Page Section: Centre Content Column

Other health services

Problem with methadone clinic

Agreement with Ambulance Service regarding care following seizures

Fulfilling the needs of the consumer

Private surgery

Return to pharmacy

Medication risks during pregnancy

Hospice think tank helps achieve resolution

The importance of being listened to

Charges for prescriptions

Being listened to

Providing support at a GP visit

Changing to a new GP

Care provided in a hospice

Missed diagnosis

Prescription of antibiotics following surgery

Regular eye tests for intellectually disabled man with diabetes

Delayed diagnosis and poor communication

Being taken seriously by a GP

A GP's lack of consumer-centred care

Co-operation between providers of palliative care

Dealing with POW grief and an ambivalent GP

Assistance with communication at outpatient clinic

Provision of complusory medication

Learning from mistakes

Treatment at accident and medical centre

Hospice care

Learning from a mistake

 

 

 

Problem with methadone clinic

A mother of five children who had been part of the methadone programme for a number of years, contacted Advocacy as the clinic had abruptly stopped her 'takeaways' following an allegation that she had been selling her medication.

The advocate assisted the woman to write letter to the clinic, in which she strongly denied the allegation, expressed concern that it had been taken as fact and that had not been given the opportunity to discuss or defend the allegation.

The change to the pickup of her medication had a financial impact upon the family as well as the children being exposed to a part of her life she did not want to share with them.

The woman requested the opportunity to meet with clinic staff with the advocate for support. At the meeting, the providers explained their responsibilities and the guidelines and protocols within which they are required to work. They discussed an action plan that would allow the woman to return to her previous regime as quickly as possible.

Following the meeting the woman said she was happy that she had been heard. She was committed to following the action plan to speed the reinstatement of the original regime and restore normality to her family.

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Agreement with ambulance service regarding care following seizures

A consumer requested advocacy support to assist her to reach an agreement with St Johns ambulance staff. The consumer suffered from seizures and wore a medic alert which gave information about not needing hospitalisation following a seizure. Often, when a seizure occurred in a public place, members of the public would call the ambulance and she would be taken to hospital unnecessarily.

The consumer felt that if St Johns understood that her seizures only required quiet time to recover and not a trip to the hospital, it would improve the situation for everyone involved and conflict would be avoided.

With advocate support the consumer wrote to St Johns and they were able to reach an agreement on how to manage the situation. The consumer decided to carry the care plan with her at all times. 

The consumer was delighted that the ambulance service took her care plan on board and have even gone the extra mile by making sure she has a place to go after a seizure.  The consumer told the advocate that since this was so successful she was going to use the same method for other organisations she has frustrations with.

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Fulfilling the needs of the consumer

A consumer, who had been on the methadone programme for 10 years, discovered he had Mäori ancestry. As a result of contact with his whänau, a weekend at his home marae in another part of the country was organised so he could be introduced to his whakapapa, maunga and customs. He was unsure of the exact date but told the provider it would be within the next month and asked for alternative arrangements to get his methadone, to which the provider agreed. When a date was confirmed he contacted the provider only to be told he had not given sufficient notice.

The consumer decided he would like advocacy support at a meeting with his doctor and case manager, and asked the advocate to organise the meeting. The consumer explained how he felt he was treated like a naughty boy unable to make any life decisions because of mistrust, and mentioned his clean record. The provider acknowledged his concerns and record, and explained they have the discretion about whether "takeaway" is allowed. The doctor also explained that they had thought he would be staying on the marae and were concerned about the risk to others who may try to steal his medication.  The consumer responded saying he was going to visit the marae but was staying with his grandfather, and would have provided this information if asked. 

The consumer advised he had another trip planned and asked if he could get "takeaway" for that. The provider agreed, with the proviso the consumer submitted his planned itinerary as soon as possible and could prove he had a secure place to keep his medication.

The provider also committed to

• ensuring arrangements for pick-ups at out of town chemists are well organised so people can get their medication,
• looking at their processes for gathering information from clients wanting to apply for "takeaways",
• putting the onus on the provider to ask the right questions to get the correct information to determine important decisions that affect the consumer.

The consumer was very happy with the outcome.

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Private surgery

Surgery ~ Private care ~ Hidden cost ~ Right to be fully informed ~ Right 6(b)

A consumer contacted an advocate as she felt she had not been fully informed. She had chosen to have an operation in private and had agreed to the costs presented to her in advance.

