A woman who lost both of her legs below the knee after a complication during varicose vein treatment should have been referred to an emergency department, the Aged Care Commissioner has found.
The woman, in her 70s, suffered an inadvertent intra-arterial injection during treatment for varicose veins which was suspected but not addressed quickly enough by the doctor, who waited for further results instead of referring her to a hospital.
Intra-arterial injection is a complication which can occur even at the hands of experienced doctors and can lead to muscle and skin damage.
"I am critical that Dr B [the doctor] did not refer Mrs A [the patient] to an emergency facility immediately when he recognised that a significant arterial event might have occurred," Aged Care Commissioner Carolyn Cooper said in a report.
"It is important to note that the outcome of care provided is not a relevant factor when assessing the standard of care provided, as sometimes even an appropriate standard of care can result in an adverse outcome."
Just before the treatment on February 19, 2020, the patient was provided with an information sheet explaining the small possibility of intra-arterial injection. During the injection, the patient experienced some pain in the first ankle and then explosive pain in the second.
The next day, at another appointment, the doctor apologised and explained that intra-arterial injection had occurred but the final outcome of the complication wouldn't be known for about six weeks. He kept in contact with her via phone and text message over the coming days, including when she visited the emergency department for pain at the base of both feet. She was given pain management and told to return if it worsened.
On February 25 she was admitted to hospital with painful and discoloured feet. She was diagnosed with bilateral ischaemic feet secondary to private varicose vein surgery.
On March 6 both her legs were amputated below the knee.
The patient said that a doctor of his credentials — he specialised in vein treatment — should have been aware of all the possible outcomes and should have taken any steps he could instead of adopting a "watch and see" approach.
She said she'll never know what would have happened had she seen a vascular specialist earlier.
Alongside the doctor's failure to refer his patient immediately to a hospital, the report also acknowledged it was "was not the best decision" to provide compression stockings due to their potential to restrict blood flow.
"I consider that Dr B did not provide Mrs A with services with reasonable care and skill," Cooper concluded.
The Aged Care Commissioner noted the doctor had closed his practice since the events and no longer performs any vein procedures.
Her report noted that he "is truly sorry for the 'devastating complication' that happened under his care, and that he often reflects on this case".
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