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Prison Health

Prisoner needing comprehensive assessment

Managing complaints about Prison Health Services

Poor communication leads to complaint

Lack of continuity between prisons

Information needed about chemical burns

Information needed about ongoing treatment and pain management

Clarity needed on hospital referral

Cancer patient ignored by prison staff

No treatment following fall

Help for a prisoner whose medication had been stopped abruptly

Mental health support in prison

A genuine mistake at a DHB

When systems fail

Getting a firm diagnosis

Sudden discontinuation of medication

Terminally ill prisoner

Getting a specialist referral

Misunderstanding about special diet

Appointment for an artificial limb

Mental health support in prison

Access to appropriate services while imprisoned

Difficulty getting a special diet in prison

Overcoming problems getting access to the doctor

Risk of ongoing damage due to delays in getting an urgent referral

 

 

 

Prisoner needing comprehensive assessment

Prison Health  ~ Right 4 ~ Appropriate standards ~ Right 5 ~ Effective communication ~  Comprehensive assessment

A prisoner contacted an advocate about his lack of success in getting medical care for his multiple serious health concerns.  As well as severely decayed teeth he suffered from double vision affecting his eyesight. He also found it difficult to walk and suffered from numbness on his face and left arm.

He felt that the prison health professionals were not listening to him and he was worried that something serious might be developing. He wanted a comprehensive assessment and treatment as soon as possible. 

The consumer asked the advocate to speak to the Prison Health Centre Manager and organise a resolution meeting. He also asked for the advocate's presence at the meeting.

At the meeting, the consumer was able to raise his various health issues which he felt needed urgent medical attentions. After a long discussion, the Prison Health Centre Manager agreed to what the consumer was requesting.

The consumer was happy about this outcome and was smiling when the discussions were concluded on such a positive note.

The advocate contacted the consumer after a couple of weeks to see how things had progressed. He confirmed that he had been seen by both the optometrist and the dentist and that the multi-disciplinary approach was also currently underway. 

He acknowledged that he was pleased with the excellent outcomes achieved with the advocate's support. 

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Managing complaints about Prison Health Services 
General approach to prison health complaints
Upon receipt of a complaint about the Corrections Health Centre, I provide the option of conveying the prisoners concerns by letter.  If this is taken up, I draft the letter and check the content with the consumer making any changes. I then put it on 'Electronic' letterhead, stating that I am writing the letter on their behalf and with their permission and email it to the Health Centre Manager, at the same time sending a copy to the consumer by post.  In the letter I ask for the Manager to respond in writing directly to the consumer and to send a copy to me.
The consumers I have worked with in this way have found this a very efficient and timely way of having their concerns heard and responded to. Upon receipt of a copy of their response I make contact with the consumer to ensure they are satisfied with the response.

Managing complaints about Prison Health Services 

General approach to prison health complaints:  Upon receipt of a complaint about the Corrections Health Centre, I [an advocate] provide the option of conveying the prisoner's concerns by letter.

If this is taken up, I draft the letter and check the content with the consumer making any changes. I then put it on 'Electronic' letterhead, stating that I am writing the letter on their behalf and with their permission and email it to the Health Centre Manager, at the same time sending a copy to the consumer by post.  

In the letter I ask for the Manager to respond in writing directly to the consumer and to send a copy to me.

The consumers I have worked with in this way have found this a very efficient and timely way of having their concerns heard and responded to.

Upon receipt of a copy of their response I make contact with the consumer to ensure they are satisfied with the response.

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Poor communication leads to complaint

Prison health ~ Plastic surgery ~ Oncology services

A consumer in prison required plastic surgery to his hand from an injury he sustained in the community. He complained to an advocate that the prison health service had not given him any information about when this would happen.

He had also been advised by his oncology specialist that he needed a regular colonoscopy to check for 'reoccurring' prostate cancer. He also had no information about whether prison health had referred him for this.

