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Delay in diagnosis of streptococcal infection in patient presenting with back pain (04HDC20951)
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(04HDC20951, 25 January 2006)
Orthopaedic surgeon ~ General practitioner ~ District health board
~ Gentamicin ~ Heart disease ~ Valve replacement ~ Gastroscopy ~
Gastrointestinal bleeding ~ Drug toxicity ~ Back pain ~ MRI ~
Streptococcus ~ Septicaemia ~ Blood cultures ~ Record-keeping ~
A 58-year-old man complained that
serious symptoms were overlooked because of staff minimising the
significance of his symptoms and contributing them to his back
condition. The man had a history of congenital heart disease. He
suffered a work-related back injury and, when acupuncture and
manipulation were ineffective, he consulted his general
practitioner. Blood tests were performed and analgesics prescribed.
The pain did not settle and his general condition worsened.
A few days later he developed
atrial fibrillation and was admitted to a public hospital, where
this was treated. He was transferred to an orthopaedic ward at a
second public hospital for further assessment of his back pain. He
was seen by an orthopaedic surgeon, who ordered X-rays,
physiotherapy assessment and pain relief. His condition stabilised
and he was discharged. However, he remained unwell, developing
anaemia, and was referred to the orthopaedic surgeon for further
The following month he was admitted
to the first public hospital, where he was seen by the consultant
physician for assessment of anaemia. Upper gastrointestinal
bleeding was considered and he was transferred to the second public
hospital for a gastroscopy examination. When the consultant
physician learned that the gastroscopy was negative, he arranged
for the man to have further diagnostic examinations and assessment
as an outpatient.
The man was found to have bacterial
endocarditis and was commenced on a short course of Augmentin.
After one month of treatment with no improvement in his condition
he was readmitted and further blood tests again identified
Streptococcus B. He was started on a course of gentamicin before
the decision was made to transfer him to a third public hospital
for further management, which included a prolonged course of
penicillin and gentamicin for suspected endocarditis. As a result
of the antibiotic therapy he developed a toxic reaction to
It was held that the consultant
physician's management of the man did not minimise potential harm
and resulted in a three-week delay in diagnosis of the infection.
He therefore breached Right 4(4).
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