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Treatment of gastrointestinal symptoms (06HDC11343)
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(06HDC11343, 27 June 2007)
Medical officer in general practice ~ Medical centre ~
Investigation and treatment ~ Gastrointestinal symptoms ~ Standard
of care ~ Conflicting expert advice ~ Documentation ~ Rights 4(1),
4(2), 4(4), 6(1)
A 64-year-old man complained about the care provided by a
medical officer (MO) working in general practice at a medical
centre, mainly relating to two periods: March to August 2004, when
he was diagnosed with duodenal ulcers, and December 2004 to August
2005, when he was found to have a cancerous tumour of the colon.
The MO was not vocationally registered as a GP but was sitting
examinations with the Royal New Zealand College of General
Practitioners, and was being supervised.
The man was diagnosed with duodenal ulcers in October 2004,
after three months of vomiting, nausea and weight loss. The key
issues in relation to the MO's care during this period were whether
he gave adequate consideration to the possible causes for the man's
symptoms, and whether he managed the man's deteriorating condition
appropriately.
In the face of conflicting expert advice, it was held that the
MO did not maintain a holistic oversight of the symptoms the man
was experiencing. An earlier or more urgent referral for an
endoscopy could have occurred if he had carried out basic physical
examinations and remained alert to alternative causes for the
symptoms. His overall care of the man was not of an appropriate
standard and was not provided in a manner that minimised the
potential to harm or optimised the quality of the man's life,
breaching Rights 4(1) and 4(4). A patient in these circumstances
would expect to receive information about the risk that his
medications could cause gastric irritation, together with advice on
what to do if that occurred. The MO therefore breached Rights 4(1)
and 6(1). There was a mix-up with his medication when he was
prescribed a lower than recommended dose of omeprazole, which meant
that the man received less than the recommended dose for five
months until May 2005; this represented a breach of Right 4(1).
The man consulted the MO regularly between May and August 2005
with nausea, vomiting, loss of appetite and weight loss before he
was finally taken to hospital by ambulance in August 2005. The key
issue in 2005 is whether the MO should have referred him to
hospital for investigation of these symptoms rather than continuing
to treat him as a general practice patient.
It was held that a May 2005 consultation should have been
followed up with a referral for an endoscopy, and physical
examinations should have occurred at each consultation. The MO's
care was found to be deficient over a sustained period of time, and
his documentation was inadequate and, accordingly, he breached
Rights 4(4) and 4(2).
The medical centre was found not directly or vicariously liable
for the MO's omissions.