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Rural GP did not respond appropriately to urgent calls from district nurse (00HDC07870)

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(00HDC07870, 28 June 2002)

Rural general practitioner ~ Standard of care ~ Co-operation among providers ~ Reception staff ~ Surgery ~ District nursing ~ Follow-up care ~ RNZCGP standards ~ Rights 4(2), 4(5)

The daughter of a 74-year-old woman complained about the services provided to her mother by a GP and a medical practice. The GP failed to provide assistance to the woman despite several calls to the GP's surgery from the daughter and a district nurse. The woman had undergone open heart surgery 10 days earlier. The GP was in a solo medical practice and, when on call during weekends, covered a large geographical area. The GP's husband was her practice manager and also acted as receptionist when she was on call, answering the phone and arranging consultations.

The district nurse made a scheduled visit to the patient during the weekend and determined that her blood pressure and pulse were abnormal. The incident related to phone calls from the district nurse to the medical practice and difficulties arranging for the patient to be transferred to hospital.

The Commissioner held that the GP breached Right 4(2), as her failure to respond appropriately to the increasingly urgent calls from the woman's daughter and the district nurse amounted to a breach of her ethical duty to attend or arrange immediate assistance in an emergency.

The Royal New Zealand College of General Practitioners (RNZCGP) standards require that there be a designated medical person available to deal with emergencies at all times, that reception staff have undergone training to help them recognise and respond appropriately to urgent medical conditions, and that reception staff know how to access practice nurses or doctors if immediate attention is required for patients. There was no evidence that the practice manager/receptionist had received training to help him recognise and respond appropriately to urgent medical conditions. The patient required immediate medical attention and was denied access to the GP by the GP's failure to respond to calls and by the receptionist's actions as intermediary. These failures reflected a breach of the RNZCGP standards and consequently of Right 4(2) of the Code.

The GP also breached Right 4(5) as her failure to arrange hospital admission for the patient amounted to a failure to co-operate with other providers to ensure quality and continuity of care.

The Commissioner recommended that a review of the GP's competence be undertaken by the Medical Council, and referred the matter to the Director of Proceedings, who decided not to issue proceedings.