Vision loss, harm to newborn, cancer diagnosis delay linked to Covid-19 disruption: DHB reports

A delayed cancer diagnosis and vision loss are among patient harm incidents linked to Covid-19 restrictions, with a newborn needing surgery after lockdown led to a lack of donor breast milk.

The country’s 20 DHBs have begun publishing details of “serious adverse events”, which are generally defined as having resulted in serious harm or death.

Most summaries of events for July 1 2019 to June 30 2020 don’t provide enough detail to determine whether Covid-related measures or disruptions were a factor, however a handful do.

At Counties Manukau, a delay in eye treatment resulted in a “poor outcome” for a patient who was a high priority, given they had vision in only one eye.

They were on a clinic list that wasn’t reviewed as requested, amid “variation in practice across Auckland DHBs with Covid-19 pandemic planning” for patients getting Avastin injections to slow vision loss from diseases including age-related macular degeneration and diabetes.

“There was no audit completed as requested … so it is unknown how many other patients have been compromised,” the report states.

Southern DHB, which covers Dunedin, recorded a number of patient falls, including one resulting in a wrist fracture during lockdown.

Staff had been sent to the emergency department, leaving only three to care for a ward of 28 patients: “Ward areas combined due to Covid-19 meant there was limited staff available. Duty manager aware and unable to assist”.

Another incident led to a delay in cancer diagnosis, with the report stating, “deferred due to Covid-19”.

A baby born in a rural birthing unit died after a delay in transfer to secondary care. There were “discrepancies between perceived information given by the lead maternity carer and the patient’s understanding”, with “significant impact of Covid-19 pandemic and partner restrictions on decision-making by the patient”.

Wellington’s Capital & Coast DHB reported a delay in treatment for a stroke during lockdown.

A premature baby in Wellington Hospital’s neonatal intensive care “received formula due to a lack of supply of donor breastmilk during Covid-19 lockdown resulting in complications that required surgery”. A donor milk pasteurisation and storage facility has since been bought.

The Health Quality & Safety Commission had a total of 975 serious adverse events reported to it for 2019/20, with 627 reported by DHBs.

Some DHBs are yet to release reports. They include Auckland DHB, which has started investigations after four women died during or soon after pregnancy this year, with three happening after level 3 restrictions began on March 23.

One maternal death was recorded in the previous three years.

Reviews into each case are being finalised, and an overarching review will then begin. Auckland DHB says all women had one-on-one care and the causes don’t appear related, but it’s crucial to identify any systemic problems.

While Covid-19 restrictions have been linked to serious harm, they averted hospitals being overwhelmed by coronavirus cases, and avoided other usual harm, such as deaths from flu and reduced road accidents.

However, backlogs and pressure on some services remains an issue, despite Budget 2020 providing a one-off boost of $283 million over three years to clear backlogs.

Child suffers under ‘final letter’ policy

An Auckland child didn’t get free dental treatment over seven years, and needed extensive work when they were finally treated.

The case has been listed as a serious adverse event in the 2019/2020 report by Waitematā DHB, which runs the Auckland Regional Dental Service, providing free dental care to children and teenagers across greater Auckland.

An investigation found there was no proper engagement with the family to ensure the child received timely appointments.

Prior to 2018, if a child didn’t attend two appointments, the service sent a “final letter” advising no further appointments would be made.

Recommendations related to the case included stopping the practice of issuing “final letters”, and to use better systems to monitor children who aren’t brought to appointments.

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