Mr A visited Whanganui Hospital eight times between June and August 2018. Photo/Google maps
A chronically ill man who visited the emergency room six times with a sore toe ended up having his lower leg amputated after his ingrown toenail became gangrenous.
The man, referred to as “Mr. A” in a Health and Disability Commission decision made public today, visited Whanganui Hospital eight times between June and August 2018, six of which were in the emergency department.
His care over those three months has now been criticized by the Assistant Commissioner for Health and Disability, Dr Vanessa Caldwell, who concluded that the WDHB had breached the Health and Disability Services Consumer Rights Code regarding human care, because each patient has the right to quality and continuity of services.
Mr. A, in his 60s, had a complex medical history including type 2 diabetes, heart attacks, stroke, peripheral neuropathy, vascular disease and iliac bypass surgery.
Diabetes can cause reduced blood flow to the feet, making it more difficult for wounds or infections to heal, such as Mr. A’s toenail. Mr. A’s illness contributed to the recurring nature of his infection, including increased risk of gangrene with possible spread of infection to bone.
After several trips to the hospital, Mr. A was diagnosed on August 9 with a severe blockage in his arteries, restricting blood flow. The tissue on his toe was dying off and he was officially diagnosed with gangrene, resulting in his toe being amputated.
Six days later the infection continued to progress and he went to another hospital where his right leg was amputated below the knee.
The commissioner said in today’s decision that a plan of care was never established and that lack of communication between doctors meant the infection was always treated in isolation, reoccurring until amputation point.
Caldwell said she is concerned that despite multiple presentations to the hospital, the man, who has a complex medical history with a chronic condition, does not have a coordinated care plan put in place by senior staff. . “A hospital system would be expected to operate in such a way that a patient who has presented repeatedly with the same problem would benefit from continuity of services, for example by having a dedicated team to oversee , to monitor and plan patient care,” Caldwell said.
She said she would expect the WDHB system to work that way, and it should have been the case with MA.
Caldwell criticized three doctors who were in charge of Mr A’s care and praised the actions of two others.
The Whanganui DHB has since established a “High Risk Foot Clinic” which focuses on care including education and awareness, assessment, diagnosis and development of a care plan, treatment initiation, follow-up and subsequent referral.