Whanganui man loses lower leg after inadequate treatment of ingrown toenail

Mr A went to Whanganui Hospital eight times between June and August 2018. Photo / Google maps

A chronically ill man who visited the emergency department six times with a sore toe ended up having his lower leg amputated after his ingrown nail turned gangrenous.

The man, referred to as 'Mr A' in a Health and Disability Commission decision released today, went to Whanganui Hospital eight times between June and August in 2018, six of which were to the Emergency Department.

His care over those three months has now been criticised by Deputy Health and Disability Commissioner Dr Vanessa Caldwell, who found the WDHB to be in breach of the Code of Health and Disability Services Consumers' Rights regarding the man's care, as every patient is entitled to quality and continuity of services.

Mr A, who was in his sixties, had a complex medical history, including type 2 diabetes, heart attacks, stroke, peripheral neuropathy, vascular disease and iliac bypass.

Diabetes can cause a decrease in blood flow to the feet, making it more difficult for wounds or infections, like that in Mr A's toenail, to heal. Mr A's illness contributed to the reoccurring nature of his infection, including a heightened risk of gangrene with the potential for the infection to spread to the bone.

After multiple trips to the hospital, Mr A was diagnosed on August 9 with a severe blockage in his arteries, restricting blood flow. The tissue on his toe was dying and he was officially diagnosed with gangrene, leading to the amputation of his toe.

Six days later the infection continued to progress and he went to a different hospital where his right leg was amputated below the knee.

The commissioner said in today's decision that a care plan was never established and lack of communication between doctors meant the infection was always treated in isolation, recurring to the point of amputation.

Caldwell said she was concerned that despite multiple presentations to the hospital the man, who has a complex medical history with chronic Illness, did not have a co-ordinated care plan put in place by senior staff. "A hospital system would be expected to operate in such a way that a patient who has attended numerous times with the same issue would be afforded continuity of services, for example by having a dedicated team assigned to oversee, monitor and plan the patient's care," Caldwell said.

She said she would expect the WDHB's system to operate in this way, and that should have been the case with Mr A.

Caldwell criticised three doctors who were in charge of Mr A's care, and praised the actions of two others.

The Whanganui DHB has since set up a "high-risk foot clinic" which focuses on care, including education and awareness, assessment, diagnosis and care plan development, initiation of treatment, follow-up, and onward referral.