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A six-month-old baby with superbug was seen four times in a hospital emergency before being referred to a specialist, as part of a violation of patients' rights.
The Commissioner for Health and Disability, Anthony Hill, found in a report released today that the Waikato District Health Board and an unidentified emergency physician have violated patients' rights.
The boy was rushed to a rural hospital with flu-like symptoms at the end of November 2015. He was diagnosed with a viral illness and was discharged.
His mother then brought him three more times over six days, but he returned for the first time on December 1 with a temperature, a bleeding nose and a rash.
Some of his vital signs were recorded, but no series of observations was undertaken and no observations were repeated. The doctor diagnosed a rash.
Three days later, the baby and his mother were back – he had fever and new symptoms, including a swollen face and an inflamed throat. The baby only took small amounts of food, did not sleep, and cried all night.
A nurse shared her concerns with an Emergency Department physician during this visit, but did not get the impression – in the overall clinical picture of the child – that the changes were significant enough to refute the view that it was a viral disease.
According to Mr. Hill's report, this doctor – "Dr. B" – did not think the baby should be referred to the pediatric ward.
"Dr. B stated that nothing in Baby A's presentation was unusual for a viral infection …"
The next day, the baby's mother brought him back to the hospital emergency at 2 am.
"Baby A cried inconsolably and refused to eat," Hill wrote. "[His mother] reported that the swelling of his lip had worsened during the day. "
It was agreed that the pediatric service should monitor the baby – a 100 km trip at 3 am, left to the mother as the ambulance was not available. Emergency staff did not ask the mother if she was ready or if she preferred to spend the night at the hospital and transfer her ambulance the next day.
At the second hospital, the baby was intubated because of compromised airways and transferred to the intensive care unit.
The superbug MRSA [methicillin-resistant Staphylococcus aureus] was diagnosed and the boy started taking stronger antibiotics. He was transferred the next day to another hospital.
He was also diagnosed with severe sepsis with Ludwig's associated angina and needed the replacement antibiotic for a month.
On January 5th, 2016, the baby left the third hospital due to persistent problems, including partial paralysis or weakness of the facial nerve and an exposed area of bone in the mouth.
Mr. Hill's report stated that the mother had stated "the effect is that, although Baby A is a handsome boy, he looks crooked when he cries or smiles, and nothing can not be done to remedy the situation before the age of about 10 years ".
Repeated presentations of a baby to an emergency department at the hospital are a "red flag," the report noted. Despite the fact that the baby was presented four times, no complete series of observations were made during one of the presentations, and repeated observations were not made two of them.
Nor did staff properly use the Child Emergency Assessment Chart.
These shortcomings meant that the DHB had violated patients' rights for failing to provide the services with reasonable care and skills.
Mr. Hill stated that the baby was seriously ill when he arrived at the hospital emergency on December 4 and that Dr. B did not refer him for a pediatric evaluation. specialized, thus violating the code.
Mr. Hill stated that Dr. B had waived his exercise certificate and that it would revert to the exercise of his skills by the Medical Council.
Waikato DHB has updated its Infant Emergency Assessment Chart since these events to include a section on "red flags". The DHB has also put in place a policy to ensure that during a second emergency visit, children are discussed with the pediatric ward of the other hospital.
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