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Decision 99HDC06743
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Names have been removed to protect privacy. Identifying
letters are assigned in alphabetical order and bear no relationship
to the person's actual name.
Complaint
The Commissioner received a
complaint from the Accident Rehabilitation and Compensation
Insurance Corporation ("ACC") about the treatment the consumer
received from the general practitioner. The complaint was that:
- On 14 November 1998 the general practitioner did not provide
the consumer with services of an appropriate standard when
administering an IM [intramuscular] injection of kenacort to her
left deltoid [muscle] resulting in fat atrophy in the area of the
deltoid muscle.
Investigation Process
The complaint was received on 8 June
1999 and an investigation was undertaken. Information was obtained
from the ACC file.
The general practitioner was
notified of the Commissioner's investigation and invited to
respond. The general practitioner provided no information to the
Commissioner. The Commissioner reviewed the consumer's medical
records.
Information Gathered During Investigation
In early November 1998 the consumer
consulted with the general practitioner because she was suffering
with hay-fever. According to the general practitioner's records of
the consultation the consumer requested an injection. The general
practitioner prescribed kenacort 40mg intramuscularly and discussed
the "pros and cons of it". The general practitioner confirmed to
ACC that the kenacort intramuscular injection was given into the
consumer's left deltoid muscle of her upper arm.
Five days later the consumer
returned to the surgery with atrophy of the tissues of her left
shoulder at the site of the kenacort injection. The examining
doctor recognised the cause of the atrophy and referred her to
ACC.
The Pharmaceutical Companies
kenacort product information supplied with kenacort A40 injections
stated:
"[U]nless a deep intramuscular
injection is given, local atrophy is likely to occur. Due to the
significantly higher incidents of local atrophy when the material
is injected into the deltoid area, this injection site should be
avoided in favour of the gluteal area. Only very unusual
circumstances would warrant injection into the deltoid area".
On 4 August 1999 the general
practitioner was advised of the complaint and the Commissioner's
decision to investigate the matter. The general practitioner was
invited to respond. On 4 October 1999 the Commissioner again wrote
to the general practitioner without response.
The Code of Health and Disability Services Consumers'
Rights
RIGHT 4
Right to Services of an Appropriate Standard
...
2) Every consumer has the right to have services provided that
comply with legal, professional, ethical and other relevant
standards.
...
Opinion: Breach
In my opinion the general
practitioner breached Right 4(2) of the Code of Health and
Disability Services Consumers' Rights. An intramuscular kenacort
injection was prescribed and injected into the deltoid muscle which
resulted in atrophy of the tissues. This is contraindicated in the
product literature because of the potential to develop fat atrophy.
Failure to inject kenacort A40 in the appropriate muscle is a
breach of professional standards.
Actions
I recommend that the general
practitioner takes the following action:
- Apologises in writing to the consumer for breaching the Code of
Rights. This letter is to be forwarded to the Commissioner who will
send it to the consumer.
Other Actions
A copy of this opinion will be sent
to the Medical Council of New Zealand, and the ACC Medical
Misadventure Unit.
The Medical Council of New Zealand
will be asked to review the general practitioner's competency.
For further information, contact:
HDC Communications Section (09) 373 1060.
Or by email: your.rights@xtra.co.nz