At the consumer's request the advocate wrote to the prison health service and received a copy of the letter to the consumer confirming he had had the hand surgery and that an appointment with the hospital gastroenterology department had been made for the colonoscopy. This was confirmed with the consumer. The letter also noted that they could not give out actual times and dates for appointments outside the prison.

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Lack of continuity between prisons

Prison health ~ Right 4 ~ Cooperation between providers ~ Consistent with needs

A consumer complained to the advocacy service about the lack of continuity between the health services and an appropriate standard of care when he was transferred to another prison. He suffered from multiple conditions including a gastric condition requiring corrective surgery and a special diet as well as bilateral Occupational Overuse Syndrome in his wrists requiring surgery and nerve conduction studies.

During his time in the first prison he was able to access the special diet recommended by his surgeon and had follow up orthopaedic and neurological outpatient appointments organised for him. However he had not been able to organise a similar arrangement at the second prison and had contacted an advocate after receiving an unsatisfactory response from them.

At the consumer's request a meeting was arranged by the advocate to discuss the issues with the medical and unit managers. At the meeting it became apparent that there was some scepticism by the nurse as to whether the consumer actually suffered from these conditions and required the treatment he received whilst in the first prison. However they had also been reluctant to allow the consumer to access the medical officer or refer him for specialist advice to clarify the situation.

They agreed to organise an appointment for the consumer to be reviewed by the medical officer to assess his needs and any special arrangements that needed to be put in place.

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Information needed about chemical burns

Prison health ~ Right 6 ~ Fully informed ~ Chemical burns

A Maori consumer contacted the advocacy service to complain that he hadn't received a clear explanation about the extent of damage caused by chemical burns he received during routine cleaning of machinery. The chemicals had seeped down his arms into the safety gloves he was wearing at the time. He was experiencing burning through the tissues of his hand and it was starting to creep up his arm. Black spotting had also started to appear from the chemical splashes. He had been seen by a specialist at the hospital and was having his wounds dress by the prison health service. He was feeling quite fearful and wanted to know what would happen to his arm.

A representative from the medical team explained that the chemical burns had resulted from not wearing the proper safety gloves and that he had been aware of this at the time. As there had been a mixture of chemicals that he had come into contact with, the current treatment regime was all that could be offered. He was also told that if his condition worsened they would transfer him back to the hospital.

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Information needed about ongoing treatment and pain management

Prison health ~ Right 6 ~ Fully informed ~ Pain management

A consumer complained to an advocate that despite following the correct procedure required by the prison health service, he had not been seen by the doctor. He needed to discuss his treatment and pain management for symptoms while waiting for surgery. He was also concerned that he had not been advised of the approximate time he would have to wait before being seen by the hospital surgeon. After discussing the options, the consumer asked the advocate to contact the Health Centre Manager in writing on his behalf.

The consumer and advocate discussed what should go in the letter - which included a request for the response to go directly to the consumer, with a copy to the advocate.

The consumer received a positive response. He was seen by the GP soon after and given information on ongoing treatment and pain management for his symptoms. He was also given information on an estimated timeframe for his surgery. He was happy with the outcome and thanked the advocate for supporting him to raise his concerns with the Prison Health Centre Manager.

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Clarity needed on hospital referral

Prison health ~ Right 6 ~ Fully informed ~ Chemical burns

A consumer sought the help of an advocate to find out what had happened to his referral. He was experiencing pain and discomfort from an abdominal hernia which also affected his mobility. He had been seen by the prison doctor three weeks previous. The doctor told him that a referral would be sent to the local hospital requesting an appointment with a specialist. He had not heard anything since his appointment and felt his concerns were not being taken seriously by either the doctor or the hospital.

After considering the options, the consumer asked the advocate to make contact with the Prison Health Centre Manager to establish what had been done since his visit to the doctor three weeks earlier.

The Prison Health Centre Manager confirmed that a referral had been made to the local hospital on the day the consumer saw the doctor, although no appointment had been received from the hospital. When the advocate contacted the consumer to pass on this information he said he felt reassured his health concerns had been taken seriously by the health centre and that he would contact the advocate if he required further support.

