Page Section: Centre Content Column

Public Hospital

Surgery and full information

Delayed surgery

Standard of care and communication in hospital

Slow specialist

Needing a care plan

Showing a lack of respect

Consumer resists tests

A child with kidney disease

Left with lots of questions

Wanting a second opinion

Getting the right information

Disappointing cancer care

Communication breakdown

Just listen to me please

Coordination between primary and secondary care

Being able to choose

Painful insertion of luer generates complaint

Attending an appointment made a big difference

Poor nursing care with delays in getting to the toilet

Sharing information about a disaster can be helpful

Working with two different advocates worked well

Older woman bullied by hospital staff

Section 34 referral for a complaint about a biased OT

Rude treatment in the Emergency Department

Consumer proudly showed her discharge summary

Why not give me this information in the first place?

A different surgeon carried out the surgery

Advocacy assistance in clarifying concerns to the consultant

Meeting with the surgeon after an HDC investigation

Public hospital apology

Paying for surgery in installments

User of mental health services gets inadequate pain relief

Getting the run-around

Dispute in the Eye Clinic

Novel plan to address pressure sore failure

Major vein cut during surgery

Too old to care for?

Withholding information

Confusion over consent

Serious adverse event from preventable prescribing

Information leads to action

Lack of privacy in the corridor

Only the CEO will do!

Being kept informed makes all the difference

New surgical technique unavailable at DHB

Writing a complaint to a DHB

A simple pain management solution

Complaint from a diabetes exercise group

What happened to our Dad?

Being ignored for 50 hours following surgery

Discharged without medication

Doctor needed a reminder about seeking permission for student

Frustration at ongoing pain

Preventing a recurrence of poor care

Meeting helps answer questions

Assisting a non-English consumer to communicate with a DHB

'Bad luck' at the Glaucoma Clinic

Advocacy at the consumer's pace

Meeting helps answer questions

Lack of co-operation leads to frustration

Confusion at the hospital

Preventable death of a medical practitioner

 


Surgery and full information

DHB ~ surgery ~ Right 1 ~ respect ~ needs, values and beliefs of Maori ~ Right 6 ~ the right to be fully informed

A Maori  consumer  had a hysterectomy. Prior to the procedure she advised the charge nurse and doctor that she wanted to take her uterus home and bury it with her children's umbilical cords.  She was given a consent form to sign. She signed the space below "yes, I want to take my body part home" but did not read the rest of the form and neither was it bought to her attention that by signing where she did, she was agreeing to allow her body parts to be sent to the lab for testing prior to it being sent home with her.

For four days following surgery the consumer asked for her uterus but no-one knew what had happened to it and she left the hospital without it. For the next two weeks she rang the hospital on a daily basis looking for someone who knew something about her uterus.  Finally she received a call from the Bereavement Centre at the hospital to say that they had her uterus and could someone pick it up.  She sent her daughter to collect it.

The consumer was distressed when she realised that her uterus had been sliced into several pieces and she made the comment that the uterus could belong to anybody.

Goals 

1.   Her cultural beliefs and values were ignored by staff at the hospital. 

2.   She was not fully informed at the time she signed the consent form that the consent allowed her uterus to be sent to the lab for testing.

Desired Outcome:

  • The consumer sought a full explanation regarding why her uterus was sent to the lab for testing.
  • She wanted to know what training staff had in Tikanga Maori.
  • She sought an apology for not being fully informed.
  • A commitment from senior management that they will do what is necessary to ensure that staff are aware of Maori cultural values so this never happens again to any other Maori women.

The consumer felt that a letter was not a suitable medium for her complaint so she asked that the advocate to arrange a meeting with the staff from the hospital. 

The consumers sister spoke on her behalf explaining that in terms of Maori tikanga the uterus represents mankind and in particular future generations and that it should be buried whole and while still warm.  

The head of obstetrics apologised for his staff's insensitivity and gave a commitment in terms of staff and their understanding of tikanga Maori. For the consumer the most positive aspect of the meeting was that this complaint is to be flagged as a sentinel event which means that it will be discussed at a regional DHB level.  

The consumer was asked if she would be willing to recount her experiences to the board when it next met.  She agreed to do this.

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Delayed Surgery

DHB ~ Surgery ~ Right 1 ~ respect ~ Right 4 ~ appropriate services ~ Right 10  ~ complaint

An advocate was contacted by a complainant because they had waited twelve months before a provider had agreed to meet with them. At the meeting it was agreed they would be sent a copy of the minutes from the meeting - 10 weeks later these had still not been received.

The consumer, a fit 88-year-old lady, fell fracturing her neck of femur. The only thing of significance in her medical history was the diagnosis of an aortic stenosis for which she would require surgery sometime in the future. Her treatment plan while in the emergency department included preparation for surgery on her femur, pain relief and traction was discussed. 

Late in the afternoon traction had not been applied and the consumer and her family were advised her operation was postponed until the next day. The speed at which she was transferred to the orthopaedic ward left her nauseated and distressed. The complainant advised that after many hours without the fracture being stabilised the family insisted something be done to make the consumer more comfortable. The complainant believed the delay resulted in serious consequences for the consumer. 

The complainant wrote to the provider and a year later was finally given the opportunity to meet and discuss her concerns. She did not feel as the provider did, that the matter had been resolved.  She was angry about the delay with the minutes from the meeting. 

Following discussions with the complainant regarding her outstanding concerns, it was agreed the first issue to be dealt with was the minutes of the meeting. At the complainant's request the advocate contacted the provider who duly sent the minutes to the complainant along with a letter of apology.

Upon receipt of the minutes the complainant advised she wanted to challenge some of the points made and also get clarification around some others. After discussion with the advocate a further letter was sent to the provider stating that the family believed the twelve-hour delay had resulted in the consumer's deterioration. They said it was in no way related to her heart condition as her cardiologist had advised the heart condition would not be compromised by surgery of this nature.

The complainant wanted an assurance from the provider that systems had been improved so no-one else would go through the same experience. The response from the provider did not provide that assurance. Rather, they advised that they had emphasised with staff the need for better communication. The provider advised all that could be done had been done.

The complainant was not at all happy with the response and with advocacy support wrote to the CEO of the DHB and sent a copy to the quality assurance manager.

Finally, after almost two years from when the event occurred, the complainant received a comprehensive letter detailing the changes to be made as part of their quality strategies to improve services. Each change and the methods used to carry out those changes were fully explained. The complainant was pleased with this response.

 

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Standard of care and communication in hospital

DHB ~ Right 4 ~ appropriate standards ~ Right 5 ~ effective communication

A consumer had been in hospital for three nights. He said he had felt unwell and asked a nurse for oxygen but it was refused. The following day he said he still felt unwell but made the effort to sit up for the doctor's round. The doctor advised he was to be discharged despite the consumer stating he still felt unwell. He said this made him feel like he was wasting the doctor's time. He did not feel listened to and that this was contributing to his anxiety. 

He says he asked the doctor why he was having so many coughing spasms and the  doctor  responded sarcastically with "well you might have a tumour".  The consumer was concerned there were no follow-up checks or appointments relating to this comment. After discussing the role of the advocate and how advocacy could assist, the consumer elected to ask for a meeting with all those involved in his care so he could tell them how he had felt. 

Once the meeting had been organised, the advocate met  again  with the consumer to discuss her role at the meeting, the issues the consumer would raise and the outcome he was seeking.

At the meeting the consumer was able to speak directly to the doctors and nurses involved in his care. This made him feel empowered.  At the end of the meeting the consumer had no desire for any follow-up action.

He was very content and happy to have had the opportunity to voice his concerns. 

