The effects of a delay in diagnosis

Delay in diagnosis has unfortunately been quite prominent in recent months. In University Hospital in Kerry a recheck of over 46,000 scans is underway after it was discovered that there were errors found with a number of results. To date, the hospital has acknowledged that seven serious cancer cases were either missed or misdiagnosed.

The timeline of events in University Hospital in Kerry span back to July of last year, when management were alerted about a critical missed cancer diagnosis by hospital staff, which resulted in a delayed diagnosis. Further to this two other patients who had cancer misdiagnoses were identified over the summer months. In August 2017, it was decided by management that a look-back was needed and attention was focused primarily on the work of a previous hospital staff member. The full review of 46,000 scans commenced in October of last year, affecting 26,000 patients. The look back is expected to continue for another few weeks yet. It has been announced that any patients needing urgent intervention during the audit period will be contacted immediately.

Minister for Health, Simon Harris commented:

“My priority is to make sure the hospital has the resources and gets through this as quickly as possible, that’s why we increased the number of radiologists on the review just before Christmas.” He added that once the review was completed (by the end of this month or by the start of February 2018) that he will be meeting with South/South West Hospital group to “find out what lessons need to be learned and are those lessons applicable to other hospitals across the health service.”

The review involves a range of scans, including ultrasounds, x-rays and CAT scans, with the period of query ranging from March 2016 to July 2017 and spans to patients from across Kerry, North Cork and South Limerick.

Unfortunately, the issue of delay in diagnosis and/or misdiagnosis has been an issue in other hospitals in the country. Just last week, a woman who sued over an alleged delay relating to cancer diagnosis settled a High Court action for €700,000. This settlement was made without an admission of liability. The lady is question gave birth to her daughter in late December and the court was informed that the bulk of the settlement is for the child. This lady now has to be tube fed six times a day. The plaintiff’s pregnancy posed a huge risk as her tumour was diagnosed as an aggressive and unusual form of throat cancer. She was suing the HSE and a local GP over the alleged delay in diagnosis of her throat cancer. After repeated visits to her GP and to her local emergency department complaining of ear, nose and throat pain, she was referred to the ENT department outpatient clinic. On her last visit to A&E she underwent a CT scan and a subsequent scan a number of days later. A tumour was then found and confirmed as malignant with chemotherapy treatment following shortly after the diagnosis. It was claimed that there was a failure to diagnose the plaintiff in a timely manner and this allegedly caused a delay in her cancer treatment.

A five year look back conducted by The State Claims Agency last year finding that medicine, maternity, surgery, disability and older persons were the most common services in our hospitals in which clinical incidents were identified. Almost 70,000 incidents related to medicine. There were eight areas that were analysed including mental health, radiology, emergency medicine, cardiology, gastroenterology, respiratory, neurology and infectious diseases. In the review, incidents related to delays were prominent. This included failure to treat or delay leading to an adverse outcome. Incidents that were pertaining to diagnosis, featured in the ten most common clinical incidents in emergency medicine nationally over the period of review. The cost of finalised claims in emergency medicine in 2014 was €12.6m, with an average cost per claim of €395,035.

The authors of the review stated that working in the emergency department ‘presents specific challenges. These include regular overcrowding and shortage of space within which to examine patients, the clinical working environment, and a mix of both surgical and medical emergencies.”

Claims related to diagnosis, including the categoris of failure to diagnose and delay in diagnosis were relatively frequent and combined, were found to account for 19% of the ten most common clinical claims. The authors of the report continued by stating:

“Reducing the number of clinical incidents and improving patient safety is a goal shared by all. This report aims to help achieve this goal by identifying adverse clinical incidents’ trends and focusing on areas for improvement.”