However after the surgery she was required to wear a 'moon boot' which cost $280.00. This was an additional cost she had not been told about.

After considering her options the consumer decided to approach the provider directly. The provider advised that as most surgery done privately is paid for by ACC or private medical insurance he hadn't thought to mention the cost.

He then advised that it wasn't really necessary for her to have the boot and took it back agreeing to give the consumer a credit. The consumer was happy with this outcome.

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Return to pharmacy

An elderly consumer contacted an advocate with a complaint about her local pharmacy. The pharmacy had recently come under new management and she felt that some staff were disrespectful in their manner towards her.

The consumer had recently been prescribed new medication by her GP and was apprehensive about returning to the pharmacy, but had no other option as it was the closest to her home. After discussing her options she thought that a phone call to the manager would be the best way to resolve her concerns. She did not feel she could do this herself and asked that the advocate ring to inform the manager of how she felt about returning.

The consumer returned to the store and felt that her concerns had been successfully dealt with. The manager invited the advocate to do some training with staff around the code.

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Medication risks during pregnancy

A woman visited a locum GP complaining of a fungal infection of her foot. He prescribed an eight-week course of fluconazole (Diflucan). Several weeks later, the woman found out that she was pregnant. Her usual GP informed her of the possible risks of fluconazole during pregnancy. The woman and her husband concluded that the risk was too high and they reluctantly decided to terminate the pregnancy. The woman said that if she had been informed from the beginning of the risks she would never have put herself in the position of becoming pregnant while on that drug.

An advocate arranged a meeting with the GP and the woman. At the meeting the woman stated that she accepted that the GP had not deliberately prescribed something that could harm her unborn child. She wanted him to understand the effect of the termination on her and her family, and expressed her hope that others would not have to go through the same experience.

The GP had prescribed fluconazole for a number of years and had not been aware of the possible risk during pregnancy. He stated that the current New Ethicals Catalogue listed pregnancy as a "precaution" in the use of fluconazole, but previous years' New Ethicals had carried no such warning. He provided her with a copy of his revised information sheet on the use of anti-fungals, and agreed to refund her consultation fee.

He expressed his concern that it was difficult for GPs to stay abreast of changes in prescribing information, as there was no reliable method of alerting GPs to changes in New Ethicals. Following the meeting, HDC informed the Medical Council, Medsafe and the Royal NZ College of General Practitioners of the circumstances surrounding the complaint so that they could take appropriate follow-up action.

Both parties were happy with the outcome of the meeting.

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Hospice think tank helps achieve resolution

A woman whose husband had recently died at the local hospice after a long illness contacted an advocate about her concerns. She had kept an up-to-date journal recording her concerns about her husband's care. Despite the concerns, she made it clear that without exception all the hospice staff had been kind and caring.

Her concerns included:

1. incorrect prescribing and delivery of medications on a number of occasions
2. A lack of careful observation and basic nursing care
3. A repeated failure to meet her husband's needs causing unnecessary and avoidable distress to them both

She had only contacted advocacy after receiving a poor response to her letter to the Hospice Manager. She felt they had failed to own the problem, had minimised her concerns and had not even reviewed their processes.

She wanted to be reassured that the problems she and her husband had encountered would not happen again.

During the period of working with advocacy and considering her options, the hospice rang to invite her to be part of a think tank meeting. They thanked her for being the catalyst in setting up this meeting which was to look at all their processes to see what could be improved. For this person it was a much-needed affirmation that her concerns were validated and her complaint had been heard.

Although the advocate, in this instance, did nothing more than speak with her on a number of occasions, the woman made it very clear that having someone on her side at a very difficult time had helped her have confidence in the complaint process as well as with grieving..

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The importance of being listened to

A woman contacted an advocate to make a complaint about the midwife who provided her maternity care. Sadly, her baby had died and the woman believed this to be a direct result of the midwife taking no notice of her concerns that something was wrong. The woman felt that had the midwife listened to her, acknowledged her previous birthing experience, acted on comments that this pregnancy felt very different from her other ones and that it didn't feel right and called an obstetrician earlier that her baby would be alive.

