ZB

Boy on waiting list with vision problems had an undiagnosed tumour

Author
Open Justice,
Publish Date
Mon, 16 May 2022, 3:17pm
Dr Vanessa Caldwell found multiple issues in the care a DHB provided that contributed to a delay in a boy experiencing eyesight problems getting an appointment with a specialist. Photo / Supplied
Dr Vanessa Caldwell found multiple issues in the care a DHB provided that contributed to a delay in a boy experiencing eyesight problems getting an appointment with a specialist. Photo / Supplied

Boy on waiting list with vision problems had an undiagnosed tumour

Author
Open Justice,
Publish Date
Mon, 16 May 2022, 3:17pm

A young boy with symptoms of reduced vision had to wait six months for an appointment before his mother eventually took him to a private ophthalmologist who diagnosed him with a brain tumour. 

The frustrated mother, who complained to the Health and Disability Commissioner, says she could have lost her then 6-year-old son to negligence as a result of the unacceptable wait. 

The boy should have been seen within three months of his first referral to the district health board on June 6, 2019. After a six-month delay his mother took her own steps and arranged for a private consultation on December 3. 

An urgent CT head scan on December 20 revealed a solid mass lesion in the back of his brain. The growth was subsequently removed on December 30 and fortunately found to be benign. 

His mother told the Health and Disability Commissioner she was upset that the referral process had taken so long. 

"I could have lost my son due to negligence of the system, if it wasn't for the [two people 
who] pushed for [her son] to be seen I don't know what could have happened and we 
would probably still be waiting now." 

HDC deputy commissioner Dr Vanessa Caldwell today released a report finding the DHB in breach of the Code of Health and Disability Services Consumers' Rights for failing to provide services with reasonable care and skill. 

Two referrals were sent to the DHB, by two different GPs, requesting an appointment for the then 6-year-old boy who was experiencing worsening eye symptoms in his right eye affecting his sight. 

Initially, on June 6, 2019, the boy was triaged with the aim to be seen within 12 weeks, and then later re-prioritised following the second referral on August 28, to be seen within four weeks, however he did not receive an appointment. 

Subsequently, his mother took him to a private ophthalmologist in December who arranged for the CT Scan. 

Caldwell found multiple issues in the care provided by the DHB contributed to the delay, including the boy's initial referral missed the eligibility check which led to a delay in being placed on the waitlist, and both referrals were graded incorrectly. 

She considered multiple service delivery issues by the DHB led to an unacceptable delay in the boy being seen by an ophthalmologist and individual errors made by an orthoptist when grading two referrals were a failure to provide the boy with services with reasonable care and skill. 

"Many aspects of the care provided to the boy by the DHB fell below accepted standards. 

"It is concerning that in order to receive treatment within a reasonable timeframe, the boy's family had to seek care privately. 

"While I acknowledge that demand for this service exceeds capacity, the key concerns in this case also relate to the way in which the service is run." 

It was recommended the DHB provide the HDC with an independent evaluation of the systems in place to identify and prioritise overdue first specialist assessment of ophthalmology patients and undertake a random audit of paediatric ophthalmology referrals over a three-month period to ensure they have been graded appropriately and consider the independent adviser's comments regarding alternative care options. 

It was also recommended the orthoptist undertake further training through the DHB on the new grading guidelines. 

As a result, the DHB made many changes to its ophthalmology service to address the resourcing pressures, making key improvements to adapt and respond effectively to foreseeable effects of skill shortages in the health sector. 

Caldwell said it wasn't the first time HDC had investigated matters relating to delays in the DHB's ophthalmology services which had impacted negatively on a consumer. 

"It is concerning that, despite changes made, we continue to see negative impacts on consumers because of delays in the service. 

"It is clear there are still systems issues at the DHB which need to be addressed." 

The Ministry of Health was also advised of the concerns about the DHB's ophthalmology service and has been working closely with the organisation to improve waiting times. 

"The Ministry of Health has a role, with DHBs, to recognise the effect of pressures on the system, and plan accordingly. However, the existence of systemic pressures does not remove provider accountability in addressing such issues," Dr Caldwell said. 

- by Leighton Keith, Open Justice