North Shore Hospital report - New Zealand Doctor

Health and Disability Commissionersituation with the infectious diseases specialist, in particular that his sputum hadcultured the organisms Pseudomonas and H. influenzae, as well as Pneumococci thatwere resistant to penicillin. The medical registrar was advised to start Mr D on theantibiotic ciprofloxacin.At 10pm, the family were notified that their father‘s condition had deteriorated. Hewas moved to a side room and reviewed by the on-call house surgeon, but no changewas made to the treatment plan.Mr D‘s second daughter, (who lives in another region), visited her father for the firsttime on 16 October after being phoned by her sister, who said their father had had a―turn‖. When she arrived she was upset at his condition.Transfer to private careOn 16 October, Mr D‘s second daughter and her husband insisted that the doctorsmeet the family because they had received ―mixed messages‖ from different staffmembers. The daughter believes that her mother had not been given all the facts aboutMr D‘s condition at this time. The daughter asked the medical registrar at the meetingwhat her father‘s ―full diagnosis‖ was. He provided information (eg, about Mr D‘senlarged heart) about which the family were unaware. The daughter said that when hetold her and her family that Mr D needed to be in the hospital to be built up andrehabilitated, he did not realise that he was talking to a person ―who had years ofexperience in palliative care and the dying‖. The daughter alleges that the family wasmisled about the rationale for the prescription of the hypnosedative zopiclone for theirfather. Mr D‘s wife was told that the drug would keep him comfortable and notdistressed, but was not told that it would ―knock him out‖ and cause him to have―psychotic dreams and fuzziness‖.Mr D‘s daughter stated that she, not the medical registrar, suggested Mr D betransferred to a rest home or private hospital. She said, ―I had to get him out of there,when I witnessed the lack of cares and integrity [of the staff].‖A social worker met with the family later that day and noted their anxiety about howto manage Mr D at home if he improved sufficiently to be discharged, and wanted to―explore the options‖ for supporting his wife.Mr D‘s daughter stated that it was discovered, at this time, that her father had a large,painful pressure sore on his sacrum, which was only attended to when she brought itto the attention of the nursing staff. However, the only pressure sore recorded in theclinical records is the one noted on 28 September, which was relatively minor andmanaged.On 17 October, following discussion with the AT&R physician and the medicalregistrar, Mr D was seen by the AT&R Clinical Nurse Specialist. She noted that MrD‘s condition had deteriorated and was not expected to improve, although the medicalteam did not consider him, at that time, to be palliative. Mr D‘s family were advisedof his condition and that, as his care needs were very high, private hospital care wasthe preferred option for ongoing care. Mr D‘s daughters made enquiries that day about26April 2009