Both the obstetrician and midwife provided explanations and an account of what had happened. Despite her grief about the loss of her baby, the woman felt 'lighter' having had the opportunity to tell her story and hear the accounts from the two health professionals involved.

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Charges for prescriptions

A locum saw a young woman who needed a prescription for her epilepsy. While there she asked for a prescription for her children. The doctor did three prescriptions for the children but was told to make another appointment for her epilepsy medication. She did this despite although her family could not afford the additional cost. When her partner picked up the medication he discovered that the epilepsy medication was incorrect and that despite all three scripts for the children being for the same thing he was to be charged $5 for each of them. He contacted the medical centre to discuss this and while speaking with the receptionist brought up the additional visit and associated cost. The receptionist said that he shouldn't complain, as the visits were subsidised.

The woman asked the advocate to contact the practice manager on the family's behalf. The practice manager said that another GP would take on the woman's care until her own GP returned, and that the correct prescription would be faxed to the chemist at no charge. The practice manager would speak to the chemist about the individual charges for the childrens' treatment as prescriptions for the same medication for the same family could be put into one prescription.

The family was impressed not only by the process but by the short time frame in which it had been achieved.

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Being listened to

A consumer felt her GP was not listening to her and that as a result of incorrect information being given to a specialist she had lost her driver's license.  She decided that the best option was to obtain services from a new GP but requested advocacy support at the first consultation where she intended discussing all the medical issues she felt had not previously been addressed.

The new GP listened, completed forms and referrals to specialists as requested, then reviewed and reduced the consumer's medication. The consumer left the consultation feeling she had been heard, and that appropriate actions had been taken by the new GP.

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Providing support at a GP visit

A man visited his GP on a number of occasions for sores on various parts of his body. On two occasions surgical intervention was required to drain the sores. While the GP had given the man an explanation of the cause of the sores, it was in medical terms which  consumer didn't understand. He was too embarrassed to ask for clarification, and asked for advocacy support at his next appointment.

With this support, the consumer felt able to ask for an explanation in simple terms. The GP told him how he could care for the sores himself, and the GP offered a specialist referral if necessary.

The consumer called two weeks later to say his skin was looking great and he was delighted that by simply changing towels daily and using an antiseptic soap he was able to leave the house without embarrassment. He felt he did not need specialist intervention and was grateful for the support he had received from the advocate.

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Changing to a new GP

A consumer felt that the service she was getting from her GP of twenty years was not what she desired. She had requested a change via the receptionist and this had not been acted upon. The consumer did not want to lay a complaint as she lived in a community where there were few options for medical care.

The consumer discussed the options with an advocate, and chose to write to the GP of her choice at the practice requesting she be taken on as a patient of that GP. She felt confident that her request would be met and thanked me for my assistance.

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Care provided in a hospice

A woman contacted advocacy following her husband's death in a hospice.  Her husband had been in considerable pain and the family had worked with the hospice to provide care which they were very happy about.

On one occasion, however, a nurse requested the family leave while she provided a bed bath for the man. When they heard him screaming they returned to see what was happening, but again the nurse requested they leave, which the family found very distressing.

Following the man's death, his wife lodged a complaint with the hospital about the care provided by the nurse. She was contacted by a manager and invited to meet to discuss her concerns. The complainant sought advocacy support, and prior to the meeting they discussed the meeting process, what the woman wanted as a result of the meeting and what support an advocate can provide. The woman was very clear that she was seeking an apology, and that she wanted the nurse to either receive further training or to be stopped from providing care in a hospice.

The manager acknowledged her concerns, provided an assurance that the nurse would receive further training and offered an apology. The consumer was happy with the outcome. 

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Missed diagnosis

A young mother in her early twenties contacted advocacy as she had recently been diagnosed as having stage 4 bowel cancer with a prognosis of twelve months to live. She had been a patient at the same medical centre for eight years, and had repeatedly requested her general practitioner take her health concerns seriously (bloated stomach and problematic/painful bowel).

After discussing the options available, with the support of an advocate she sent a formal letter of complaint to the medical centre informing them of the recent diagnosis. She requested a copy of her full medical history. She wanted her diagnosis and treatment as managed by her GPs to be recognised as inadequate, and a formal apology.

The practice manager responded immediately providing her medical records, acknowledging the inadequacy of diagnosis and treatment, and providing a formal apology, which the consumer accepted.

