An 82-year-old man died the day after being sent home from the emergency department, where a junior doctor had misdiagnosed his abdominal aneurysm as a hip sprain.
By Kate Green of RNZ
A report by Deputy Health and Disability Commissioner Dr Vanessa Caldwell criticised Health NZ, and particularly Waikato Hospital's emergency department, for inadequate oversight of a junior doctor and poor documentation practices leading up to his death.
The man, who the report calls A, had been diagnosed 10 years earlier with an abdominal aortic aneurysm (AAA) – a bulge in the wall of the body's largest artery – which had been picked up during a CT scan for another condition.
In June 2020, an ambulance crew found A unable to get up after working on hands and knees under his kitchen bench. He was clammy, nauseated and pale, and had progressive hip pain.
He was taken to Waikato Hospital's ED and assessed by an emergency department house officer, or junior doctor, who noted discomfort moving the left hip, and suspected A had suffered a musculoskeletal injury.
The commissioner found conflicting reports as to whether hospital staff knew about A's history of aortic aneurysm. A's wife said it had not been mentioned during his assessment, and another consultant involved in A's care said he was not aware of it either.
But the junior doctor who assessed A said he was aware of it, although it was not documented at the time. He said he did not think A's symptoms were in line with an aortic aneurysm rupture.
That afternoon, A was discharged with safety-netting advice to return to the emergency department if the pain worsened or did not improve. A's wife said he continued to experience pain on discharge and had difficulty mobilising.
Around 12 hours later, A was back in the emergency department due to a rupture of the AAA. He deteriorated and died, a day after he was initially discharged.
The deputy commissioner found Health NZ did not provide a reasonable standard of care to A.
"Given the lack of a musculoskeletal cause for A's hip pain, alternative differential diagnoses should have been considered.
"I consider this to be a systemic failure due to the lack of recognition of AAA symptoms and history taking by multiple ED staff, the inadequate oversight of a junior doctor, the poor documentation practices as evidenced by the lack of records relating to important discussions held with the ED consultant and the ED registrar prior to discharge, and the poor communication among Health NZ providers as evidenced by the conflicting accounts of the discussions that took place regarding A's care."
Health NZ said at the time of the report's writing that it had reviewed the decision, recommendations, and follow-up actions.
The agency has been approached for further comment.
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