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Slow specialist

DHB ~ specialist ~ Right 1 ~ respect ~ Right 4

A complainant sought assistance to write to the Health and Disability Commissioner. The specialist his wife was seeing failed to respond to their complaint about the time it took to get a referral to another specialist. In the meantime his wife's condition had deteriorated. After discussing all the options available for resolution the complainant and his wife opted to approach the Commissioner as both they and their GP had attempted to address their concerns directly with the specialist.

Goals:  

1.   Appropriate standards: The specialist failed to make the referral within an appropriate timeframe. 

2.   Lack of respect: The specialist made a flippant remark during the consultation.

After discussing the options the complainant and consumer decided they would like help in writing their letter to the Commissioner. The consumer and complainant wanted the specialist to be held accountable for his actions and to prevent a similar situation happening for others.

The advocate assisted the complainant to clarify the issues and identify the desired outcome in his letter. He sent the letter to the Commissioner.

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Needing a care plan

DHB ~ Right 4 ~ appropriate standards 

A consumer's health was deteriorating so he contacted the advocacy service. He was on daily pain medication but had no ongoing care plan and was concerned at a lack of support and communication from his surgeon.

The consumer decided the best way forward was to meet with hospital staff to discuss his concerns. A meeting was set up between the consumer, advocate, the quality manager and the assistant director of nursing. 

At the meeting the following was agreed and clarified: 

  • The quality manager would speak to the surgeon prior to the consumer's appointment the following week so any misunderstanding could be sorted at that appointment
  • If required  the consumer could have a second opinion 
  • The pre-op assessment process was clarified and the consumer advised that a house surgeon conducts this process, including any blood that needs to be taken
  • The consumer's file was to be checked to ensure it contained a red flag re morphine.
  • A meeting would be held in the new year to discuss the consumer's plan of care.

At the appointment with the surgeon the consumer had his questions answered and arrangements were made for the consumer to get a second opinion.

The consumer was happy with the support and outcome and the advocacy file has now been closed.

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Showing a lack of respect

DHB ~ GP ~ emergency doctor ~ Right 1 ~ respect 

After sustaining an injury at home a consumer sought treatment from his GP who advised it was soft tissue and muscular damage. The GP advised no further action was necessary as it would heal on its own. The consumer was not given any pain relief.

A few days later when his pain had not improved he attended the emergency department where a doctor examined him and sent him home with a prescription for paracetamol which also did not relieve his pain.

The consumer described feeling "fobbed off" by both doctors and he felt both were less than professional. He felt the doctor at the emergency department was more interested in the rugby than examining him and listening to his concerns.

The consumer wanted to meet with both doctors to tell them how they had made him feel. He wanted a letter sent to each outlining the things he wished to discuss at the meetings. As he was unable to write the letters himself he requested the advocate do them on his behalf.

Prior to the first of the meetings the advocate clarified the role she would take and the issues that would be discussed. The consumer was advised he could stop the meeting at any point if he was uncomfortable with the way things were going.

At the first meeting with hospital staff it became apparent that the consumer had a number of health issues which had resulted in his presenting at the emergency department 50 times during the year. The head of the department suggested that it might be appropriate to involve other services in the consumer's health care. The consumer was not happy with this approach.

The next day we met with his GP with a similar outcome in that the GP felt he was providing the best care he could. He offered the consumer the option of having another GP provide his care. The consumer chose not to change GPs. 

Following the meetings the consumer advised he did not want to pursue the matter. He felt empowered by having the opportunity to meet with the providers and discuss his concerns.

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Consumer resists tests

Right 1 ~ respect ~ Right 5 ~ effective communication

A consumer had a medical condition which prevented him from undergoing a particularly stressful test. He believed the test would result in detrimental effects to his existing medical condition. He was persuaded to undergo the test in spite of his reservations. It was not possible to complete the test and as a result, he spent four days in hospital recovering from the attempt.  

The consumer and advocate discussed the options available. The consumer decided to write his own letter, telling his story and asked the advocate to assist by clarifying his concerns with him and providing a letter asking the relevant questions of the provider. 

The provider responded to his concerns, providing a full explanation of why the test was necessary. The consumer advised the advocate that while he did not understand the disparity between the providers, he was happy with the response to his letter and his file could now be closed.  

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A child with kidney disease

Right 4 ~ appropriate standards ~ Right 5 ~ effective communication ~ paediatrics

A child with a history of kidney disease required ongoing management by the pediatric team at the local hospital. The consumer's mother made a complaint directly to the provider and contacted advocacy for support. She advised that a plan of treatment had been put in place two years previous, which meant that if he presented to ED or to the pediatric ward a particular course of treatment would be followed.

However, on one occasion the nurse did not know the consumer well. When she contacted the paediatrician he based his decision on the information given to him by the nurse. This meant the consumer was not immediately admitted to the ward as he should have been according to the agreed plan. 

The main issue was in relation to the communication failure. The plan was not followed as the paediatrician received second-hand information from a nurse unfamiliar with the consumer and the paediatrician did not speak to the consumer's parents.

The consumer's mother complained directly to the provider and then requested advocacy support to meet with them. Although the head of paediatrics is not based at the local hospital he agreed to meet with the consumer's parents and the advocate when he next visited the area. 

After hearing the parents' concerns the head paediatrician decided he would personally be responsible for the consumer's care, and that a new plan would be developed based on the requests of the parents and multidisciplinary specialist input. The provider also assured the consumer's parents that the plan would be made available to both the pediatric team and the ED team. He discussed the development of the new electronic system due to be operational in the near future and gave his personal assurance that the plan would be "flagged" in the new system. He offered to be available for consultation over the phone should any urgent issues arise in the future at those times he is not available in person.

The consumer's parents were happy with the outcome of the meeting. As they signed the agreement form for ongoing actions, they believe the promises made at the meeting will be kept. 

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Left with lots of questions

DHB ~ Right 4 ~ appropriate standards ~ Right 5 ~ effective communication ~ abscess ~ diabetes

A consumer told an advocate he had been expecting to be transferred to another hospital for treatment of an abscess and that the process was delayed. During the delay no-one checked his wound, he was not given any antibiotics or told why his transfer had been delayed. 

He had a number of questions he wanted answered:

  • Why was he not told about what caused the delay?
  • He did not receive any information about what effect the delay could have on the abscess. It burst and no-one attended to it.
  • He was concerned that the delay may have contributed to his having a heart attack.
  • He felt the consultations were rushed and therefore he was not listened to.  
  • No-one did anything to address his lack of sleep.
  • The consumer said his diabetes had previously been managed with oral medication but now he requires regular insulin injections. 

After considering the options the consumer felt the best process for him would be to have an advocate support him at a meeting with the medical team so he could discuss his concerns. He requested the advocate contact the DHB to arrange a meeting. 

After hearing the consumer's concerns the doctor provided an explanation for the decision not to give antibiotics and the reason for the delay in transferring the consumer. He said there were three people who all required transfer that day and that the consumer's needs had been prioritised as not being as great as those of the other two patients. The doctor explained that the consumer's admission had been fortuitous in so much as his diabetes had been under medicated which was the reason for him now requiring insulin injections. 

He said he would look into the consumer's concerns about not being able to sleep, and would contact the receiving hospital to clarify when the consumer could expect to be seen there.

As agreed, the doctor followed up with the other hospital, the consumer was transferred and underwent the required procedure the following morning. Two days later the advocate received a phone call from the consumer. He was very happy with the outcome and agreed the advocacy file could be closed. 