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Prescription of antibiotics following surgery

Following nasal surgery, as a result of an infection, a consumer was prescribed a 14-day course of antibiotics by her GP. The GP told her that a referral would be made back to the hospital if the infection did not clear.

She returned to the medical centre ten days later, and was seen by another GP who prescribed two different antibiotics to be taken during the following two weeks, and told her to return if there was no improvement. She returned at the end of the two weeks and was again prescribed antibiotics, and told to return in three weeks.

On the fourth visit the consumer informed the GP that she had had a cold resulting in her being off work for four days, and was very mucousy and had pain below her eye. She was prescribed Rifampicin, which the GP explained is normally given to patients with tuberculosis, but can assist with deep tissue infections. He referred her for an x-ray. The consumer asked about the possibility of a CT scan but was told an x-ray would be sufficient. She was advised to return in 2-3 weeks if the matter had not resolved.

Following this consultation the consumer contacted an advocate as she felt she should have been referred back to the Hospital Ear Nose and Throat Department (ENT). After discussion of the options, the advocate supported the consumer to write to the GP asking for a referral to ENT, for a copy of medical notes made during the consultations and an explanation of why a CT was not ordered.

The GP responded that he would need to see the consumer again to complete a referral to ENT and that this visit would be free. He explained that a CT scan can only be requested by a specialist. The consumer was satisfied with the response of the provider and took up his offer.

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Regular eye tests for intellectually disabled man with diabetes

At the suggestion of an eye specialist, a complainant contacted the local advocate to discuss her concerns about the care of her intellectually disabled son. Her son had type II diabetes and over a nine-year period the GP had not checked his eyesight. The complainant had noted her son's eyesight deteriorating and within a month the consumer underwent an operation. He had a second operation a month later and vision was partially restored.

The complainant believed the failure to check the consumer's eyesight was because of her son's intellectual disability and that had appropriate action been taken by the GP her son's eyesight may have been saved. Losing his eyesight compromised the his ability to be independent.

The complainant said she wanted an explanation from the GP as to why he did not perform regular eye tests. She wanted a face-to-face meeting with the GP, preferably in her own home to minimise disruption for her son, and with the support of another of her sons. The consumer agreed he wanted his mother to raise the complaint for him.

With the support of the advocate, the complainant wrote a letter to the provider outlining her concerns, requesting a meeting in her home. The provider agreed, and advised they would have another doctor with them for support. The complainant was happy with this.

The complainant opened the hui with an explanation of how her son's blindness had impacted not only on himself, but her whole family.  As she became upset, the consumer sat by her and consoled his mother. The consumer's brother took over, advising the family felt very let down by the service and wanted an explanation as to why the consumer had not had regular eye checks since his diagnosis of diabetes.

The GP was very apologetic and the senior doctor acknowledged that the service had let them down. He said they were reviewing and updating procedures as a result of receiving their letter of complaint.  

The GP explained that when the original referral for the consumer was sent, the section relating to the eye test had not been completed, and as a result the referral was returned and no further action was taken. The doctor said they now had implemented a system where returned referrals would be brought to the attention of the appropriate GP to enable them to take further action. They agreed, within a week, to complete the necessary paperwork for a treatment injury claim under ACC for the consumer. 

At the end of the meeting, the complainant thanked the doctors for their time, said she was now ready to move forward, and athat she accepted their apology and their mistake. She explained she did not want any other family to go through what they had had to go through.

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Delayed diagnosis and poor communication

A consumer saw her GP about a lump on her leg, and was sent for a scan. The radiologist advised she may need a biopsy. The GP made a referral to the hospital. However, she was told that as she would not be seen within six months, and her GP arranged for her to be seen privately.

Following the scan, the specialist advised that he thought the lump was harmless but referred her for further tests including an MRI. The MRI confirmed the specialist's diagnosis that the lump was harmless and despite her leg becoming increasingly painful she did not worry. Later the same year she had a routine mammogram and was diagnosed with breast cancer which was operated on two months later.

Her pain in her leg increased as the lump continued to grow. Eighteen months after she had first seen her GP about the lump, she was referred back to the first specialist who had been so reassuring and had another MRI. The consumer then asked her GP to refer her to another specialist who requested an urgent biopsy be done. The lump was found to be cancerous and was removed within a month. While in the hospital she had a chest CT scan.

