Page Section: Centre Content Column
Roles and responsibilities in prioritisation for first specialist assessment (04HDC13909 )
Download Roles and responsibilities in prioritisation for first specialist assessment (04HDC13909 ) (PDF 145Kb)
(04HDC13909, 4 April 2006)
Urologist ~ Public hospital ~ District health board ~ PSA ~
Waiting lists ~ First specialist assessment ~ Duty of care ~ Rights
4(1), 4(5), 6(1), 6(1)(c)
A 61-year-old man experiencing urinary problems was referred to
the urology department at a public hospital by his GP. He had a
significantly elevated prostate specific antigen (PSA) test result,
indicating a high likelihood of cancer. The following month, the
urologist wrote to the man's GP requesting further investigations.
With this additional information he placed the man on the urgent
waiting list for first specialist assessment (FSA). The urologist
notified the man and his GP by letter that the man was likely to be
on the waiting list for several months. However, he did not receive
The man did not receive any further correspondence from the
hospital or the urologist. He continued to have PSA tests
with the GP, who forwarded the results to the urology department.
Nearly two years later, the man was experiencing urinary problems
and consulted his GP's locum, an oncologist, who referred him to a
private urologist. Biopsies revealed that he had adenocarcinoma of
It was held that the urologist did not fulfil his
responsibilities in relation to prioritisation. His high level of
assigning patients to "urgent" meant that he was not adequately
differentiating between patients in this group, breaching Right
4(1). He also had a responsibility to provide accurate information
about the expected waiting time. His failure to do so was a breach
of Right 6(1)(c).
It was held that the patient and the GP should have been given
clear and specific advice about the option of seeking private
assessment and treatment. The GP should have been told to re-refer
the patient if his condition deteriorated or there was further
relevant information that would affect the patient's priority. The
public hospital's failure to provide the required information
constituted a breach of Right 6(1). The main reason this action did
not take place at an earlier stage appeared to be a difficult
relationship that existed between the urologist and the DHB.
To allow that relationship to interfere with its duty to
appropriately manage and monitor the FSA list clearly contributed
to the failure to provide the man with timely treatment. The DHB
breached its duty of care under Right 4(1).
DHBs have an obligation to put systems and procedures in place
to ensure an adequate and effective system for managing waiting
lists for FSA appointments, under which patients are kept informed
of their status and options. Individual clinicians have an
obligation to work with the DHB to appropriately prioritise and
offer appointments on the basis of priority. In this case, the
urologist and the DHB failed to work together effectively, and both
breached Right 4(5).
The GP also had a duty to inform the patient about his options
and to follow up his referral.