Case studies: cases finalised in assessment

Change of policy by public hospital regarding counselling for parents when unexpected births occur prior to arrival at hospital

Breast Screen Tasmania Refusal to perform a mammogram in absence of consent to share information with AIHW

Patient unable to contact doctor over holiday break

Medical Clinic - refusal by reception staff to call an ambulance

Aged care residents - concerns that diet not nutritious

Complaint made by a prisoner claiming failure to provide appropriate referral for treatment

Change in policy regarding palliative care patients and their families

Referral for second opinion following intervention by OHCC

Questioning by pharmacist as to need for non-prescription medication

Public hospital - Accident and Emergency (A&E) - urinary retention

Public hospital - private election - billing practices

 

Change of policy by public hospital regarding counselling for parents when unexpected births occur prior to arrival at hospital –

A young woman who was 36 weeks pregnant presented to a public hospital complaining of abdominal pain. She was assessed and observed for a period of 5 hours during which the pain she described was not thought to be due to her being in labour. She was sent home. Seven hours later her partner delivered the baby at home.
The woman and child were subsequently admitted into hospital. Although there were no complications, she was concerned that the hospital had not offered her counselling or any explanation as to why she had been sent home.
The hospital acknowledged that the experience had been traumatic for the complainant and apologised that she had felt unsupported and poorly cared for. The hospital explained that upon her initial presentation to hospital the birth had not seemed imminent, and apologised that the complainant had not been offered counselling or the opportunity to debrief upon her return to hospital. They acknowledged that this should have occurred and advised that a protocol had been developed as a consequence of this complaint, under which mothers who give birth unexpectedly prior to arrival at hospital are given the opportunity to debrief with a senior midwife and the opportunity of subsequent review by a social worker.

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BreastScreen Tasmania Refusal to perform a mammogram in absence of consent to share information with AIHW

A woman complained that she was denied a mammogram by BreastScreen Tasmania because she did not tick all the boxes in the consent for screening section of the registration form. She had not agreed to the release of her personal information to the Australian Institute of Health & Welfare (AIHW) and other organisations.
She was aware that a refusal to provide personal information to other medical practitioners may result in her not being able to participate in the BreastScreen Program, but did not understand how a refusal to share information with AIHW would have any bearing on the quality and outcome of the service being provided. She was seeking a change in policy and procedure, and access to the service.
BreastScreen advised that it receives funding from both the State and Commonwealth governments and that the provision of information to the AIHW is a requirement of the Commonwealth funding. They acknowledged that the consent for screening section of the form had led to a number of women believing that they could access the service without consenting to the release of this information and the form would be reviewed.
Our Office asked BreastScreen to include a paragraph in its form explaining the funding arrangements and advising that in order to access the service, the patient / client is required to consent to information being released to other organisations for research purposes. This recommendation was adopted by BreastScreen.
The woman subsequently indicated that she had another appointment with BreastScreen and had consented to all aspects of the consent section of the registration form enabling her to have a mammogram.

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Patient unable to contact doctor over holiday break

A man complained on behalf of his wife that he was unable to contact the doctor who saw his wife in a private hospital during the Christmas and New Year period. He complained that he had telephoned the doctor’s practice to tell the doctor who he should send his report to at the GP clinic normally attended by the complainant’s wife, and that there was no means by which this message could be left.
The man and his wife believed the information was necessary for her GP to be able to provide appropriate ongoing treatment, and said that not being able to communicate the GP’s contact details to the doctor caused them a great deal of anxiety. The complainant sought an explanation and disciplinary action.
The doctor advised that the reason the man had been unable to contact him was because his rooms were unattended due to the holiday break, but that his wife’s medical information had been sent to her GP when they re-opened.
Our Office suggested to the doctor, that he should have a telephone message service to record any incoming messages or to advise callers where they can obtain medical help in an emergency. The doctor responded stating he was a physician not a GP, and thus does not make himself available as the OHCC suggested.

