Warning of deadly failures at A&E

Health and Disability Commissioner Ron Paterson has been given reason for "grave concern" over the staffing of emergency rooms after a man died at home four hours after being seen by a junior doctor.

His report on the man's death highlights concern about the welfare of patients who turn up to emergency rooms at night and at weekends.

The commissioner has upheld complaints by the 59-year-old's wife and daughter.

The man was seen by a junior doctor at Dunedin Hospital and discharged, only to die later of an abdominal aortic aneurism.

In the report on the case, to be released today and obtained by the Otago Daily Times, independent adviser and emergency medicine specialist Dr Chip Jaffurs said the doctor was too busy when he was treating the patient on May 3, 2004.

Dr Jaffurs said the type of errors which led to the man's death would continue until emergency departments got more staff and resources.

The registrar was the only doctor in the emergency department after 2am.

Emergency department physicians should see one patient an hour on average, but this doctor had seen eight in the first 2 hours of his shift and saw 19 during his entire 12-hour stint.

The junior doctor was doing his best to keep a busy department moving when he misdiagnosed the patient with renal colic, Dr Jaffurs said.

"I argue that he met the standard of care delivered in most, if not all, emergency departments during night-time hours."

Registrars strove to emulate senior emergency doctors, who used judgment and experience to diagnose patients and to keep unnecessary tests and consultation to a minimum, regardless of treatment guidelines.

"This is a common system and work pattern in New Zealand emergency departments that will persist until specialist staff are plentiful enough to staff night shifts."

Mr Paterson said in his report: "If that really is the standard of most New Zealand emergency departments overnight, it is a matter of grave concern."

Although it could be challenging for hospitals to recruit enough specialists, "the bottom line is that care should not be compromised because a patient presents at an emergency department at night or the weekend". 
   
This report follows a December finding by Wellington coroner Garry Evans, who criticised Wellington Hospital over the death of Cassandra Ann Laurent.

The 19-year-old student died of pneumonia which was undiagnosed by junior doctors despite three visits to the emergency department.

The latest quarterly DHB Hospital Benchmark Information report found only four out of 20 district health boards met all three benchmarks for waiting times for the most seriously ill patients in emergency departments.

But it also found that performance standards had been maintained, despite an increase in the number of more serious cases in the past two years.

- OTAGO DAILY TIMES, STAFF REPORTER

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