GP breaches Code in care of man at risk of blood clots - 21HDC01781

The Deputy Health and Disability Commissioner has found a rural locum GP breached the Code of Health and Disability Services Consumers’ Rights in her care of a patient with ongoing right leg pain, swelling and other symptoms.

The man had presented to a medical centre three times complaining of pain and swelling in his right leg. He was a long-time smoker, had high cholesterol and ongoing heart conditions putting him at risk of blood clots.

The man received varying diagnoses for each presentation and was given pain relief. The GP attended to the man for his last visit to the centre. The next day, when his condition worsened, his friend took him to a hospital emergency department where he was transferred for emergency surgery on a blocked artery.

Dr Vanessa Caldwell found the GP failed to provide services with reasonable care and skill and breached Right 4 (1) of the Code by not performing an adequate physical examination, not completing an acute vascular referral, and because of unacceptable documentation.

In her decision, Dr Caldwell acknowledged the challenges faced by rural practices, however, she noted an important opportunity was lost.

"I am concerned that Dr A failed to recognise the seriousness of Mr B’s symptoms and decided to treat him symptomatically. This was a significant missed opportunity to identify an acute emergency through an assessment and provide timely escalation of care," she said.

"For most people, primary care is the first point of contact with health services and is a ‘front door’ to the rest of the health system. Therefore, robust primary care structures are key to ensuring that people receive timely and effective care."

Dr Caldwell acknowledged the GP’s changes in practice, in response to the complaint.

"I am pleased that Dr A has taken this case very seriously and has reflected on her care provided. I acknowledge the extensive actions Dr A has already undertaken to improve her practice…"

Dr Caldwell recommended the GP take part in a Royal New Zealand College of General Practitioners clinical notes audit and provide those results to HDC. She also recommended the GP review guidelines for peripheral vascular disease and report back changes she has made to her practice as a result.

She noted two educational comments for a nurse practitioner and another doctor who attended to the man at the clinic, focussing on reflection of practice, and reviewing best practice guidelines for managing peripheral vascular disease.