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Wanting a second opinion

DHB ~ Right 1 ~ respect ~ Right 4 ~ appropriate standards ~  Right 5 ~ effective communication

The husband of a consumer who was still in hospital contacted an advocate as both he and his wife had concerns about the care she was receiving. They had asked for a second opinion but this had not happened. The complainant said his wife was being pushed to get up and walk despite this causing her pain and making her vomit. 

The advocate visited the consumer in hospital. She had decided to take the matter to the Commissioner as she felt it had gone beyond resolution with the provider and wanted advocacy support to write up her issues. She went on to say that one doctor had said he felt he was baby-sitting her, that her care was being forced on him due to other doctor being away and that the problems were all in her head. The consumer said she knew there was something wrong but could not get people to listen to her.

The consumer was getting conflicting information from different people involved in her care. 

  • There were issues where doctors disagreed about the pain relief she was receiving.
  • Some pain relief ordered by the pain team was not being given in correct doses. 
  • The couple had requested a second opinion to try and resolve these issues.
  • The consumer had asked the doctor she had the altercation with to leave as she did not want to deal with him again, and at first he would not leave but did so later.
  • The consumer felt she was not being listened to or being taken seriously.

Her desired outcomes included: 

  • To have a second opinion, and others to be involved in her care. 
  • For the cause of her lack of progress to be investigated.
  • To have the pain team involved and their recommendations carried out.

The consumer was adamant she did not want a meeting but requested the advocate write up her concerns so her father in Australia could use the list to advocate on her behalf.  As agreed the advocate wrote up the consumer's concerns and provided her with a copy. Her father used the list to get the services his daughter required. 

Once her father took on the advocacy role the consumer was transferred to a doctor from another service. She required further surgery as there was a problem that was causing the pain and vomiting. She was given the medication ordered by the pain team and is still receiving follow-up from other services. She sent her letter of complaint to the Commissioner and the advocacy file was closed. The consumer expressed her gratitude for the support she received from the advocate. 

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Getting the right information

DHB ~ Right 4 ~ appropriate standards ~ Right 6 ~ fully informed

An advocate was contacted by a family member who resided overseas. The complainant was concerned that the consumer, who had had a severe stroke, was not receiving the appropriate level of care. The advocate discussed how advocate's work and sought permission from the complainant to go to see the consumer.

The advocate visited with the consumer. She introduced herself and quickly ascertained that the consumer had not recovered his power of speech. It was apparent though that the consumer understood what was being said so she sought his permission to speak with his wife about the concerns of the relative from overseas. The consumer was happy for the advocate to speak with his wife. 

The consumer's wife said she was happy with the level of care being provided and was concerned that the complainant may be being misinformed. The consumer's wife decided the best way forward was for the consumer and her to meet with the doctor to discuss the consumer's care and then nominate a person to relay information to the rest of the consumer's family. 

A meeting was duly arranged and a plan for communication put in place to enable overseas family members to obtain accurate information. The consumer's wife rang the advocate a few days later to say the plan was working well and that the consumer was continuing to make good progress with his recovery.

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Disappointing cancer care

DHB ~ oncology service ~ Right 4 ~ appropriate standards ~ Right 5 ~ effective communication ~ palliative care

A complainant contacted the advocacy service to discuss her concerns about her mother not receiving adequate pain relief during her final days. The complainant said she had written directly to the hospital and was disappointed with their response.

After considering the options the complainant decided she would again write to the hospital expressing her disappointment with their response. She would also ask the question "as a family, how could we have communicated to the oncologist more effectively and helped our mum communicate to him more effectively, her needs and knowledge of her impending death." She requested a meeting with the oncologist and advised she would be taking advocacy support if the oncologist agreed to meet.

At the meeting the complainant was able to articulate her concerns regarding her mother and also the impact the situation was having on her as a nurse. 

Following the meeting the advocate debriefed with the complainant who said she felt the oncologist had been very open and honest in his response. She said she felt she had been listened to and believed. The doctor had told her he would take her comments back to his team and also to the palliative care team. The advocacy file was closed as the complainant was happy with the outcome.

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Communication breakdown

DHB ~ Right 1 ~ respect ~ Right 4 ~ appropriate standards ~ Right 5 ~ effective communication ~ pain relief ~ next of kin

A complainant contacted an advocate as her aunt, who was elderly with complex issues, was in hospital with a suspected stroke. On arrival she was assessed by a junior doctor who seemed unsure of what to do. The complainant attempted to provide vital information to the doctor but he lacked interest and was not listening. 

The issues were lack of communication, not being listened to, pain relief not being administered according to the consumer's needs. The type/brand of pain relief charted was not the norm for the consumer and the rudeness shown by the doctor was not appreciated. The complainant's desired outcome was that all communication regarding her aunt be directed to her as next of kin. She needed to resolve the issues as soon as possible while her aunt was still in hospital. 

The advocate explained to the complainant what the options were for resolution. The complainant requested that the advocate support her at a meeting with the DHB. With the complainant's consent the advocate contacted the DHB to arrange the requested meeting and forwarded to them the concerns the complainant wanted addressed. They responded saying they could meet the following morning. The advocate contacted the complainant and advised she would not be available to support them at the meeting due to prior commitments. The advocate ran through processes that could be used in a meeting to enable the complainant to be in an empowered position to advocate on the consumer's behalf.

The advocate followed up with the complainant following the meeting and was advised the outcome from the meeting was positive. The complainant has been assured that she would be recognised as the next of kin, with all options being discussed with her regarding her aunt's welfare and well being. In addition the consumer was being administered enough pain relief to meet her needs.

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Just listen to me please

GP ~ rural hospital ~ Right 1 ~ respect ~  Right 2 ~ discrimination ~ Right 4 ~ appropriate standards ~ Right 5 ~ effective communication ~ drug seeker ~ pain relief ~ care plan

A consumer phoned saying she had been told by another provider to contact the advocacy service to discuss her concerns about her GP and the local rural hospital. She said she had a chronic condition and sometimes required opiates to relieve the pain from it. 

When she presented to the medical centre she felt she was discriminated against. She said the GP never gave her a chance to speak. She said it appeared a decision had already been made about her treatment and there would be no consultation. 

She felt the GP and hospital staff had formed an opinion that she was a drug seeker and treated her as such. She wanted to know why the GP wouldn't prescribe the drugs recommended by her specialists and pain clinic staff. 

After discussing the advocacy process the consumer opted for a meeting with the providers and requested the advocate be present for support.

At the meeting, the consumer began by 'telling her story'. Having heard from the consumer the providers decided her plan should be changed to incorporate the suggestions of her specialist. This meant she would be given a small supply of medication to use in the first instance while waiting to see her GP. They agreed there was no documented evidence that she was abusing the prescribed medication and that opiates were in fact the most appropriate way to treat her particular illness.  

The care plan also documented that she was allowed admission to the hospital at any time she felt she needed to be assessed as requiring IV medication. An additional section stated that staff would not question and treat her any differently from other service users. There was a directive made that if other service providers had issues with her treatment, they should contact her GP so the consumer would not be caught up in any debate about the appropriateness of her treatment. The care plan would be reviewed in twelve months time.

The consumer was very happy with this outcome.  She said the issues had been ongoing for about six years as a result of continual changes within the GP practice. She felt no-one had listened to her or heard her story. 

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Coordination between primary and secondary care

DHB ~ GP ~ Right 4 ~ Co-ordination between providers ~ Continuity of care ~ Right 5 ~ Effective communication ~ Right 6 ~ Fully informed ~ Chemotherapy ~ Radiotherapy ~ Entitlements

A consumer had been having chemotherapy and radiotherapy over the previous 12 months. She contacted an advocate to say she felt ill informed about what support services were available and subsidies she may be entitled to.

