The Health and Disability Commission discovered that Whanganui Hospital undertreated a man for an ear infection that ultimately contributed to his death because one doctor believed the patient was high on meth.
Man killed at Whanganui Hospital
After a man who visited the hospital repeatedly wasn’t given the proper care and ultimately passed away, it was determined that the Whanganui District Health Board had violated a code protecting patients’ rights.
Deputy Health and Disability Commissioner Dr. Vanessa Caldwell’s ruling about a grievance filed in 2019 over the man’s passing has been made public.
Death cause of man who died at Whanganui DHB
A guy who repeatedly sought care for an ongoing ear infection passed away after developing a brain abscess.
Deputy Health and Disability Commissioner Dr. Vanessa Caldwell found the Whanganui District Health Board (WDHB) accountable for a systemic failure in its treatment of the man in a report released today.
Caldwell claimed that the deceased, who was unidentified in the report, visited the Emergency Department (ED) of Whanganui Hospital five times in the course of two months in 2019.
However, Caldwell found that during the guy’s visits to the ED, medical professionals did not sufficiently look into whether the man had experienced any side effects from the otitis media, an inflammation of the middle ear.
Statement by Health and Disability Deputy Commissioner Dr. Vanessa Caldwell
The man’s death was the subject of a complaint that was submitted in 2019, and Health and Disability Deputy Commissioner Dr. Vanessa Caldwell issued a ruling about the matter.
The ruling emphasized the significance of thoroughly evaluating patients who present to the hospital on several occasions and who exhibit the same symptoms within a short period of time, as well as thoroughly investigating those symptoms and weighing alternative diagnoses.
By failing to deliver services with reasonable care and skill, Caldwell determined that the Whanganui District Board of Health had violated the Health and Disability Services Consumer Rights Code.
Reports of the 30-year-old Mori male patient
According to the report, the deceased was a 30-year-old Mori male who looked to have a history of drug use but otherwise was in good condition.
Even though he made numerous attempts to get medical attention, it was said that he passed away from a “wholly preventable disease.”
He had an infection on his foot and an accidental ear discharge when he first saw the doctor.
He was given medication to go home, and WDHB’s Ear, Nose, and Throat service were recommended, but he later declined.
A few weeks later, he came back with fever, neck swelling, and ear ache. Blood tests revealed a serious infection, prompting doctors to start antibiotics and order a CT scan of his neck.
The scan revealed fluid in the mastoid, the area of the skull behind the ear, as well as an infection of the external ear. The middle ear and the roof of the mastoid, however, were not visible on the scan, and no additional imaging was carried out.
What happened exactly at Whanganui hospital?
The treating physician decided that the patient was required to be admitted under the care of ENT expert Dr. G for additional evaluation and antibiotic treatment.
Dr. G, however, that the guy is discharged with eardrops, antibiotics, and an outpatient ENT consultation after discovering a little growth in his ear.
He thought the man was suffering from acute methamphetamine intoxication because he was “very active, getting up and sitting down repeatedly, pacing the corridor, and euphoric/happy.”
He wasn’t drunk, according to the man’s sister, who was with him in the hospital and later complained to the Health and Disability Commissioner about the services WDHB gave to her brother.
She informed HDC that she believed Dr. G had concluded the man was a drug user since he was of Mori heritage.
Later that day, when he was released from the hospital, a test found bacteria in his samples that could result in “devastating” post-infectious consequences and acute infections that can be fatal.
As per WDHB policy, the police were eventually called to locate him and deliver a request for him to return to ED when WDHB was unable to get in touch with him.
He did come back, and when he did, all of his vital signs were in order, the swelling in his neck had subsided, and there was no ear discharge.
Because the doctor thought the infection was going away, he released the patient with a more aggressive antibiotic regimen.
A few days later, he went back to the emergency room with discomfort, pus in his ear, and an obscured eardrum. A younger doctor eventually gave him the okay after prescribing him more antibiotics and referring him to another ENT.
The following month, the man showed up three hours early for his ENT appointment with Dr. G and was discovered dozing off in the waiting area.
He needed to be roused before dozing off again throughout the test. Dr. G informed HDC that he thought the man’s actions were the result of drug usage.
The man’s eardrum displayed irritation, discharge, and perhaps a growth during the consultation.
His important observations weren’t written down, but a strategy was created that included scheduling a CT scan to see the temporal bone.
Days later, the man passed out at home and needed to be brought to the emergency room. His relatives claimed he had been disoriented, confused, and hallucinating.
The man had an abscess in his brain, emerging from the bone behind his ear and filled with fluid. 3 days later, he passed away.
The reports and actions
According to Caldwell’s report, the DHB neglected to perform a CT head scan sooner and did not sufficiently follow up on abnormal test results.
Assuming that the man’s symptoms were brought on by drug abuse, she also criticized Dr. G’s inaction.
The clinicians involved in the man’s care, according to Caldwell, failed to recognize the significance of his frequent trips to the emergency department (ED). Caldwell pointed out that DHBs are accountable for the services rendered by their staff.
She said that they had overlooked his history of symptoms that did not go away and the potential for consequences.
Given the number of employees involved throughout numerous presentations, I believe that WDHB must accept organizational responsibility for the widespread failure in its service.
This delayed diagnosis of the man’s otitis media issues led me to conclude that WDHB had violated the [Code of Health and Disability Services Consumers’ Rights] by failing to treat the man’s needs with reasonable care and competence.
Caldwell suggested that WDHB and Dr. G send the man’s family a written apology.
She gave WDHB some advice, and she also suggested that Dr. G pursue self-directed learning on prejudice in healthcare and evaluate his treatment of this particular patient.
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The Director of Proceedings was referred to WDHB, and according to Caldwell, she “had the consideration to the particular vulnerabilities of the guy and to the public interest in enhancing healthcare outcomes for Mori.”
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