The consumer read her discharge summary when she got home and discovered there were nodules in her chest and her prognosis was not good.  She had not been given any of this information while in the hospital, or prior to her discharge.

When the consumer spoke with the advocate she was clear she wanted an explanation and an apology for the distress that was caused by her experience and because an incorrect/delayed diagnosis had led to her having a shortened life-span.  She wanted to know how this had happened. She also wanted an apology from the public hospital that had discharged her with no discussion about her situation, leaving her to learn about it from reading the discharge summary.

With the assistance of an advocate a letter was sent to the providers involved in her care and treatment. The hospital responded with an apology in writing and a staff member made contact by phone to discuss the issues. The consumer felt that this issue was resolved and that she had received a genuine apology.

The response letters from the other providers did not answer her questions and as a result she requested the advocate assist her to refer the matter to the Commissioner.

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Being taken seriously by a GP

A consumer contacted an advocate for information about her rights, as she felt her GP was not listening to her.  She had requested a referral to a specialist as she felt the medication the GP had prescribed for her skin condition was not helping and he was not taking her concerns seriously. She also had a very sore wrist and although he had referred her for an X-ray he did not provide any pain relief. She attempted to contact the Practice Manager but had the feeling no-one wanted to deal with her. She said she wanted the GP and others in higher positions in the practice to know how she felt.

After considering the options the consumer asked the advocate to set up a meeting with the provider. The provider organisation advised that those attending the meeting would be the human resources manager, the business support person, and the quality assurance manager. This information was relayed to the consumer who said she was happy to meet with them.

At the meeting the consumer spoke about her concerns and how she was feeling. Those present listened, acknowledged her concerns and apologised. They also apologised for the delay in meeting with her.

At the conclusion of the meeting the consumer said she was pleased to have had the opportunity to raise her issues in a face-to-face meeting. She said she felt empowered by the process and pleased to have been treated with respect.

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A GP's lack of consumer-centred care

A woman wrote to the GP who provided care to her recently deceased father, outlining some concerns.  She had attended a GP appointment with her father when he complained of decreasing mobility and ongoing vomiting. The daughter felt the GP had not taken the symptoms seriously, as her father was sent home. Four days later, when his condition worsened, both he and his wife left messages at the medical centre requesting either the GP or his nurse call back. Neither of them returned these calls. In the end the daughter called an ambulance, her father was admitted to hospital and died two days later.

When he received the complaint, the GP contacted the daughter and said he was willing to meet. He suggested she may wish to contact the advocacy service to have the support of an advocate at the meeting and gave her the contact details. She contacted the local advocate and they discussed the matters she had raised in her letter of complaint to the doctor. These included the GP's failure to:

1. look at her father when speaking even though he was aware of her father's significant hearing loss,
2. refer to the consumer's medical records, as well as his lack of knowledge about his past medical history,
3. take the consumer's symptoms seriously, meaning he didn't get the referral to hospital he needed,
4. return calls left at the medical centre despite being advised of the need for urgency in responding.

She wanted an apology from the GP as well as an investigation into the communication practices at the medical centre to see whether the calls not being returned were due to a system error.

The advocate supported the consumer's wife and his daughter at a meeting with the GP and Practice Manager. The Practice Manager confirmed the phone system had not been working that day and said the matter was being looked into to see what improvements could be made to prevent the problem happening again. The Manager apologised for the telephone failures.

The GP said he had been very busy on the day he saw the consumer. Upon reflection he acknowledged that he may not have been facing the consumer throughout the consultation so he missed seeing the extent of the consumer's pain. He also apologised and advised that he had identified ways he could improve aspects of his practice. He sought permission from the family to use this situation as a learning experience with his colleagues. Permission was given willingly.

The family was very satisfied with the outcome of the meeting and was pleased their concerns had been heard and improvements made as a result of their complaint.

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Co-operation between providers of palliative care

A consumer receiving palliative care support from her local hospice for multiple health issues contacted an advocate for help to stay at home. She had been admitted to hospital when her health deteriorated but had got no response to requests for information about what support was available for her to stay in her own home. She requested advocacy support to meet with the NASC, Hospice and medical staff to discuss her concerns and get co-operation between the providers involved in her care.