She was upset about always having to explain to specialists and doctors about her condition and treatments to date and didn't understand why they did not read her medical file prior to seeing her.  She said she had discussed her concerns with her oncologist particularly as she felt she was pushed from one department to another in the hospital and felt she was not being told everything.

The advocate and consumer discussed the situation, what the consumer wanted to achieve and what support she required. The consumer really just wanted confirmation that she was taking the right steps to address her concerns.

She spoke with her oncologist who had agreed to be responsible for coordinating her care in the hospital. She also spoke to her local medical centre and they scheduled an appointment with a GP who would take on the role of managing her care in the community.

The advocate was able to provide contact details for other local support agencies. The consumer left feeling happy that she was in control of the situation and knowing she could approach the advocate for help at any stage in the future. 

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Being able to choose

Right 7 ~ Choice & consent ~ Palliative care

The family of an elderly person contacted an advocate to assist the consumer to get information to make an informed choice about where care should be provided. The consumer was open to discussing their concerns with the advocate and so they arranged to meet.

The consumer had been living at home with their spouse prior to becoming ill and requiring hospitalisation. Despite the illness the consumer wanted to go home and thought this a realistic option despite the family's concerns. 

After discussing the matter with the advocate it became apparent the consumer needed more information about the services that were and weren't available if they chose to go home. The consumer requested the advocate contact a social worker and arrange for the three of them to meet to ensure full information about the options were presented. 

At the meeting the social worker suggested a full assessment needed to be done. The consumer agreed to this and when the information from the assessment was presented to the consumer, the consumer acknowledged that the level of care they required could not be provided at home. 

The social worker worked with the consumer and family to identify a suitable facility that could provide palliative care and that would be accessible for the spouse and family to visit the consumer. The consumer was happy with the outcome and felt they had been given the information they required to make their own choice. 

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Painful insertion of luer generates complaint

DHB ~ Right 4 ~ appropriate standards ~ Right 5 ~ effective communication ~ CT scan ~ pain

A consumer went for a CT scan at the local hospital. On seeing the preparation being done, she advised the nurse that from past experience she anticipated difficulty with inserting a luer in her arm. She was assured the anaesthetist was very skilled. However it took a painful forty minutes to insert and the doctor was still holding it in place until the final second before the consumer entered the machine.

The consumer said seconds into the scan she was in a lot of pain and her arm was swelling alarmingly. The attending nurses seemed to panic, not knowing what to do and this further alarmed the consumer. Two doctors were called in and checked what had been done, but seemed uninterested and did not explain what had happened to the consumer. They commented that everything seemed to be ok.

The consumer sought advocacy support to make her complaint to the hospital. After discussion with the advocate she chose to have assistance with writing a letter of complaint to the hospital. The outcome she wanted was for the Radiology Department to review their procedures for dealing with patients who anticipate problems.

The consumer was very satisfied with the response from the provider. After receiving her response letter she sent an email to the advocate explaining why:

"I feel that they treated the matter with the right amount of seriousness, they addressed all the issues that I mentioned and promised to have the right tools to cope with how to deal with a similar event happening again… I feel I can put it all behind me." 

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Attending an appointment made a big difference

DHB ~ Right 1~ respect ~ Right 5 ~ effective communication ~ surgeon

A consumer sought advocacy support for her next appointment at the outpatient department.  She felt the surgeon who she was seeing was not listening to her. She 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 all her symptoms so she was able to provide the information to the surgeon at the appointment. They also discussed how the consumer could self advocate.

As agreed, the advocate was present for the appointment, as a support person. The consumer provided her notes to the doctor which he read, and then he listened to her concerns. He advised that another appointment was necessary and the consumer may still not get a diagnosis at that appointment, but clearly further investigation was required. 

Following the appointment the consumer thanked the advocate for supporting her and said she felt the presence of an advocate had made a big difference to the level of communication with the doctor.

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Poor nursing care with delays in getting to the toilet

DHB ~ Right 4 ~ appropriate standards ~ conflicting information

A consumer who had injured her ankle/foot some years earlier had ongoing issues as it had not healed properly. She had recently undergone reconstructive surgery at her local hospital and said she had received very good care from the surgeon. However she felt the standard of nursing care was poor. She said nurses did not attend promptly when she required assistance to get to the toilet resulting in her having "accidents". The consumer says she was told not to weight-bear for six weeks but nurses told her she should be walking to the toilet. On another occasion a nurse pushing her wheelchair had banged her foot in to a wall. The consumer was concerned about the conflicting instructions and the humiliation of being made to wait too long for help to get to the toilet.

At the time, the nurse who banged her foot apologised and the consumer accepted that and did not want to take any further action on that matter. 

She said she would however like the opportunity to meet with staff regarding the conflicting instructions and care as she didn't want others to experience the same as she had. She requested the advocate assist with arranging a meeting with the Service Manager of Orthopaedics as well as her surgeon. The meeting proceeded despite the consumer being an in-patient for another procedure. She was able to discuss her concerns and also to relay that her care during her current admission was of a high standard. She was very happy to have had the opportunity to raise her concerns with the support of advocacy.

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Sharing information about a disaster can be helpful

Right 5 ~ Effective communication ~  Right 6 ~ Fully informed ~ ACC Claim

A consumer who works in health industry administration contacted an advocate with her concerns about a recent experience with a specialist she had been referred to.  The specialist had failed to send paperwork on to ACC, resulting in her claim being declined.  

The specialist also had no administration staff to oversee his clinics. In addition there were lengthy delays and rescheduling issues combined with no or poor communication. The consumer got so fed up with what was going on so she made a booking to have her procedure privately with an out-of-region specialist.

The original specialist made contact after hours to advise her partner he could finally reschedule her which had upset her partner greatly. The challenging situation for the consumer was she felt embarrassed by her partner's reaction as "two wrongs did not make a right." 

The consumer met with the advocate to have assistance with her letter to diplomatically outline her issues. The specialist responded to the consumer's letter acknowledging the justification for her partner's frustration. He also disclosed details that a specialist machine had broken down contributing to the lengthy delays with overbooking of clinics and the late notification of appointments as he was operating out of a temporary facility.

The specialist apologised, and identified the need for better communication to keep consumers informed.

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Consumer's perseverance leads to a positive outcome

Right 3 ~ Dignity & independence ~ Right 5 ~ eEfective communication

A young man who had suffered with back pain for three years was advised by a surgeon that he would receive surgery on his back within four months. He became very despondent when at the 11th hour he received a letter that he was no longer on the waiting list.

He was in a lot of pain and had been taking strong medication over the three-year period.

He contacted the advocacy service and advised he had become quite despondent to the point that he was not sure whether making a formal complaint would help matters or further exacerbate the situation.

With advocacy support the consumer met with the provider where he was able to discuss his history face to face. He was also able to express his concerns about how the inconsistent information sent by the staff had impacted on him.

Within two weeks of the meeting the consumer received a letter confirming that he was back on the list and could expect his surgery to take place within the next three months.

The consumer advised he was very pleased that he did not give up and had persevered with the matter. 

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Working with two different advocates worked well

DHB ~ Right 6 ~ Fully informed

A consumer advised she had been working with an advocate who had since left the advocacy service. The issues from the original complaint that the former advocate had been supporting her with had been resolved. However there was an outstanding issue relating to the death of a family member at the local DHB.

The consumer wanted to have full resolution of all her concerns and asked the advocate to support her with this outstanding issue.

After speaking with the consumer, the advocate reviewed the former advocate's case notes.  It was very easy to see where the outstanding issue fitted into the wider picture and why, in the context of her story, it was important for the consumer to achieve resolution for that issue as well.

