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Care of rural hospital patient granted home leave with compromised lung function (07HDC11548)
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(07HDC11548, 24 April 2009)
Rural hospital ~ Health service company ~ Public hospital ~
District health board ~ Medical officer ~ Physician ~ Respiratory
failure ~ Informed consent to biopsy ~ Weekend leave ~ After-hours
specialist consultation ~ Responsibility of district health board
to monitor delivery of funded services ~ Rights 4(1), 4(5)
The wife of a 66-year-old man complained about the care he
received at a rural hospital run by a health service company
contracted by the DHB to provide secondary health services in the
The man suffered worsening shortness of breath, thought to be
caused by fibrosing alveolitis or pulmonary fibrosis. The man's
condition deteriorated and he was admitted to the rural hospital as
an inpatient. A respiratory physician performed a transbronchial
biopsy to assist diagnosis, and the man was sent home on weekend
leave by a medical officer. He became breathless early the next
morning and returned to hospital via ambulance and was diagnosed
with a pneumothorax (a collection of air in the space around the
lungs), a known risk of transbronchial biopsy.
The man's condition continued to deteriorate and he was
airlifted to the public hospital in a main centre two days later.
Despite intensive care, he died of respiratory failure.
It was held that the health service company failed to ensure
that the rural hospital had appropriate policies in place in
relation to patients going on weekend leave, or appropriate
specialist support (in the form of appropriate specialist cover
and/or clear protocols for contacting public hospital specialists).
Such policies are particularly important for rural hospitals, which
often do not have local specialist cover and rely to a large extent
on locums. While such policies (and earlier consultation with a
specialist) may not have altered the outcome for the man, given his
complex condition, the health service company did not provide
services with reasonable care and skill, and did not sufficiently
facilitate co-operation between its staff and the public hospital
specialists to ensure quality of care. In these circumstances, the
company breached Rights 4(1) and 4(5).
Given the lack of appropriate arrangements for consulting with
specialists, it was accepted that the medical officer took
reasonable actions to provide appropriate care to the man and
therefore did not breach the Code.
This case highlights the important responsibility of a district
health board to monitor the delivery of services that it funds
within its district, particularly where those services are
secondary care/hospital services. A fundamental prerequisite is
that adequate systems are in place for consultation with, and
referral to, a higher level of service when the severity or
complexity of the condition is beyond the technical and clinical
capacity of the local service.