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Cancer patient ignored by prison staff

Prison Health ~ Radiotherapy ~ Pain relief ~ Fortisip ~ Right 4 ~ Appropriate standards ~ Co-operation between providers

At the request of a family member, an advocate contacted a consumer in the local prison. He was undergoing radiotherapy treatment for cancer, had poor health and was losing weight because he was often unable to eat. He was also in a lot of pain. He had many concerns about his care on a number of occasions and felt prison staff would not listen to him. His sister was very concerned about his situation and had been the one to contact the advocacy service.

The consumer's key issues were:
1. The way in which his nutritional supplement (Fortisip) was being administered. It came in a powder form and was supposed to be mixed with water, however it was often lumpy and of a glue like consistency. He found it too hard to swallow and because of this he was not consuming it.
2. The prison staff did not always follow the hospital's recommendations in regards to his medical care and treatment
3. His pain medication was inadequate so he often woke during the night in pain.

As he was bedridden and very unwell, the advocate offered to send a letter to the prison health service on his behalf. The consumer agreed and relayed the main points he wanted in the letter.

The prison responded five days later. In their response they reassured the consumer they would be working closely with the hospital and would be following recommendations from the hospital regarding his care in future.

They agreed to provide him with a pre-mixed version of liquid fortisip. His pain medication was reviewed by the prison doctor and a more suitable slow release option was prescribed.

The man was satisfied with the outcome. He said that since the letter had been sent to the prison health service, his care and general support had improved.

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No treatment following fall

Prison health ~ Fall ~ Fracture ~ Right 4 ~ Appropriate services

A consumer contacted an advocate because five months previously, as a result of a fall, he had concussion and had injured his toe. His ongoing pain was not taken seriously so he received no medical treatment and his injuries were not followed up, despite the pain and requests for an x-ray.

The advocate spoke to the consumer about how he wished to progress the matter and supported him to write a letter of complaint requesting information and a treatment plan.

The consumer believes that as a consequence of his seeking assistance from the advocate he finally had an x-ray which revealed a fractured toe. As a result of the x-ray he is receiving ongoing treatment at the fracture clinic for the toe injury. 

He was very happy with the progress made by involving the advocate and chose to make the Health and Disability Commissioner aware of the fact that the provider did not listen to him or take his concerns seriously until he sought advocacy help.

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Help for a prisoner whose medication had been stopped abruptly

Prison Health ~ medication~ right 6 ~ fully informed

A woman prisoner contacted an advocate after a medication she should have been weaned off had been abruptly stopped. Although she had filled in the appropriate form to see the doctor she had not heard anything and was becoming anxious. After considering her options she asked the advocate to contact the Health Centre Manager and alert them to her situation.

The Health Centre Manger confirmed that she was aware of the situation and that she had a scheduled appointment at the Health Centre the following day. At this appointment she was advised that the medication had been stopped because it was addictive. Because of this it would not be reinstated so she was offered an alternative medication she had previously refused.

Although she was unsuccessful at getting her medication reinstated she was happy to have had advocacy support to raise her concerns and be given the opportunity to discuss these with staff at the Health Centre.

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Mental health support in prison

A prisoner contacted the advocacy service saying the judge who sentenced him had said he was to have help from the local forensic mental health team. However, nothing seemed to be happening and he was becoming quite stressed about it. He had seen someone on one occasion earlier on in his sentence, but they had not come back as promised, and he couldn't remember who they were. He had asked within the prison what was happening but had been unsuccessful in getting an answer.

The advocate spoke with the prisoner and described what he could do. It was agreed the advocate would email the team leader of the medical unit to search out the information he needed and arrange for him to be seen.

The nurse emailed back saying there was meant to be an arrangement for the forensic mental health service to come back and see him. She set up a new appointment for him and he was happy about that.