The consumer took the option of meeting with the provider and asked the advocate to support her to do this. It was a very productive meeting for the consumer. She said she felt listened to and had her questions answered.

The advocate spoke to her later about how she felt having to work with two different advocates.  She said that for her it had worked well.

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Older woman bullied by hospital staff

DHB ~ Right 1 ~ Respect

An elderly woman contacted the Advocacy Service because she was very upset with the attitude of a nurse while she was a patient at a public hospital. She felt that the nurse bullied her into leaving hospital before she was ready and was rude to her husband because he didn't want to drive in to pick her up during peak traffic. 

The advocate discussed options for follow-up with the consumer and she chose to write a letter of complaint to the DHB with the support of the advocate. The advocate visited the consumer and assisted her to draft a letter of complaint. The advocate typed this up and posted it to the consumer so she could check it before sending it on to the DHB customer services team. 

Several weeks later the advocate contacted the consumer to see if there had been any response. She hadn't received anything so the advocate offered to contact the customer services team to check on progress. The customer services team reported that a response letter was in the post and the consumer should receive it in a few days.

 

A few days later the advocate contacted the consumer and she said she had received a written response which apologised for the way she was treated. She said she was very pleased with the response.

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Section 34 referral for a complaint about a biased OT

DHB ~ Occupational therapist ~ HDC s34 ~ Right 1 ~ Respect ~ Right 5 ~ Effective communication 

This complaint was originally made to HDC where it was referred back to the DHB (as a section 34) to try and get a resolution between the parties. All section 34 referrals mention the availability of an independent advocate to support the consumer.

The consumer approached the advocacy service for support and explained the issue. She had suffered a brain injury from a fall from her bicycle two years previously.

She had placed a formal complaint to the DHB about the occupational therapist. The consumer was unhappy with the conduct of the occupational therapist throughout her assessment. She felt the OT had a biased opinion (supplied by inaccurate information in a previous file) and that the OT made assumptions about problems that didn't exist.  

The consumer complained that the OT did not act in an appropriate manner with her, nor treat her with respect or listen to her effectively.

The consumer met with the advocate several times to discuss her options on how to get a satisfactory resolution.  After much discussion, it was decided to set up a resolution meeting with the DHB so the consumer could meet face to face and explain her story. Her goal was to get an apology from the occupational therapist and have another assessment done giving an accurate and fair assessment to go on her file to counteract the inaccurate one that was completed by the current OT. 

The consumer, supported by the advocate attended the resolution meeting. The advocate ensured the consumer was given time to explain her issues and the effect it has had on her. The provider was sympathetic and apologised for her own performance and that of the OT.  They agreed to write a file letter to explain the complaint and the effect it has had on the report. The resolution agreement form was used and the outcome resulted in education sessions for both staff and the manager from the DHB along with the file note to ACC. 

The advocate rang the consumer later to see if she was happy with the outcome. She was at the time - however two days later when the consumer sighted a copy of the note to go on her file, she decided that she wasn't happy with how the file note read so she contacted the advocate again.  She again met in person with the provider along with the advocate for support where the provider explained that she was legally unable to write what the consumer wanted. They had investigated the complaint and found that the OT had worked in a way which although was not conducive for the consumer, was found to be within the requirements of their policies. The provider explained this fully to the consumer.

After the meeting the advocate spoke with the consumer at length going over the issues raised by the provider and the consumer decided to leave it at that.

While the complaint was only partially resolved in the end, both parties were satisfied with the involvement of the advocate. It resulted in two education sessions and the provider is now more aware of the Code of Rights. While the consumer felt her complaint was not fully resolved, she felt happy with the process and was pleased with herself for raising the matter and seeing it through. She thanked the advocate for her support throughout the process.


Rude treatment in the Emergency Department

DHB ~ Emergency Department ~ Right 1 ~ Respect ~ Right 10 ~ Complaint

A consumer contacted the advocacy service with a complaint about how she had been dealt with in a hospital emergency department. She said she had been spoken to disrespectfully by a doctor and she was unhappy with what had happened.

She had approached the hospital with her complaint but was not happy with the initial response so had decided to approach the health and disability advocacy service.

After considering the options she decided that she would like to meet with a staff member at the hospital to discuss her experience directly with them.

At the consumer's request the advocate made contact with the customer services department at the hospital. From there a meeting was set up with the consumer and a representative from the emergency department. Although it was offered, she did not seek advocacy support at this meeting.

She later telephoned to say she was satisfied with both the outcome of the meeting and the assistance from the advocacy service in resolving her complaint.

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Consumer proudly showed her discharge summary

DHB ~ Right 1 ~ Respect ~ Right 4 ~ Appropriate standards ~ Right 5 ~ Effective communication

A consumer contacted the advocacy service as she was unhappy with a response from hospital staff. They had brushed aside her concerns by saying her problem was in her head (psychological) and not medical. They refused to provide any medical investigations and only offered counselling.

The consumer discussed her options with an advocate and drafted a letter of complaint which she sent to the DHB.

Following her letter, a DHB doctor agreed to carry out investigations and confirmed that the consumer did indeed have a medical problem and offered treatment for it.

After her discharge, the consumer proudly showed the discharge summary, and said that this proved that the problem was not in her head. She thanked the advocate for supporting her through the process.

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Why not give me this information in the first place?

DHB ~ Paediatric service ~ Right 6 ~ Fully informed

The complainant's 6-month-old daughter was admitted to an out-of-town paediatric hospital. The father was concerned that after his daughter had undergone 7 months of biopsies and muscle testing, a blood test was finally taken and after another six weeks, a diagnosis was made of a rare condition.

The father contacted the local advocate as he wanted to know why it had taken so long to do a blood test which then provided a diagnosis. The advocate met with the father who decided that he would like to meet with the head doctor caring for his daughter. The doctor was overseas so the meeting waited until his return.  

The meeting was held with the medical team, the father and advocate in attendance. The father received an explanation from the doctor as to why the blood test was not able to be taken sooner. It was explained that due to the complex and changing symptoms his daughter was presenting, the blood test was not a routine test. The blood test also had to be sent to the United Kingdom.  

The complainant was satisfied with the explanation he received and thanked the advocate for her support in the process. 

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A different surgeon carried out the surgery

DHB ~ Surgery ~ Right 6 ~ Fully informed ~ Right 7 ~ Choice and consent

A consumer contacted  the advocacy service concerned that when she went for a knee operation, she found out after the operation that a different surgeon to the one consented to had performed the surgery.  It had been a critical factor in her decision making that the surgeon she had selected be the person to do the surgery.  

He had previously successfully operated on her other knee, and she had great faith in his skill and expertise.  She only found out it was a different surgeon when she went for a post-operative appointment because of problems with the newly operated knee.  The specialist admitted that the operation performed by his colleague had clearly been unsuccessful and consequently further surgery needed to be rescheduled.

She spoke with the advocate about her rights in this situation and how she should approach the specialist about her concerns.  Key issues were highlighted for her to discuss with the specialist. 

At her next appointment, she spelt out clearly that it had been critical to her consent that the specialist she selected did the surgery and that she was upset to find out later that this had been ignored.

She received an assurance about who would do the corrective surgery and an apology for the past failure to fully inform her of the change to a different surgeon.

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Advocacy assistance in clarifying concerns to the consultant

DHB ~ Right 1 ~ Respect ~ Right 5 ~ Effective communication

A consumer contacted the advocacy service saying she had been pushed to the extreme by the consultant and his team refusing to listen to her concerns. The consumer was upset that the consultant kept ignoring her concerns by saying it wasn't true, as he had not seen it in other patients.

