients, and noted that other patients also had their surgery postponed.

The DHB met to discuss the complaint, and acknowledged the woman had waited too long for surgery.

In a report issued today, Health and Disability Commissioner Ron Paterson found the DHB had not adhered to its own guidelines and had breached the patients' code of rights.

The woman had been given the wrong priority according to the DHB's own guidelines for acute surgery. Furthermore, lower priority patients were treated before she received surgery.

The 48 hour delay was inappropriate, and the DHB erred by failing to give the woman antibiotics while she awaited the procedure.

It also failed to prioritise its resources optimally, and had not successfully managed the competing demands on the one full-time acute theatre, Mr Paterson said.

The DHB did not adequately explain why the surgery had been delayed, nor did it give her an adequate explanation of the surgical findings or the reasons for her extended stay in hospital.

"Delay in itself is bad enough, but it is unacceptable for a patient to face delay without sufficient information and appropriate care in the meantime," Mr Paterson said.

"Poor communication would only have increased her anxiety in an already uncertain and stressful situation."

Mr Paterson recommended the DHB review the management of acute surgery and the availability of surgical theatres at Whangarei Hospital. It should also review its processes for determining clinical priorities when there are competing demands for acute surgery.

Staff should also be reminded of their obligation to keep patients informed.

The DHB is expected to report back to the commissioner by March 31.

- NZPA