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Failure to inform and follow up abnormal test results (14HDC00368)

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(14HDC00368, 19 January 2016)

General practitioner ~ General practice ~ Primary care ~ Blood test ~ Abnormal test results ~ Rights 6(1), 4(1)

A 21-year-old, generally healthy man had been feeling unwell with flu-like symptoms, achy bones, and a headache. He saw a general practitioner (GP) after about ten days. The GP undertook a physical examination and queried whether he had a viral infection. The GP prescribed pain relief and referred him for blood tests, which were undertaken that day.

The GP reviewed the blood test results at 9.45am the next day. The results were abnormal. In particular, C-reactive protein was markedly elevated, the blood count was abnormal, and renal function tests were abnormal. The GP intended to have a practice nurse contact the man to advise him of the results and to ascertain his current condition, but he forgot to ask the nurse to do this.

The man remained unwell. Two days later, he tried to get up but could not walk, so his father took him to the local accident and medical clinic. The man was assessed by a doctor who accessed his recent blood test results, noted the abnormalities, and referred him to the medical registrar at the local public hospital.

The man was transferred to the hospital by ambulance. He was treated with broad spectrum antibiotics and admitted to the intensive care unit. He was reviewed by a number of specialities and a variety of causes of his illness were considered. At 5.30pm the following day, nursing staff noted the man was conscious. At 12.30am the next day the man had a lumbar puncture. By that afternoon, he was unconscious and was intubated to protect his airway. The man then had a CT scan of the head, chest and abdomen, which confirmed swelling of the liver and spleen, and suggested that he had swelling of the brain. At this stage, he was presumed to have meningitis. Over the following days, the man remained unconscious.

At that stage, there was no known diagnosis despite a number of tests being undertaken. The man was eventually reviewed by a visiting neurologist from another district health board, who considered that the man's condition was consistent with severe acute demyelinating encephalomyelitis, a post-infectious inflammatory disease that damages the protective myelin layer around the nerve fibres in the brain, following a systemic viral illness of undetermined nature.

The man was transferred to another public hospital to undergo treatment recommended by the visiting neurologist. He remained there for around three months, then moved to a unit for rehabilitation. He is now tetraplegic and lives at a residential care facility.

It was held that the GP failed to fully inform the man of his abnormal blood test results, breaching Right 6(1)(f). The GP failed to ensure that the abnormal results were followed up in a clinically appropriate manner, breaching Right 4(1).

Adverse comment was made that, at the time of these events, the medical centre did not have in place a formal process for the tracking of urgent results. The care the man received at the first public hospital was held to be appropriate in the circumstances.


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