The consumer said that she once took extreme measures so that she could be taken seriously by the DHB. The advocate supported the consumer in writing a letter to the consultant. In her letter the consumer, rather than blaming the consultant for his attitude, focused on her own suffering and what could be possibly be done to resolve her issues.

Following the letter, with the support of the advocate, the consumer met with the consultant. The consultant apologised and clarified that it was not his intention to ignore her concerns and agreed to trial a new treatment plan.

The consultant arranged for his nurse to support the consumer during the trial period. The consultant also agreed to talk to his peers (experts) and find out if any other patients were experiencing the same clinical issues as this consumer.

The consumer thanked the advocate for helping her write a letter which had led to such a successful resolution.

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Meeting with the surgeon after an HDC investigation

DHB ~ Right 4 ~ Appropriate standards ~ Right 6 ~ Fully informed

A consumer contacted the advocacy service to discuss a complaint which had previously been investigated by the Health and Disability Commissioner. The consumer had undergone plastic surgery but was unhappy with the results. The consumer's complaint had been investigated but the HDC findings showed the surgeon had not breached the code of rights. 

The consumer wanted to meet the surgeon to discuss some new information he had. He also wished to make the surgeon aware of the psychological impacts this process had had on him. After considering the options available to him the man asked the advocate to support him in a meeting with the surgeon. 

At the consumer's request the advocate arranged a meeting with the surgeon. The consumer and the surgeon had had no direct contact since before the HDC investigation. Early on in the meeting the advocate clarified with both the consumer and the provider that the purpose of this meeting was not to discuss previous issues (already investigated by HDC), but to focus on the new issues. 

The consumer was well organised. He had prepared a list of points and proceeded to explain how the surgery and subsequent investigation had taken a toll on his mental well-being. He also presented new information, to which the doctor gave feedback.

The consumer expressed his frustration that he had paid for corrective surgery, which he believed should have been provided free of charge. The surgeon showed empathy for the consumer's situation. He offered a refund for the corrective surgery and commented that he was pleased they had been able to meet face to face.

The consumer agreed that the "human element" had been beneficial to resolving his concerns.

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Public hospital apology

DHB ~ Right 6 ~ Fully informed ~ Apology

A consumer attending a public hospital surgical consultation understood she would be having tests and a CT scan prior to returning in a month's time for surgery. However, she received a letter in the mail two days later notifying her that she had been removed from the surgical list despite receiving appointments at the same time for tests and a CT scan scheduled at the same hospital.

The consumer contacted an advocate for assistance as she had found the public hospital administration systems to be confusing, upsetting and intimidating. 

A complaint letter was sent to the public hospital and the consumer received a prompt response two days later with a written apology for any misunderstanding. An explanation was also provided to say she had been removed from the surgical list as results of her tests and CT Scan were outside the proposed next available surgical list.

She was further advised a surgical consultation with her specialist was being mailed out for the results to be discussed with her prior to surgery and clarification on what was to happen next in relation to her ongoing treatment. 

The consumer was very happy with the outcome and thanked the advocate for her assistance.  

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Paying for surgery in installments 

DHB ~ Surgery ~ Right 5 ~ Effective communication ~ Right 6 ~ Fully informed ~ Visa ~ Eligibility

A consumer told an advocate that when he was referred to a specialist for surgery he had to prove his eligibility in order for his surgery to be funded. The consumer provided the required documents and was granted funding, and his surgery was booked. While awaiting a date for the surgery the consumer's work visa expired and he was granted a study visa. 

The consumer had his surgery as planned, and was then sent an invoice and a letter informing him that he was no longer eligible for funding. The consumer said he had not been informed that the change in his visa status would mean his eligibility for funded surgery would also change. If he had been informed he said he would not have had the surgery until he could afford it. In his discussions with the advocate he said the outcome he sought was for either his bill to be waived or to be allowed to pay in installments.

When discussing the options the consumer advised he had already drafted a letter, but prior to his sending it he wanted the advocate to read it, as English is his second language. The advocate suggested some changes and then the letter was sent to the appropriate people. 

The provider responded advising they were unable to waive the fee, however, agreed to payment by installment as they accepted that the consumer may have not been provided with the right information.

The consumer and provider worked out a payment plan together in order for the consumer to successfully pay the bill. The consumer was very happy with the outcome and thanked both the advocate and provider for their help throughout the process.

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User of mental health services gets inadequate pain relief

DHB ~ Emergency Department ~ Right 1 ~ Respect ~ Right 4 ~ Appropriate standards ~ Fracture ~ Pain relief ~ Mental health

After a fall, a consumer went to the local emergency department where she was diagnosed with a sprained ankle. She felt she was not given appropriate pain relief and returned to the emergency department later the same evening as the pain was unbearable.

This time she was diagnosed as having a fracture and once again was not given sufficient pain relief. The consumer believed that the decision about the level of pain relief was influenced by the fact she receives support from mental health services.

After discussions with the advocate the consumer elected to have help to write to the provider about her concerns, particularly around the pain relief. She received a response which contained an apology for both the failure to diagnose her condition correctly and also for the fact she had been given inadequate pain relief. The response went on to say that her experience would be used for teaching staff to prevent a similar situation from occurring. 

The consumer was happy with the outcome of her complaint and the support from the advocate.

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Getting the run-around

DHB ~ Physiotherapy ~ Orthopaedics ~ Right 1 ~ Respect ~ Right 4 ~ Appropriate standards ~ Right 5 ~ Effective communication ~ Refugee ~ Language barrier

At a meeting between an advocate and a consumer, the consumer advised that since the previous year she had had problems with her back. She said she had constant pain over her back and legs, and that her condition wasn't being taken seriously. She was from a refugee community so had difficulty understanding English.

The consumer said her GP referred her to the physiotherapy department. She waited for six months to get an appointment with the physiotherapist only to be told she needed to see an orthopaedic specialist not a physiotherapist. 

Instead of referring her directly to the orthopaedic specialist the physiotherapy department referred her back to her GP. The GP referred her urgently to the orthopaedic department. At the consultation with the orthopaedic specialist she was told she needed physiotherapy and was again referred to her GP. 

Her GP did another referral to the physiotherapy department. She received a letter stating her referral had been received and she would be sent an appointment within six months. 

The consumer was upset, stressed, and disappointed that she had spent a year being sent to various health professionals yet nothing was happening. 

The advocate helped her to write a letter to the health provider outlining the issues and her feelings. In her letter, the consumer said she wanted an urgent appointment with a physiotherapist and to find out what was wrong with her back. 

The hospital responded with an apology from the physiotherapy department and an appointment for the consumer. 

She was very happy and thanked the advocate for the good service provided to communities with a refugee background. It can be very difficult for them to contact a health provider directly because of language barriers.         

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Dispute in the Eye Clinic

DHB ~ Eye department ~ Right 1 ~ Respect ~ Right 4 ~ Appropriate standards ~ Right 5 ~ Effective communication ~ Right 6 ~ Fully informed

A consumer had received care from the same specialist for many years and put up with rude and dismissive behaviour as she believed the specialist to be a capable clinician.

On a recent visit to the DHB Eye Department the consumer was seen by a locum. After a full consultation the locum informed the consumer, that in their opinion, the consumer did not have any form of eye condition. The locum gave a full explanation for that opinion. The consumer said she felt she had got more from that one appointment than from any of the others over the many years.

The consumer was angry to have been receiving treatment all these years for no reason. The medications that she had been given had had huge side effects with a detrimental effect on her quality of life. The consumer was also unhappy about how she had been treated by her usual specialist and wanted to know how she could have been treated for a condition she did not have, for so long.

