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Specialist care for young woman rapidly deteriorating with rare illness (01HDC11283)

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(01HDC11283, 10 December 2002)

Public hospital ~ Haematology ~ System for labelling blood products ~ Rare disorder ~ Pain relief ~ Breaking bad news ~ Rights 4(1), 4(3), 6(1)(a)

A complaint was made by a woman about the services her 26-year-old sister received from a public hospital. The complaint was that hospital staff:

1)  did not provide adequate information about the patient's diagnosis (of the rare disorder thrombotic thrombocytopenic purpura) and changes in her condition;
2)  provided information about the patient's illness in an inappropriate manner;
3) supplied files and plasma labelled with someone else's name for use in the patient's treatment;
4)  gave the patient no assistance with toileting;
5) did not note or act quickly enough on the patient's deteriorating condition; and
6) did not provide appropriate pain relief.

The Commissioner held that the public hospital breached Right 4(1) by not having a system in place to ensure that blood products were correctly labelled, and breached Right 4(3) because it was not appropriate for nursing staff to give the patient a complex information sheet about her illness at 2am, even if she was awake; and it failed to assist the patient with toileting when she had requested help and clearly required it.

One haematologist breached Right 4(1) because he failed to ensure that his oral instructions were carried out appropriately. The hospital did not breach Right 4(1) in this matter because, in the absence of any reason for concern, the hospital is not responsible for ensuring that senior clinicians communicate orders correctly and check that their orders are carried out appropriately.

There was no breach of Right 4(1) by the specialists as: (1) even though the blood products had been incorrectly labelled, the specialists ensured that the correct blood product was administered; (2) the treatment provided was appropriate and administered within reasonable time frames given that the patient's deterioration was rapid; and (3) the pain relief was appropriate since any stronger pain relief could have hindered assessment of the patient's neurological status. There was no breach of Right 6(1)(a) by the specialists with respect to the information provided to the patient, as it was as clear and appropriate as possible in the circumstances of her complex and rapidly changing condition.