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Patient not informed of abnormal skin biopsy test result (14HDC00132)

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(14HDC00132, 23 March 2015)

Plastic and reconstructive surgeon ~ Basal cell carcinoma ~ Mole ~ Abnormal test result ~ Follow-up ~ Rights 4(1), 6(1)(f)

A man saw a plastic and reconstructive surgeon on referral from a general practitioner (GP). The man presented with lesions on his left nasal ala (nose) and scalp, and had a family history of skin cancer. The plastic surgeon considered that the lesions on the man's left nasal ala and scalp were suspected basal cell carcinomas (a form of skin cancer), and planned to perform surgery in the coming weeks.

The plastic surgeon performed incisional biopsies of the lesions on the man's left nasal ala and scalp, and excisional biopsies of lesions on the man's left cheek and right lumbar (lower back) region, and sent the biopsies for histology testing. A week later, the man returned to the clinic for removal of his sutures. The nursing note of the consultation states that the histology report was not available at that time and that the man was advised to contact the clinic by the end of the week if he had not heard anything from the plastic surgeon. However, the man recalls being instructed to wait for further advice.

The next day, the histology report was sent to the clinic. The result showed that the left nasal ala and scalp lesions were basal cell carcinomas. The man required further follow-up, but he was not informed of the histology results and no follow-up was arranged.

Over a year later, the man consulted his GP to arrange vaccinations for upcoming overseas travel. The GP noted three areas on the man's scalp suspicious of basal cell carcinoma, and arranged to see the previous histology report. A week later, the man had a further consultation with the GP, who informed him that the histology report had shown basal cell carcinoma and, following examination, the GP referred the man to a skin specialist for surgery.

It was held that, by failing to inform the man of his abnormal test results, the plastic surgeon breached Right 6(1)(f). In addition, the plastic surgeon failed to provide services with reasonable care and skill by not arranging the follow-up care that the man required at the time the biopsies were taken, breaching Right 4(1).

It was also held that the lack of safeguards in the clinic's systems for handling patient test results directly contributed to the man receiving suboptimal care. By failing to ensure that its systems were sufficiently robust, the clinic failed to provide services to the man with reasonable care and skill and, therefore, breached Right 4(1). 

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