After considering the options the consumer requested advocacy support to write a letter of complaint requesting answers to her questions.  She also requested that it be noted on her file that she was not to be treated by the initial specialist again. 

The reply letter from the hospital raised further concerns.The Head Consultant of the Eye Department expressed concern that the consumer had been discharged and requested the consumer have further tests to ensure the locum was correct. With advocacy support the consumer requested a meeting with the consultant and the locum, so the consumer could hear both views and decide what treatment, if any, she would consent to. The locum was no longer employed by the District Health Board so with advocate support the consumer requested that the locum be present via telephone conference.  

Prior to the meeting, the advocate assisted the consumer to develop an agenda and a list of questions that needed to be answered. At the meeting the consumer had her questions addressed by both clinicians with the result being the consumer agreeing to a consultation with the Head of the Department to decide if she needed and would consent to further treatment. A note was placed on the consumer's file to say that if possible she was always to be seen by the Head of the Eye Department.

At the meeting the consumer was told that due to her complaint the system within the Eye Department had been changed so that locum discharges are routinely checked by the consumer's lead clinician and opinions discussed in full before no further follow up is decided.  

The consumer was happy with this outcome. 

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Novel plan to address pressure sore failure

DHB ~ Right 1 ~ Respect ~ Right 4 ~ Appropriate standards ~ Right 6 ~ Full information ~ Pressure sore

Earlier this year, an advocate met with a consumer and his wife to discuss concerns about the man's hospital care. Sadly, the consumer died not long afterwards. His wife, however, wished to pursue concerns about the care her late husband had received in hospital. The day after the terminally ill man was discharged; the complainant discovered a large, necrotized pressure sore on his body.  

She opted for a resolution meeting with a friend, an advocate and DHB staff. The advocate explained to the attendees that this was an opportunity for the complainant to express her concerns and to explain what resolution would look like for her. The complainant was well prepared and extremely well organised. She brought a timeline, a written summary of the issues (which she had also outlined in the agenda that she created), and photographs of the consumer's pressure sore. 

The complainant eloquently described the impact the pressure sore and treatment of it had on the consumer's already limited life. She acknowledged that there was no way of knowing whether his life would have been longer without the sore. Her main concerns were that the quality of the time the consumer had left was diminished, and that neither she nor the consumer had been told about the sore. She pointed out that surely someone within the hospital must have known about it. 

The provider organisation staff acknowledged that there had been a failure of nursing care in respect of this consumer. They said there had been a communication breakdown; nursing staff had not told the specialists about the pressure sore. Nor had they told the consumer and the complainant. The staff wanted to know what would resolve this complaint for her. 

She requested a written apology and a written acknowledgement of the failures. In addition the complainant explained that the consumer had created a "bucket list" i.e. things he wanted to do before he died. Due to treatment of the pressure sore, he wasn't able to do the activities on his "bucket list."

The complainant said that one wish was for the consumer, the complainant and three other family members to go fishing with a company that caters to wheelchair users. The complainant asked the provider organization staff to pay for the trip for her and the family members. This would be to honour the consumer's memory. The staff said they would consider this and would let the complainant know. 

This demonstrates that sometimes it takes something unconventional to resolve a complaint. 

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Major vein cut during surgery

DHB ~ Right 4 ~ Reasonable care and skill ~ Varicose vein surgery ~ Major vein cut 

Upon making contact with the advocacy service a consumer advised she had had surgery for her varicose veins at a rural hospital. During the surgery a major vein had been cut which resulted in her being transferred by helicopter to a large city hospital for remedial surgery. She had received a verbal apology from the surgeon and information from the DHB about the advocacy service. Prior to contacting the advocacy service, the family had sought legal advice. 

The advocate visited the consumer at her home following her discharge from hospital and was able to explain the DHB complaints process to the consumer and her family, the Code of Consumer Rights, the role of an advocate, HDC as well as the ACC Treatment Injury process. 

The consumer wanted a full explanation from the surgeon about what had happened to her during the operation including how and why the injury occurred, and a written apology. She also sought an assurance from the DHB that they had reviewed this event and that the surgeon was fit to practice. She also wanted a copy of her notes. The advocate was able to inform her how to request these and how long this process would take.

The advocate was able to assure the consumer and her family that the DHB would value meeting with them to ensure she was heard and to discuss the surgeon's ability to practice safely. The advocate supported the consumer to write to the DHB outlining her concerns. Once they received the written response, the advocate supported the consumer and her family at a meeting with DHB providers. As part of preparing for the meeting the consumer wrote down additional questions she wanted to address.

At the meeting the consumer received a sincere apology from the surgeon as well as a full explanation as to how injury occurred. The surgeon also acknowledged that the error had an immeasurable impact on the consumer and her family. The consumer was advised that this incident would be used for training and education sessions around NZ, and had been discussed at a monthly surgeon's meeting. It would also be discussed at an audit meeting later in the month. If any recommendations were made as a result of those discussions the consumer would be informed. 

At the conclusion of the meeting, the consumer and her family were satisfied that the DHB had thoroughly investigated their concerns. They were happy with the support they received from the advocacy service though a difficult time.

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Too old to care for?

DHB ~ Right 1 ~ Respect ~ Right 2 ~ Dignity ~ Right 5 ~ Effective communication

An 83-year-old consumer contacted the advocacy service after ongoing problems following a medical procedure performed approximately eighteen months previous.

She said her GP referred her to a specialist who had advised that based on a rushed clinical investigation there was no problem. Following her appointment she received a letter saying that there would be no further investigations and when she spoke with her GP she was told nothing could be done despite her ongoing symptoms. 

She was apprehensive about making a complaint, but said she had pages of information about her suffering. The advocate visited the lady at her home on three occasions to assist her to compose a letter to the DHB. In response she was invited to meet with another specialist who the consumer felt took the time to actually listen to her concerns. The specialist made a diagnosis and referred her to ACC for treatment injury. She was also referred to an advanced clinic where she would be seen by experts in her medical condition.

At the conclusion of the meeting the consumer said that she was very happy she had come to the advocacy service as for eighteen months she had gone through so much and been so angry with so many people, that this had got in the way of her healing. She said that she was not angry any more.  

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Withholding information

DHB ~ Right 1 ~ Respect ~ Right 5 ~ Effective information ~ Right 6 ~ Fully informed ~ Right 7 ~ Informed consent ~ Informed choice

A consumer contacted the advocacy service after getting no answers from the hospital where she had been admitted. Despite requesting information about why she was there, when she would be going home, and when she could expect to receive an assessment by hospital staff about continuing to live independently, no-one had given her any answers.

At the consumer's request the advocate called the hospital, but was also unable to obtain this information. 

The advocate contacted the consumer to discuss options to progress the matter. The consumer chose to request a meeting with the Charge Nurse, with an advocate to support her. At the meeting the Charge Nurse explained that the consumer was admitted following a fall at her home. She had also been diagnosed with a urinary tract infection. She explained that they believed she was delirious as a result of the infection. For this reason, they wished to keep her on the ward to treat the infection. Only then, explained the Charge Nurse, would they be able to fully assess her competence to return home.  

After hearing this explanation the consumer agreed to take the antibiotics which she had previously refused. The Charge Nurse said that she would speak with the consumer on a daily basis to keep her updated on her situation.

The following week the consumer was assessed and discharged.

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Confusion over consent

DHB ~ Surgery ~ Right 5 ~ Effective communication ~ Right 6 ~ Fully informed ~ Right 7 ~ Informed consent ~ Informed choice

A consumer described to an advocate having consulted a specialist who referred her to a surgeon. At the surgical consultation she was told that she would require three procedures but they could be done as one operation. She agreed to this.  