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A genuine mistake at a DHB

Public hospital ~ Surgery ~ DHB ~ Rights 2, 6 ~ Prisoner

A referral was made for a prisoner to see a surgical specialist at the local hospital. He received a letter advising his referral had been prioritised as semi-urgent and that he would be seen within 2-6 months.  A few days later he received a second letter stating his referral had been declined. He believed the second letter was due to his being detained in a correctional facility and that he was being discriminated against because of his situation. He was very concerned about this and said it was causing him a lot of stress and anxiety. He sought advocacy support to help him clarify if he had an appointment or not. 

With assistance from the advocate, he wrote to the DHB asking for an explanation regarding the two letters and clarification of whether he would be seen by a specialist. He also made them aware that he felt the second letter was based on his situation.

The DHB responded with a written explanation and an apology and advised his condition was considered semi-urgent and he would soon be receiving an appointment with a specialist.

Extracts from the response follow:

"I have reviewed your complaint on behalf of the Surgical Service and sincerely apologise for the confusion and inconvenience caused to you.

Our investigation shows that a referral letter was received in January and you were added to the waiting list on 03 February.  I can confirm that you remained on the waiting list until an appointment was sent to…… as is the normal procedure.

The computer generated letter that was sent to you a few days later was generated in error by a staff member who is new to the organisation.  We have now provided additional training to ensure that this error is not repeated.

I hope you have found this response helpful.  Thank you for taking the time to convey your concerns."

The consumer was happy the issue was resolved and was pleased to have an appointment.

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When systems fail
The niece of a Samoan woman telephoned the advocacy service very upset about her aunt having been given ten times the amount of chemotherapy prescribed. She said the drug had "burnt all her insides". The consultant had prescribed 180ml/g of the chemotherapy drug, failing to put in the decimal point to make it 18.0ml/g per day for four days.

This pharmacy duly dispensed the drug as prescribed and a specialist nurse administered the treatment. At no point was this questioned or checked with the consultant even though staff involved thought the prescribed dose was very large.

A meeting was arranged to discuss what had occurred. The consultant and team leader from the ward were present. At the meeting the consultant was very remorseful and apologised sincerely for her mistake. The family accepted her apology but were very concerned about the lack of adequate systems in place to protect the consumer.

The team leader acknowledged that there had been a breakdown somewhere and that check points had been put in place to avoid situations such as this. She undertook to make sure these areas would be revisited and reviewed.

Although the consumer's condition was critical following this incident, she did recover.

The family was happy with the outcome of the meeting. It was important for them to have the acknowledgement of what had happened and to hear the doctor's remorse. They were also pleased that steps had been taken within the hospital to work towards ensuring patient safety and preventing such an event happening again.

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Getting a firm diagnosis

A consumer had been receiving treatment for a sore on his right leg over a period of six weeks. He felt that rather than getting better his condition was worsening.

He had been seen by five different staff and each one had a different opinion on what the sore could be. One had suggested it may be from diabetes and could lead to amputation. This suggestion caused the consumer a great deal of anxiety. He said his goal was to see a doctor to get a firm diagnosis but this had not happened.

When the advocate made contact, the man advised that the sore was healing and as he had been moved to a different facility he was not sure what he could do. After discussing the support advocacy could provide he decided he would like to send a letter to the Health Staff at the previous facility to make them aware of his experience. He knew it wouldn't change the past but hoped it might influence the care of others in a similar situation.

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Sudden discontinuation of medication

A consumer in prison contacted advocacy advising her medication had been stopped without consultation. She believed she should have been weaned off the medication rather than it being stopped outright, and had requested to see the doctor but had not received a response and was becoming anxious.

The consumer sought the advocate's assistance to call the Health Centre Manager as she wanted an urgent appointment to get her medication reinstated. The Health Manager informed the advocate that the consumer had an appointment with the doctor for the following morning. The Manager had already spoken to her about the matter and when seen by the doctor would be offered an alternative medication.

The consumer was happy with the outcome.