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Medical Clinic – refusal by reception staff to call an ambulance

The complainant was upset that reception staff at a medical clinic had refused to call an ambulance for her husband when he collapsed and lost consciousness in the car park outside the surgery. He was there to attend his first appointment with a doctor at the clinic.
His wife subsequently called an ambulance on her mobile phone which she had left in the car. A member of the reception staff came out later to offer assistance. An ambulance took the man to hospital, and the man died 2 weeks later.
A response was obtained from the owner of the clinic, who advised that it was clinic policy that only a specialist on duty can authorise the calling of an ambulance and the staff member was following policy. He explained that the reason for this is because only a doctor can assess a patient’s medical condition in order to determine urgency.
At the time of this incident the doctor was with a patient or was on the telephone and could not immediately assess the man’s condition. As soon as he became available, he attended to the man in the car park.
Our Office recommended to the provider that the Clinic change its policy to a more flexible one, noting that such a rigid policy may put a patient or the public at risk. It was recommended that staff be given the discretion to deal with an emergency in a more considerate way, noting that in this case it would have been appropriate to offer the woman the use of the phone to call the ambulance herself.

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Aged care residents – concern that diet not nutritious

A woman employed at a district health service, which also provides care to the aged, complained on behalf of a male resident that a healthy and nutritious diet was not being provided to the man and other residents/inpatients.
The service responded by advising that all clients’ dietary needs and food preferences are taken into account on admission, and that these are regularly reviewed. They provided a summary of the man’s particular dietary requirements demonstrating this. They explained that catering staff had offered to cook anything for the man to encourage his appetite, but without success.
The service advised that meals for the residents/inpatients are cooked on site and frozen. The menu has a four weekly rotation, prepared in consultation with the residents, nursing staff, catering staff and a nutritionist. Most of the food is prepared from fresh ingredients, except for a few frozen foods, which are on the menu six times in total over a 28 day period. A copy of the menus was provided.
The service advised that in response to this complaint a project to review the menus was being undertaken by the Nurse Unit Manager, in collaboration with the dietician. This would include undertaking a nutritional assessment, and educational sessions addressing the nutritional needs of the elderly, with a view to improving the choice and variety of foods that could be provided by the catering services.
The complainant acknowledged the efforts of the service in responding to her complaint and advised that she had noticed an improvement in the nutritional content of the meals provided to the clients at the facility. She congratulated the provider, catering staff and management in their prompt resolution of the complaint.

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Complaint made by a prisoner claiming failure to provide appropriate referral for treatment

The complaint was made by a female prisoner about a delay in having a gastroscopy and colonscopy in a public hospital. She believed she had been placed on an urgent list for these procedures.
Correctional Primary Health Services (CPHS) advised that the complainant had been examined by a doctor and, although she was found to have a positive faecal blood count on routine stool screening, this had been diagnosed as being due to her having constipation, as opposed to any other condition requiring early intervention. She was prescribed antispasmodic medication and booked for non-urgent gastroscopy and colonoscopy at the hospital.
She was advised she should discuss her ongoing concerns with the doctor at the prison.
Although the complainant was obviously concerned about her health, based on the information above, her complaint appeared to be misconceived, in that an urgent appointment had not been requested by CPHS. The complaint was dismissed.

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Change in policy regarding palliative care patients and their families

A woman, representing her family, complained about the treatment their deceased mother received at an aged and community care facility. They were unhappy with:

  • the care and treatment provided to their mother as a medical patient, specifically in relation to the following: use of incontinence pads, intravenous antibiotic line, call bell, confidentiality, provision of a bed pan, restriction of visitors, review by the doctor, and a delay in pain relief.
  • the unprofessional and uncompassionate treatment from the residential care manager.

The response from the regional manager contained an apology from the residential care manager and advised that a change in policy had occurred and outlined proposed improvements:

  • a change in documentation regarding complaints, clarifying that issues can be raised with management reinforcing the need for confidentiality
  • providing written information to families about the grief process; and
  • initiating discussions with relatives of patients whose care is palliative.

