Director of Proceedings v Counties Manukau District Health Board  NZHRRT 4 (5 February 2020)
The Director of Proceedings filed proceedings by consent against Counties Manukau District Health Board (“CMDHB”) in the Human Rights Review Tribunal (“the Tribunal”) regarding ophthalmological services the DHB provided to Miss A.
At the age of ten, Miss A’s optometrist referred her to CMDHB’s specialist ophthalmology service to assess unexplained reduction in the visual acuity of both eyes. At her first specialist assessment (“FSA”) the consultant ophthalmologist diagnosed Miss A with possible early fruste forme keratoconus (progressive thinning of the cornea, which most commonly affects teenagers). The consultant ophthalmologist requested that Miss A be reviewed again in 12 months’ time or sooner if there were any problems. A copy of the findings and follow-up plan was not provided to the referring optometrist or the family. The specialist ophthalmology service subsequently cancelled the planned 12-month follow-up review appointment for Miss A. Miss A’s father contacted the service and was told the clinic was short-staffed and could not always make appointments requested by the clinic team. A year later, CMDHB rescheduled another appointment for Miss A. By this stage, Miss A’s planned follow-up specialist appointment was 12 months overdue and it had been two years since Miss A’s FSA. Three months later, Miss A’s GP became aware that the initial 12-month follow-up had not happened as planned, and he contacted the ophthalmology department to ask if Miss A had been “lost to follow-up”. However, his attempt at re-referral was rejected. The Blind and Low Vision Education Network New Zealand also sent an urgent form to CMDHB and an appointment for Miss A was made for five months’ time. Two years and nine months after her FSA, Miss A was reviewed by the consultant ophthalmologist, who found Miss A’s vision to be significantly reduced and confirmed a diagnosis of severe bilateral keratoconus, especially in the right eye, which was beyond appropriate treatment.
CMDHB accepted that Miss A did not receive timely follow-up specialist eye care in line with appropriate clinical timeframes, and that she experienced significantly greater visual loss (in a progressive disease that affects children and young adults) that would have been treated at a much earlier stage had her review appointment occurred in the planned 12-month period. CMDHB accepted that its failures in care amounted to a breach of the Code of Health and Disability Services Consumers’ Rights (“the Code”), and the matter proceeded by way of an agreed summary of facts. The Tribunal was satisfied that CMDHB failed to provide services to Miss A with reasonable care and skill, and issued a declaration that it breached Right 4(1) of the Code.
The Tribunal’s full decision can be found at http://www.nzlii.org/nz/cases/NZHRRT/2020/4.html