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Terminally ill prisoner

A prisoner, terminally ill with metastatic melanoma, and his wife, complained to an advocate about his treatment in prison. Although his prognosis was poor with a limited life expectancy his family were trying hard to be up-beat and positive.

Their concerns were about past treatment for his terminal illness and the need for a care plan for the future.

Problems with his care included:
1. No pain relief provided overnight for up to 16 hours

2. No consistent monitoring by medical staff. (He had had major surgery three times for his melanoma.)

3. Prolonged delays with referrals to oncology after new lumps appeared

4. Treatment and medical care being given during lock down procedures and at times that suited custodial staff rather than according to his needs.

5. An incident where he had to be rushed to hospital after being found gravely ill in his cell - requiring further surgery

6. Another incident where five stitches from recent chest surgery were missed by the prison health service resulting in a severe infection over a three-week period  - delaying other surgical consultations.

The advocate spoke with the prison health service on his behalf and agreed to remain involved to support the couple and monitor the situation.

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Getting a specialist referral

A man in a correctional facility had seen the medical officer a number of times regarding ongoing pain in his right hip. He was prescribed mild pain relief, which did not relieve his pain. He felt that health staff saw him as a drug seeker and did not take his concerns seriously.

With the support of an advocate the man wrote a letter of complaint, asking for a referral to the appropriate specialist for a full assessment of his condition, and asking to receive adequate treatment to resolve the pain.

The Health Manager spoke with the man about his needs. As a result, an x-ray was ordered and he received physiotherapy at the local hospital. He also received confirmation that a referral had been sent for further assessment of his condition.

The man was pleased with the outcome and felt he was taken seriously because he received formal support through the advocacy service.

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Misunderstanding about special diet

A resident of a Corrections facility contacted advocacy as she had a condition that required her to receive a special diet which she was not being provided. She understood that her specialist had given specific instructions to Corrections regarding her diet and that her GP had also expressed concern that she was not getting the correct diet.

She had attempted to address her concerns directly with health staff but had not been able to progress the matter. After discussing the options with the advocate the consumer requested the advocate contact health staff on her behalf.

The health team advised that at the appointment with the specialist both they and the consumer had been given information on how to manage her condition and that a special diet was not required. As a result of receiving the woman's complaint it had become obvious that she had not fully understood the information from the specialist.  The health team provided her with further information and offered to make an appointment with a dietitian if she wished.

The woman advised she had been given further information and was satisfied that the appropriate action had been taken.

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Appointment for an artificial limb

A consumer in a corrections facility contacted advocacy to discuss concerns about his artificial limb, which needed replacing. This would usually be processed as urgent and a hospital appointment booked, but two weeks after his initial request, he had still not heard when he could expect an appointment.

The advocate assisted him to write a letter to the health unit manager outlining his concerns. The manager apologised for the administrative oversight, and made an urgent referral to the hospital. The man later advised he valued the input of advocacy services, thought that without that assistance he would still be waiting for his limb.

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Mental health support in prison

A prisoner contacted the advocacy service saying the judge who sentenced him had said he was to have help from the local forensic mental health team. However, nothing seemed to be happening and he was becoming quite stressed about it. He had seen someone on one occasion earlier on in his sentence, but they had not come back as promised, and he couldn't remember who they were. He had asked within the prison what was happening but had been unsuccessful in getting an answer.

The advocate spoke with the prisoner and described what he could do. It was agreed the advocate would email the team leader of the medical unit to search out the information he needed and arrange for him to be seen.

The nurse emailed back saying there was meant to be an arrangement for the forensic mental health service to come back and see him. She set up a new appointment for him and he was happy about that.

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Access to appropriate services while imprisoned

Prison health service ~ Care of chronic condition ~ Pain management ~ Education ~ Dignity and independence ~ Complaints process ~ Rights 3, 4, 10

A prison inmate made a complaint to an advocate about the management of his colostomy and difficulties he was having with receiving adequate pain relief. Prior to his imprisonment, his care was provided by a family member. This meant he was not familiar with details of his care and he lacked the confidence to change his own colostomy bag. He also needed to arrange for an ongoing supply of colostomy bags. He was frustrated at the lack of help provided by the prison health service.

