An elderly man who fell and fractured his hip was forced to wait four days for surgery and died eight days later after staff failed to notify a senior medical officer of his deteriorating condition.

Health and Disability Commissioner Anthony Hill found Waikato District Health Board failed to provide adequate care to the man when he was admitted.

The 78-year-old man had lived at home with his wife and was active and mobile before the fall although he suffered from emphysema.

He was admitted to hospital after falling over and was diagnosed with a displaced left neck of femur fracture. The orthopaedic surgeon on that day decided an acute total hip join replacement was needed and anticipated he would be operated on later that morning.


However, at 6pm the surgeon finished for the day and handed over to another consultant orthopaedic surgeon.

The man was due for surgery on Saturday but at 8am the surgeon decided it was better to defer it until Monday despite the optimal time frame for such acute surgery being no more than 48 hours.

The first doctor said surgery was delayed because there were others more in need of an operation. The second surgeon said there were no dedicated orthopaedic theatres available over the weekend and that it was best to wait until a weekday when staffing levels were higher and he could be better looked after.

In the evening of his fifth day in hospital he finally had the operation.

The day after surgery the man began to deteriorate and died on his 13th day in hospital.

Hill said the hospital had a policy that a senior medical officer should be contacted if a patient deteriorated rapidly as the man did between day six and seven of his hospital admission, but that did not happen.

Hill said the case highlighted particular hospital systems issues that contributed to the provision of suboptimal care. In particular, the delay in carrying out the surgery was over double the optimal timeframe for such surgery, and then a failure to escalate appropriately to senior staff in accordance with DHB policy when the man deteriorated post operatively.

As a result, it was found that the health board failed to provide services to the man with reasonable care and skill, Hill said.


He recommended that the district health board report back to him on the effect of the key changes it had made to its services on acute orthopaedic waiting times and quality of patient care.

Those changes included dedicated orthopaedic operating theatres, an acute escalation process, orthopaedic service subspecialising, and an integrated orthogeriatric service.

Hill also recommended that the health board conduct a scheduled audit of the standard of care provided to acute patients with hip fractures, based on the Australian and New Zealand Guideline for Hip Fracture Care, and provide evidence of an up-to-date audit of staff compliance with the application of health board policy, including the recognition of the deteriorating patient and the escalation of care to senior staff.