The woman replied that family was not fully satisfied with the outcome but appreciated the apology and that the facility is reviewing its procedures. She acknowledged that their mother did receive some professional and compassionate care. She indicated that the family did not wish to pursue the complaint any further.

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Referral for second opinion following intervention by OHCC

A woman complained about a specialist at a public hospital, claiming that he was rude to her, turned his back on her, refused her medication, would not support her request for a particular spinal procedure, and would not advise her who could undertake that procedure in Tasmania. She had booked an appointment with a specialist interstate who had indicated that, subject to review, he was willing to undertake the procedure.
A response was obtained, and further discussions were held with the hospital and the specialist. The complaint was resolved on the basis that, although the specialist did not personally believe the procedure would provide the complainant with long term pain relief, he would provide an unbiased referral for review by a specialist in Tasmania who performs the procedure she was seeking.

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Questioning by pharmacist as to need for non-prescription medication

The complainant alleged he was unreasonably questioned by the respondent pharmacist when attempting to purchase Mersyndol tablets, a non prescription medication for treatment of pain and tension.
In her response to the complaint, the provider explained that:

  • her actions had been in accordance with the relevant legislation and guidelines
  • the complainant had attended on a number of occasions, and she had informed him that each time he attended that she would have to make the same enquiries; and
  • she had advised him to ask his GP to provide her with a letter giving reasons for his need for the medication, to avoid being asked each time he wished to purchase Mersyndol.

The Pharmacy Registration Board did not seek referral.
The complainant was dismissed on the basis that the explanation provided by the provider was reasonable. It was clear that the provider was required by the Poisons Regulations to question the consumer regarding his request for the medication.

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Public hospital – Accident and Emergency (A&E) – urinary retention

A woman lodged a complaint on behalf of her husband, who had presented to a public hospital A&E on three consecutive days over a weekend, due to an inability to urinate. She alleged he was not appropriately assessed or treated until his third presentation.
The hospital responded, outlining the treatment provided and acknowledging that at the second presentation a catheter could have been inserted. It was explained that the risk of infection, preference for having an ultrasound performed prior to catheter insertion, and district nurse availability had contributed to the delay.
The hospital advised that as a consequence of this complaint the practitioners involved had indicated that they would change their practice and develop guidelines for the treatment of urine retention and the use of indwelling catheters in A&E. The guidelines would include contacting the urology registrar, notifying the patient’s GP of the need for a review, and referral to a urologist.
The complaint was closed on the basis that the complainant had been given a reasonable explanation and information.

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Public hospital – private election – billing practices

A mother lodged a complaint on behalf of her 19 year old son with Aspergers Syndrome, against an Oral and Maxillofacial Surgeon. The complainant alleged that the surgeon failed to discuss the cost of surgery which had resulted in $988.70 out of pocket expenses, and had failed to return her call. She was seeking a change in policy or procedure, a waiver of the $988.70 gap and conciliation.
The background was that the son attended a public hospital Emergency Department (ED) some days after being assaulted. He indicated that he was covered by his parent’s private health insurance and was then allegedly advised to have his facial fractures repaired by a private Oral and Maxillofacial Surgeon.
The complainant advised that there was a gap of $988.70 to be paid after deducting the amounts Medicare and the Health Fund would pay. She was also concerned that information was not given to her or her son about the costs associated with choosing to be treated as a private patient in a public hospital.
The Oral and Maxillofacial Surgeon explained his role in the consumer’s treatment. He stated that he had understood the son to be a public patient, but had then discovered that the son had been admitted to the public hospital as a private patient. This had resulted in the generation of the patient account. The Surgeon noted how he could have dealt with the situation better, and waived the outstanding $988.70.
The complainant accepted the waiver of the fee, and did not wish to pursue the matter further.
The complaint raised the issue as to the manner in which a patient presenting for treatment at the public hospital A&E is invited to elect to be a public or private patient, and whether they are informed of the consequence of this election. This aspect of the complaint is being followed up by this office as a public interest issue.

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