Health NZ Southern has been approached for comment.
Photo: 123rf
The Health and Disability Commissioner has found a man dying of cancer was failed by Health NZ Southern after he did not receive a first specialist appointment with the oncology service, along with delays in his treatment.
The man experienced worsening pain in his left thigh that left him unable to sit or stand for long periods, before he was diagnosed with terminal oesophageal cancer that had spread throughout his body.
He did not receive follow up radiation treatment or chemotherapy – despite it being identified as part of his plan for palliative care.
The Health and Disability Commissioner said Health NZ Southern failed to provide treatment within the required timeframes, which greatly affected the man’s quality of life before he died.
Health NZ Southern has been approached for comment.
A delayed cancer diagnosis
The man visited a medical centre five times between March and April 2021 due to the pain in his thigh that left him struggling to walk.
A semi-urgent referral was made to orthopaedics at Dunedin Hospital, along with referrals for an ultrasound of his left hamstring and an x-ray of the limb.
The orthopaedics referral was declined until the ultrasound and x-ray were completed in June.
During that time, the man’s condition began to deteriorate, to the point he was unable to sit or stand for longer than 10 minutes.
Scans at a private hospital that June showed a haematoma, a suspicious tear of the hamstring and a clot, and the man was given medication and another semi-urgent referral was made to orthopaedics.
An orthopaedic specialist later that month ordered an MRI scan, over concerns the man was not suffering a hamstring injury. It showed a tumour in his left lower limb and the pelvic region that was suspected to be cancer.
Additional scans revealed oesophageal cancer, which was thought to be the primary cause.
The man was then transferred to the oncology team at Dunedin Hospital, where it was found that his oesophogal cancer was incurable and palliative treatment, including radiotherapy, was recommended. An initial round of radiation treatment occurred, but a second round was delayed and did not occur before the man’s death.
It was also found that the man should have received chemotherapy, but he never received a first specialist appointment despite the criteria at the time being that he receive one within four weeks and several approaches from his family.
The complainant believed that “any opportunity for… palliative chemotherapy was delayed until it was no longer possible” and that it took a toll on his family and friends, and access to palliative chemotherapy might have reduced his suffering.
It was not clear whether the delay or the reasons for it were communicated to the man or his family at the time.
Investigation into delays in provision of non-surgical cancer services
In 2023, the HDC published a report following an investigation into Health NZ Southern’s delivery of non-surgical cancer services, including delays in patients obtaining first specialist appointments between 2016 to 2022.
It found Health NZ Southern breached the Code of Health and Disability Services Consumers’ Rights by failing to provide services to patients that minimised potential harm and optimised their quality of life.
The report said Health NZ Southern failed to recognise and respond to the clinical risk created by lack of capacity within the Southern Blood and Cancer Service. This was due to poor overall clinical governance systems, including inadequacies in quality measures and indicators, and poor relationships between clinicians and executive management.
The report acknowledged the resource constraints affecting the timely provision of specialist procedures but considered that the care provided by Health NZ Southern was not adequate in the circumstances.
The commissioner made several recommendations, including that a system, like a patient navigator service, be established to provide a single point of contact for people waiting for a first specialist assessment.
Findings
Health and Disability Commissioner Morag McDowell
Photo: HDC / Supplied
Health and Disability Commissioner Morag McDowell said Health NZ Southern failed to provide the man with a first specialist appointment for oncology services within the required timeframe, or radiation therapy to his pelvis, which greatly affected his quality of life in his final months.
She said those failures showed he was affected by the delays in Health NZ Southern’s non-surgical cancer service as identified in the 2023 report.
“Given the resource constraints, I would have expected Health NZ Southern to discuss the situation with [the man] to explore the options of receiving treatment at another hospital or not receiving radiation at all. I am critical that [he] remained bed bound and in pain while waiting for radiation treatment, with little communication from Health NZ Southern.”
In response, Health NZ told the HDC that because of the rapid deterioration of [the man’s] disease, by the time he was due to be seen by a medical oncologist, he had deteriorated to the point that chemotherapy was not appropriate; the benefit even if treatment had been given earlier was doubtful.
It also said that delays to the man’s second radiation treatment were due to the oncology department being at capacity due to a post-COVID surge of patients receiving treatment and under different circumstances the man would have been scheduled for earlier treatment.
“Despite this, I remain critical that the systems in place at Health NZ Southern meant that cancer patients who were to be seen by a medical oncologist were not seen within the appropriate timeframes or, in [this] case, at all.
McDowell said the man and his family had struggled under the burden of diagnosis and illness to follow up on what was happening, ultimately without successfully obtaining an assessment.
She was also critical of Health NZ’s “apparent lack of communication with patients affected by delays” and said the man would have benefited from contact with clinical navigators while waiting for his first appointment with the oncology service, so that his circumstances could have been re-evaluated and further options discussed.
“When resource constraints cause adverse effects on patients, I expect providers to have frank discussions with these consumers to manage expectations and discuss the options available to them. I am critical that this did not occur in [this] case.”
Health NZ Southern said it had since employed two additional medical oncologists which had improved the waitlist for first appointments.
McDowell recommended that Health NZ apologise to the man’s family and update the HDC on the current wait times for first specialist appointments in the Southern Blood and Cancer Service, including any actions being taken if wait times were outside recommended clinical timeframes and the staffing numbers and recruitment efforts.
She also recommended Health NZ consider evaluating the effectiveness of the patient navigator service and provide the HDC with a report, including any corrective actions.
Health NZ ‘sincerely sorry’
In a statement, Health NZ Southern and Te Waipounamu chief medical officer Dr David Gow said it accepted the commissioner’s findings about the man’s care.
“We are sincerely sorry for this patient’s experience and acknowledge that our failures in providing timely care caused significant distress for the patient and their whānau,” he said.
“We know that any wait for health care treatment is very distressing, and we remain committed to providing timely and accessible cancer services to our community.”
He said Health NZ had apologised to the man’s family and provided the HDC with an update on wait times, staffing numbers and recruitment efforts.
The agency had reviewed the patient navigator service that was implemented in 2023, Gow said.
“The establishment of these navigator roles has provided a single point of contact for patients during treatment and a continued assessment process for patients waiting to be seen,” he said.
“We acknowledge the commissioner’s reference to the 2024 HDC report regarding delays in our non-surgical cancer service between 2016 and 2022 and sincerely apologise to all patients who have been affected by this.”
“We have since strengthened our oncology clinical governance and regional networks and developed a close and collaborative working relationship with Te Aho o Te Kahu – Cancer Control Agency.”
The Southern Blood Cancer Service has six radiation oncologists and six medical oncologists at present.
“We are continuing to utilise locum support while we work to recruit further staff,” Gow said.
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