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Eye Department's management of urgent cases (00HDC09046)
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(00HDC09046, 25 October 2002)
Public hospital ~ Eye Department ~ Ophthalmologist ~ Patient
monitoring and response to cancer ~ Delays ~ Resource constraints ~
Rights 4(1), 4(5), 6(1)(a), 6(1)(b)
A 78-year-old man complained that ophthalmologists at a public
hospital did not advise earlier that tissue spreading over his left
eye was cancer, and did not offer the option of transferring tissue
from his right eye. He also complained that after surgery, which
kept his eye free of cancer for two years, the subsequent
management was not effective and he was not monitored effectively,
creating the need for removal of his left eye.
The complaint was also that: the Eye Department did not respond
adequately to the urgency and delayed an urgent appointment;
insufficient reading of the case notes prevented the treatment of
his eye; there was poor communication between clinicians because of
inadequate clinical notes (as evidenced by his being asked about
the rate of the spread of cancer instead of this being documented
in the notes); and there was insufficient information between the
clinicians and administration (as shown by the delays in obtaining
an urgent appointment).
The Commissioner held that there was adequate monitoring and
follow-up, as the reviews were regular, timely and ongoing, and
there was no evidence that the management contributed to the loss
of the patient's eye. It was likely that the ophthalmologists read
the case notes and were alert for signs of recurring carcinoma;
significantly, there was no evidence that the carcinoma should have
been diagnosed earlier.
The clinical entries made by ophthalmology staff in the outpatient
setting appropriately recorded the chronic and progressive nature
of the condition, although the standard of detailed corneal
drawings would ideally have been higher.
There was no breach of Right 6(1)(a) because, although the patient
was not fully aware of the potential for recurrence, the
consequences were explained to him as soon as it became apparent
that the lesion had progressed to a squamous cell carcinoma.
Although the patient maintained that he was never offered the
option of restoring his left eye, there was no breach of Right
6(1)(b) because the records showed that the option of a stem cell
autograft was discussed and offered on a number of occasions.
It was noted that while every patient with this condition should
be treated soon after diagnosis, restraints on staff and resources
make this an impossible goal. However, the Eye Department should
ensure that, in scheduling appointments, "urgent" cases are
prioritised, patients' requests for earlier appointments are dealt
with appropriately, and patients are kept well informed. There was
a breach of Right 4(5) by the department because it did not provide
the patient with the recommended urgent appointment.
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