A woman has been left with arthritis and underwent surgery multiple times because a doctor failed to order an X-ray when she first injured her thumb.
In a decision released today, Deputy Health and Disability Commissioner Vanessa Caldwell found a rural doctor in breach of the Code of Health and Disability Services Consumers' Rights for failing to provide reasonable care and skill for the patient.
The woman's experience has left her wary of people getting near the injury and she complained to the HDC about the lack of urgency she felt throughout the process.
On November 3, 2018, she presented at a rural hospital with a thumb injury sustained in a fall.
Her wound was cleaned and sutured but despite the findings of the triage nurse at the time, who noted the thumb to be "swollen" and "bent back at time of injury", no X-ray was ordered.
This, according to the HDC, was a breach of her right as a patient "to services provided with reasonable care and skill".
Two weeks after the initial treatment the woman went to another hospital where she was treated for an infection. She required surgery and developed arthritis in her thumb.
Despite differing recollections of the conversation about the injury, the initial doctor believed the injury was a laceration caused by a fall, and at the time was not aware of any issues with joint movement.
After-hours imaging services were limited at the hospital where the patient was first treated.
Caldwell noted the unavailability of X-ray services at the rural hospital, which had ED capacity of only 10 beds but said it would have been appropriate to advise the patient to seek an X-ray the following day.
"Had greater care been taken to enquire fully, and to assess and investigate Ms A's injury at its earliest presentation, her recovery may have been more favourable," Caldwell said.
The Deputy Commissioner considered that the medical officer who initially treated the woman failed to provide services with reasonable care and skill because he did not obtain an adequate history in relation to the woman's injury, and didn't arrange for an X-ray.
"I am satisfied the doctor did not enquire fully into how the woman's thumb was injured," Caldwell said.
"It was the doctor's responsibility to read the nursing triage notes and to obtain an adequate history of the fall and the mechanism of the injury."
The report extensively outlined the patient's experience through the medical system, including septic infections, and on one occasion was told the best outcome would be a partial amputation.
She was told at one point she may partially lose the thumb, and has since developed arthritis in the joint, undergoing multiple surgeries. Further treatment will be needed.
"This case highlights the importance of obtaining an adequate history from a consumer following an injury, including reading triage notes, and the importance of effective communication," Caldwell said.
It was recommended by Caldwell that the doctor provide a written apology to the woman and a meeting be facilitated to enable her to talk to the clinicians involved and discuss how the care has affected her.
Further recommendations were that the DHB use an anonymised version of the report as a case study to encourage reflection and discussion within its orthopaedic service, confirming that all senior medical officers have attended a conference on the management of minor fractures.