As well as the lack of co-operation, her complaint highlighted:

• Inadequate information about support services and equipment from the NASC including respite options and costs.
• Lack of information about options for support in her current situation.

The consumer wanted sufficient information to make informed decisions about her ongoing care and was frustrated that her wishes to stay in her own home had been ignored by the Hospice and NASC, despite having the support of her family.

The advocate supported the consumer at the meeting. Her questions were answered and she was discharged from hospital to her own home with the appropriate support. The consumer was very happy with this outcome.

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Dealing with POW grief and an ambivalent GP

A former prisoner of war complained to an advocate that his GP was not listening to him. He said the GP had dismissed requests for further referrals suggested by the specialists screening him for Veterans Affairs.  It had taken this man 60 years to speak up about his days as a POW and he felt belittled by the GP's remarks about his past history.

He had suffered several severe chronic conditions, both physically and mentally, most of his life. He was keen for these conditions to be finally recognised as a result of his POW days and the information used for statistical and historical purposes.

With the support of the advocate and the knowledge of his rights, he was able to insist on further examinations which led to his conditions being recognised. He finally felt listened to and that he was getting recognition for the grief he had suffered over the last 60 years. 

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Assistance with communication at outpatient clinic

Surgeon ~ Outpatient clinic ~ Communication

A consumer sought advocacy support for her next appointment at an outpatient clinic, as she felt the surgeon was not listening to her. She also wanted to discuss what the next step in her treatment would be as she had been unwell for eighteen months and still had no diagnosis.

The advocate assisted the consumer to document her symptoms so she was able to provide the information to the surgeon. At the appointment the consumer provided her notes to the doctor which he read, and he then listened to her concerns. The consumer thanked the advocate for supporting her and said she felt the presence of an advocate had made a difference to the doctor's communication.

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Provision of compulsory medication

Public health ~ Tuberculosis ~ Compulsory treatment order ~ Respect

A young woman phoned advocacy with concerns about a compulsory treatment order which required her to take medication in front of a public health nurse at her place of work. Some months earlier she had been diagnosed with TB and as a result was referred to the Public Health Section for Communicable Diseases.

The consumer was concerned that she was required to leave whatever she was doing to meet the nurse outside the grounds to receive the medication. She also felt her privacy was being compromised as her employer did not know that she had tested positive for TB.

The consumer sought advocacy assistance to request she be able to self medicate, or if that was not possible then requested the public health nurse change the time she delivered the medication so the consumer would receive it after work, at her home.

At the request of the consumer, the advocate sent an email to the Public Health section and asked that they reconsider their treatment order and allow the consumer to self medicate. In response, the advocate received a call from the registrar who advised that she was going overseas for a week and that she would get in contact on her return.

As agreed, the registrar phoned on her return and advised that she would set up an appointment with the consumer to do more tests, in the hope that she would not need to take any further medication.  The consumer was elated with the response and attended the appointment. Following the appointment the consumer advised the advocate she would only require medication for another month and that as requested, the medicine would be delivered to her at her home.

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Learning from mistakes

Mrs C saw Dr D, who was not her usual GP, complaining of a fungal infection of her foot. Dr D prescribed an eight-week course of fluconazole (Diflucan). Several weeks later, Mrs C found out that she was pregnant. Her usual GP informed her of the possible risks of fluconazole during pregnancy. (Medsafe advises that fluconazole should be avoided in pregnancy except in patients with severe or potentially life-threatening fungal infections, in whom fluconazole may be used if the anticipated benefit outweighs the possible risk to the foetus. There are no adequate studies of the effects of fluconazole during pregnancy. Congenital malformations have been seen in a few babies whose mothers had high dose treatment (>400 mg/day) in early pregnancy, and in animals exposed to toxic doses.)

After weeks of agonising decision-making Mrs C and her husband concluded that the risk was too high and they reluctantly decided to terminate the pregnancy. Mrs C complained to HDC: "If I had been informed from the beginning of the risks I would never have put myself in the position of becoming pregnant while on that drug. I am hoping something can be done to make [Dr D] more diligent while prescribing drugs that could possibly change people's lives forever."

Face-to-face meeting
The complaint was referred to a patient advocate, who arranged a meeting with Dr D and Mrs C. At the meeting Mrs C stated that she accepted that Dr D had not deliberately prescribed something that could harm her unborn child. She wanted Dr D to understand the effect of the termination on her and her family, and expressed her hope that others would not have to go through the same experience.

