The Health and Disability Commissioner (HDC) has found a GP in breach of the code after she shrugged off a man's neck lump that turned cancerous and resulted in the removal of all his teeth and half a lung.
HDC deputy commissioner Dr Vanessa Caldwell found the GP's management of a lump on a man's neck breached the Code after two appointments in 2021.
Dr Caldwell found the GP failed to urgently refer the man for specialist review or investigation of his neck lump.
It began when the man had difficulty swallowing so went to his medical centre GP twice about it. Dr Caldwell said the lump had been present for around a year, but had increased in size and "become more tender over the preceding three months".
"The GP failed to urgently refer the man to a specialist or arrange for his lump to be investigated," Dr Caldwell said.
"Further, at the man’s second appointment around six months later, the lump was still present and was not explained by other symptoms, but the GP again failed to refer the man for specialist review or provide him with follow-up or safety-netting advice."
Months later, the man moved overseas where he sought further medical advice. Dr Caldwell said a biopsy of the neck lump found it to be a rare cancer - adenoid cystic carcinoma.
The man then underwent two surgeries on his neck, where he had all of his teeth and half of one lung removed.
"The cancer had spread to the lung by the time it was diagnosed."
"His specialist team told him that his lung surgery and the loss of his teeth could have been avoided if his neck lump had been dealt with appropriately 12 months earlier."
Dr Caldwell said there were two missed opportunities to diagnose the man's cancer at an earlier stage.
"I acknowledge that the GP does not disagree that it would have been prudent to have arranged further evaluation of the man’s neck lump at both appointments."
HDC said the GP had very recently arrived in Aotearoa at the time of the man's first appointment, and told HDC she was still learning the processes of a new country.
"The GP accepted there did not appear to be substantial differences between the applicable neck lump guidance in her home jurisdiction, and the applicable guidance in New Zealand."
Dr Caldwell said it was important for a medical centre to ensure the GP was adequately inducted, trained and supported to work in Aotearoa, though she concluded the centre did not breach the code.
"I have seen no indication of a failure by the medical centre in respect of the GP’s induction, orientation and initial supervision. The evidence demonstrates that this was appropriate and in line with the Medical Council of New Zealand guidance."
HDC said the GP has made "several changes" to her practice in response to Dr Caldwell's investigation. The GP will also undertake an audit and write the man an apology.
