Hutt Valley DHB has been forced to apologise to a teenage girl after failing to diagnose a rare condition.
The Health and Disability Commissioner acknowledged that the illness -septic arthritis - the girl had developed was rare, and accepted that the signs and symptoms of the diagnosis may have been subtle.
However, the commissioner considered that there were a number of shortcomings in the care the girl received across her three emergency department presentations.
The teen was taken to a hospital within Hutt Valley DHB's catchment several times from September 17, 2019.
The girl had participated in sport and when she turned up to ED, she was unable to bear any weight on her knee, had trouble sleeping, was experiencing chills and vomiting. She was diagnosed with a knee strain/sprain.
The second time - when her pain had increased - she was given morphine and diagnosed with a knee injury.
She returned again - having been seen by two GPs in the interim - at which stage the pain had spread to her left knee.
An X-ray was performed and she was diagnosed with Osgood-Schlatter disease which is an overuse injury that often occurs in growing children and adolescents.
On 23 September 2019, the girl again returned to ED "significantly unwell" and was diagnosed with a bacterial joint infection - septic arthritis - in both knees.
The Commissioner commented on the need for ED staff to think critically, having regard to
the wider clinical picture, and to consider alternative explanations when someone presents
to ED multiple times with increasing pain.
The Commissioner considered that there were a number of shortcomings in the care the girl received across her ED presentations.
Firstly, her key symptoms were not documented at triage; at the second presentation, the possibility of more serious pathology was not recognised; and at the third presentation, more critical thinking was needed, having regard to the wider clinical picture.
The Commissioner found that, ultimately, HVDHB was responsible for the inadequacies
in the services provided and, accordingly, breached Right 4(1) of the Code.
The girl's aunty told HDC that the impact of Miss A's illness on the family had been "catastrophic".
She said that the girl's parents were unable to work for a period of time, and that her mother continued to care for her full time during her rehabilitation.
The aunt also said the girl's sporting future was "unclear" due to the damage already sustained.
"It is difficult to predict how much function she will get back to both her lungs and legs."
The DHB apologised to the girl and her family "for the immense pain, stress, and uncertainty that they had to endure", and acknowledged "the magnitude of the impact this illness has had".
"In retrospect, the significance of the severity of [girl's] pain was under appreciated.
"[Patient] did not show the usual signs of an infection and other information in her history
and physical examinations did not appear to suggest how ill [patient] was."
Staffing figures provided to the HDC showed the ED was busy and "staff resources were relatively stretched" on the days that she was there.