09HDC01565 - Health and Disability Commissioner

Health and Disability Commissioner
neurosurgeon Dr E. 5 Dr D noted in his referral letter that the medication had helped
with the frequency of attacks and morning headaches, but that the improved
symptoms may also have coincided with Mr A restricting his physical activity and
being able to do things at his own pace.
17. Mr A had an MRI of the spine and was seen by Dr E a few days later. In his letter to
Dr D, Dr E noted that Mr A had described the development of symptoms over the past
year becoming worse over the previous two to three months, to the point that they
worried him daily. He had reported daily headaches brought on by straining,
coughing, exercise, and any form of activity requiring increased mobility. He also
described unsteadiness of balance and abnormal vision. Dr E noted that the MRI
findings revealed ―a 2cm Chiari malformation with descent of the lower medulla and
cerebellar tonsils up to the level of the C1 posterior arch‖.
18. Dr E concluded that Mr A clearly had an Arnold Chiari malformation 6 which was
symptomatic, and that this would best be managed with a Chiari type decompression
of his foramen magnum 7 to help relieve the symptoms. Dr E noted in his letter to Dr
D: ―I have gone through the details of the procedure with him including the risks and
benefits. I suggest that this be done in the near future so he can get back to daily
activities.‖ Dr E noted the options of having this done privately under his care, or
being placed on the waiting list at the hospital to have it done publicly.
19. Dr E subsequently told HDC that he did not take undertake the consent process with
Mr A at this time, but did state that the goal of the surgery was to relieve the
headaches that came on during physical exercise. He recalls stating that he ―thought
there would be a good chance that [Mr A] would be able to return to [work] [within]
months following surgery‖.
20. The following month, Dr D wrote to Dr E asking that Mr A remain under Dr E‘s care
but be returned to the public system. Dr D noted Dr E‘s previous advice that there was
likely to be a three to six month wait for the surgery in the public sector, and asked
that Mr A be placed on a cancellation list for earlier surgery if possible.
21. Three months later, Mr A completed a preoperative questionnaire. He ticked ―yes‖ to
a question asking if he had ever had asthma, emphysema or chronic bronchitis, and
―yes‖ to having had wheeziness or croup within the past year. He noted that the only
medication he had taken in the previous four weeks was codalgin. 8 Mr A also
completed an ―Application for admission, treatment and investigation as an inpatient‖,
on which he noted he was taking no medicines at the time, and again that codalgin
was the only medication he had taken within the previous four weeks.
22. Mr A‘s mother noted in her statement for the Coroner that as a child, her son had had
ongoing chest and respiratory problems. He had asthma which often led to chest
infections such as bronchitis or pneumonia. She recalls that he was hospitalised about
5 Dr E works in the private sector, and in the public sector for Canterbury DHB.
6 See footnote 1.
7 See footnote 2.
8 Paracetamol and codeine, used to relieve pain.
5 September 2012 4
Names have been removed (except Canterbury DHB and the experts who advised on this case) to
protect privacy. Identifying letters are assigned in alphabetical order and bear no relationship to the
person’s actual name.