Dr D advised Mrs C that he had prescribed fluconazole for a number of years and had not been aware of the possible risk during pregnancy. He stated that the current New Ethicals Catalogue listed pregnancy as a "precaution" in the use of fluconazole, but previous years' New Ethicals had carried no such warning.

Dr D provided Mrs C with a copy of his revised information sheet on the use of anti-fungals, and agreed to refund her consultation fee.

During the meeting, Dr D expressed his concern that it was difficult for GPs to stay abreast of changes in medicine prescribing information, as there was no reliable method of alerting GPs to changes in New Ethicals. Following the meeting, HDC informed the Medical Council, Medsafe and the RNZCGP of the circumstances surrounding the complaint so that they could take appropriate follow-up action.

Both parties were happy with the outcome of the advocacy meeting and the complaint file was closed.

In this case, both parties were genuinely willing to try to resolve the issues raised by Mrs C's complaint. The face-to-face meeting gave Mrs C an opportunity to raise her concerns with Dr D and to explain the impact of the experience on her and her family. The meeting allowed Dr D to explain the reasons for his actions, and to provide Mrs C with an assurance that he had taken appropriate steps to protect future patients. The issue of frequent changes in prescribing information could not be fully addressed between the parties and was brought to the attention of the relevant agencies.

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Treatment at accident and medical centre

Accident and medical centre ~ Self-advocacy ~ Respect ~ Appropriate standards ~ Effective communication ~ Complaint process

A consumer went to the local accident and medical centre for treatment after binge drinking. The doctor who was treating him became very judgemental, telling him he was a 'drug seeker', and writing this on the medical notes. The consumer had had previous treatment for binge drinking and knew what worked for him. He was not seeking drugs and felt very offended by the doctor's attitude.

The consumer initially took his own action by writing a letter of complaint to the director of the accident and medical centre. After failing to get a response to his complaint he contacted a local advocate.

The consumer asked the advocate to write a letter to the director on his behalf, to remind him of his responsibility in relation to right 10 (the right to make a complaint and receive a timely response). A copy of the consumer's original complaint letter was included.

The consumer's letter of complaint outlined the following issues:

1. He felt that the doctor he had seen was rude and disrespectful towards him, judging him as a 'drug seeker' and writing this on his medical notes.
2. The doctor did not actually examine him.

He also advised the outcome he was seeking:

1. An explanation and apology for what had occurred.
2. A refund of the $65 treatment cost, as the doctor had not examined or treated him.
3. The words 'drug seeker' removed from his medical notes.

The director responded in writing to the consumer with a sincere apology and an offer to meet in person, with the support of the advocate. The director said he had removed the drug-seeking behaviour caution from the system and agreed to refund the fee for the consumer's visit.

The consumer decided not to meet as he was extremely happy with the written response. He thanked the advocate for the professional and empathetic way that his complaint had been handled.

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Hospice Care

End of life ~ Standard of care ~ Medication errors ~ Accountability ~ Self advocacy

Advocacy support was sought by a woman whose husband had recently died at the local hospice after a long illness. She had kept an up-to-date journal and was able to use this to articulate her concerns about her husband's care.

She was clear that without exception hospice staff had all been kind and caring. However, her concerns related to what she considered as part of basic requirements - incorrect prescribing and the administration of wrong medications, a lack of careful observation and inappropriate nursing care. She felt there had been many instances when her husband's needs had not been appropriately addressed. As a result they had both experienced avoidable and unnecessary distress.

By the time she contacted advocacy, she'd written a very detailed letter to the hospice manager. She was seeking reassurance that the problems she and her husband had encountered would not happen to someone else. She was very disappointed with the response and felt the service had failed to own the problem, had minimised the issues and had not reviewed their processes.

However, during the period of discussing the 'next step' options with the advocate, the hospice rang to invite her to be part of a think tank meeting. They thanked her for essentially being the catalyst for the meeting which was to review their processes to see what could be improved.

For this woman, it was a much-needed affirmation that her complaint had been heard and acted on.

Although the advocate did nothing more than talk with her on a number of occasions, she made it clear that having this support at a very difficult time had helped her have confidence in making the complaint.

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