The advocate arranged a meeting between the manager of the prison health service and the inmate. The advocate attended to provide the inmate with support. At the meeting, the inmate had an opportunity to explain the difficulties he was having in changing the bags and in getting new bags brought into the prison. He also discussed his current pain management. The meeting ended with an agreement from the manager that the doctor would review the inmate's pain relief, and they would invite an ostomy nurse to come to the prison to show him how to change and maintain his bags, and provide him with additional bags.

When the advocate contacted the man a month later, the education session and additional bags had not yet been supplied. A follow-up letter to the manager ensured that these services were provided.

The man advised the advocate that he was pleased with the outcome, and that, as a result of his experience and the support that was offered, he would like to be an advocate/educator to others in prison with colostomies. He was given the contact details of the local Prisoners' Aid and Rehabilitation Society and advised to speak to them about his plan.

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Difficulty getting a special diet in prison

Prison health ~ Coeliac Disease ~ Special diet ~ Dietitian

A consumer contacted an advocate because of the problems she had encountered getting an appropriate diet in prison. She has Coeliac Disease and told the advocate that both her specialist and GP in the community who had seen her recently had expressed their concerns about her diet.

With the consumer's agreement the advocate sent an email to the prison health team outlining the consumer's concerns. An email response was received to say that staff had spoken with the consumer and clarified with her what she could and could not eat.

When the advocate contacted the consumer, she advised she was happy with the outcome of her complaint as not only had she been given more dietary information but she had been offered a consultation with a dietitian.

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Overcoming problems getting access to the doctor

Prison health ~ Surgery complications ~ Access to doctor ~ Right 4

A prisoner contacted an advocate about his lack of success in getting a medical assessment for the complications of prostate surgery. Although the surgery had been some months before, he had experienced ongoing problems following his discharge from hospital. He developed an infection and had experienced blood clotting problems. He had always had some pain but increasing pain prompted him to contact the advocate after two appointments with the prison doctor had both been cancelled. He felt the nurses were not listening to him and that something serious might be developing, as the Panadol he was being given was no longer controlling his pain.

He felt that he had exhausted the avenues available to him without making any progress and requested the advocate speak with the Team Leader of the Medical Service on his behalf. The Team Leader agreed to organise a reassessment and contacted the advocate to say everything had been taken care of.

The consumer confirmed he had been seen by the doctor and that a referral was being made back to the hospital so he could have his symptoms investigated further. He was pleased with the outcome and the support he had received from the advocate.

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Risk of ongoing damage due to delays in getting an urgent referral

Prison health ~ Referral delay ~ Standard of care ~ Right 4 ~ Communication ~ Right 6

A prisoner contacted an advocate seeking assistance to find out whether a referral had been made to a specialist to assess his injured finger. He said he had injured it three months previously and when seen by the doctor he was told an urgent referral would be made to a specialist to assess for tendon damage. He said he attempted to follow the matter up on a number of occasions but the nurses kept advising they had heard nothing. He said the finger remained painful and that the work he did meant he often knocked the finger causing more pain. He was concerned there may be permanent damage.

After discussing the options, he requested the advocate make direct contact with the Prison Health Team to see if there had been any progress.

Three days later a member of the team advised the advocate they had contacted the local hospital who said they had never received the referral and requested an urgent referral be sent straight away. They had also spoken with the appropriate registrar who had advised how they should be managing the consumer's finger in the meantime. This information had been relayed to the consumer, along with an apology for the delay in following the matter up. They were reviewing the system for managing referrals to the local hospital to ensure this type of situation does not happen again.

The advocate contacted the consumer who confirmed that he had received an apology. The specialist said that had he been seen earlier, he would have had a much better clinical outcome as a ligament graft would now need to be done to ensure full use of the finger. The consumer was happy with the support he received from the advocate and the quick action that resulted from making contact with the advocacy service.

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