However, during her recovery from the operation she was told only one procedure had been completed as there was no documented consent for the other two procedures. She was told no further surgery would be undertaken for at least six months. The consumer was distressed by this information as she had been suffering for three years. 

With the support of the advocate the consumer wrote to the hospital outlining her concerns and stating that the outcome she sought was to have her surgery completed as soon as possible. She requested a meeting with the surgeon and advised she would have an advocate supporting her at the meeting. 

The DHB agreed a date for the meeting. Prior to it occurring the consumer contacted the advocate to say the meeting was not necessary as the surgeon had agreed to do the surgery.

The consumer considered the matter resolved. 

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Serious adverse event from preventable prescribing

DHB ~ Right 4 ~ Appropriate standards ~ Right 10 ~ Right to complain

A consumer made a verbal complaint to a public hospital, following which she received a letter. The consumer was disappointed that in the letter the hospital did not respond to her complaint adequately, and as a result she remained unhappy about what happened to her. She said she had been distressed for months not knowing how to respond to the letter as she felt that the hospital did not understand her concerns, so contacted an advocate for support.

The consumer and advocate met to discuss the details of her complaint so the advocate could offer appropriate options to have the issues addressed. The main issue for the consumer was that despite warning the hospital staff of her sensitivity to a particular drug,  during a pre-surgical out-patient clinic, she was given the drug post-operatively. This caused an adverse reaction and she had nearly died. The consumer did not want this to happen again and wanted to have an alert set up in her hospital file so that all the staff were aware of her sensitivity to this drug. 

After considering the options the consumer chose to have the advocate assist her to write another letter to make it clear what her concerns were and what it would take to resolve the matter. 

The consumer received a second response from the DHB advising they had spoken to the hospital pharmacist and agreed to place an alert in her hospital file. There was also an acknowledgement of the consumer's experiences during her hospital stay.

The consumer advised the advocate that she was happy that the second response addressed her issues. She was pleased to have had the support of the advocate to make it clear what the issues were, and her expectations for resolution. 

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Information leads to action

DHB ~ Right 1 ~ Respect ~ Right 5 ~ Effective communication ~ Right 6 ~ Fully informed ~  Cancelled appointments

Frustrated by having three appointments cancelled on the day, a consumer sought information from an advocate to help find out what was happening, as they knew their referral to the vascular surgeon had been marked urgent due to poor circulation to the foot. 

The advocate provided contact details for the person at the DHB who would be able to follow up the consumer's concerns. The consumer was happy to contact the DHB and later contacted the advocate to say that the surgeon asked why they hadn't come forward earlier.  

Upon hearing about the delays the surgeon asked for processing of referrals to be reviewed to avoid consumers falling between the gaps. The consumer was pleased that their personal experience was going to make a difference for future patients.

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Lack of privacy in the corridor

DHB ~ Right 1 ~ Privacy ~ Right 4 ~ Appropriate Standards ~ Right  5 ~ Effective communication

Prior to his death a consumer was admitted to a hospital for an MRI scan to determine if he had more than one tumour.

While in hospital his wife said she was concerned about the lack of communication about his care plan and test results. She said she received conflicting information about the amount of fluid he should have, and as a result of his confusion he had gone missing from the ward on several occasions. The complainant advised she had written to the DHB to express her concern prior to her husband's death, and their response was not what she had expected. She wanted advocacy support to arrange and support her at a meeting with the doctor and clinical nurse manager.

She wanted to receive an explanation regarding why the family had not been informed there were no further options for treatment and why they had not been informed about his discharge from hospital. She sought an apology and a guarantee that the hospital would address the systems issues on the ward to prevent any other family having to go through same traumatic experience.

The advocate supported the complainant and her son at a meeting with the clinical head of medicine and the  clinical nurse manager. In addition to the things the complainant planned to raise, she advised the doctor that the family was distressed at being able to hear the clinical discussions by the medical team after the ward round. Both the doctor and nurse verbally apologised for what had happened and the distress it had caused.

Following the meeting the complainant received a letter outlining the actions that had been taken. These included the head of medicine reminding medical staff to be 'mindful' of corridor conversation about a patient's medical conditions and progress, and to be clear when recording in a patient's notes. The  clinical nurse manager had also discussed with nurses the need to include the patient's family in the discharge process. The family's experience of 'Health Information Privacy' would be used as an example in training and orientating new staff.

The complainant was happy with the response and to have had an advocate support her through the process.

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Only the CEO will do!

DHB ~ Right 10 ~ Complaint process 

A consumer expressed concern to an advocate that rather than his complaint being shared with the CEO it had been shared with front-line nursing staff. He told the advocate that the only way he felt the matter would be fully resolved was if he could be assured the CEO had seen it. The consumer requested the advocate make enquiries on his behalf to see if the CEO had actually seen it. 

On the instruction of the consumer the advocate phoned the DHB and was told it would not be usual practice to direct what was considered a minor complaint to the CEO; the DHB's policy was that the CEO would normally receive and reply to only serious complaints. The staff member acknowledged that out-of-the-ordinary course of action was needed to resolve the consumer's concerns. 

Shortly afterwards, the advocate received a copy of the email sent from the staff member to the CEO and a copy of the CEO's reply in which he said he had received the consumer's letter from the staff member, read it, and would take no further action, as per the consumer's request. 

The advocate kept the consumer informed throughout this process. Upon hearing that the CEO had read and acknowledged his original complaint, the consumer told the advocate that he now felt able to move on to other things in his life.  

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Being kept informed makes all the difference

DHB ~ Surgery ~ Right 5 ~ Effective communication

After a consumer's initial surgery his surgeon told him he would require another operation but as it was non-urgent he would be placed on the waiting list. While waiting for his second operation to be scheduled he developed an incisional hernia which prevented him from carrying out his usual activities including his job.

A referral to the hospital by his GP was returned with the advice that the surgery was considered non-urgent. Having waited eight months for recall after the first operation and the referral by his GP being rejected, the consumer contacted the advocacy service to see how they could assist.

After considering the support available through advocacy the consumer chose to write directly to the surgeon who had performed his first operation as he was aware that his second surgery was to be performed at another DHB.

The surgeon was prompt in responding. In his letter he advised that he had been unaware of what had transpired until he received the consumer's letter, and gave an undertaking to speak to the other DHB to progress the matter. Following receipt of the surgeon's letter, and after further discussions with the advocate, the consumer decided to follow up with the second DHB to see what progress had been made, asking to be kept informed.  

It took another three months from his first contact with the advocate to get his surgery, but the consumer was kept informed of his progress on the waiting list and is now recovering and looking forward to his life returning to normal. 

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New surgical technique unavailable at DHB

DHB ~ Surgical technique ~ Right 6 ~ Fully informed

A consumer with a long-standing medical condition contacted the advocacy service. The consumer had been under the care of a specialist for several years and had had surgery, but over time the effectiveness of this had worn off. The specialist had suggested a surgical technique which might help but made it clear this was not being offered by the consumer's DHB.

The consumer undertook their own research and discovered the technique suggested was not appropriate for them based on their previous outcome from surgery. The consumer had prepared a number of questions for their next appointment with the specialist, but as they had no-one else for support wanted the advocate to be present while the discussion took place. 

The specialist took a lot of time to go over the past history of the consumer's condition including the surgery, and explained why they thought the surgical technique might work in their case. It was emphasized that the success rate wasn't 100% and that the consumer might not even be a suitable candidate. The technique was still not offered at the consumer's DHB but was available elsewhere.

As the specialist had performed this technique many times in previous jobs they were very keen to see it offered at the local DHB and in the next eight weeks they were working on developing a pilot application with a colleague returning to work after an absence. 

The specialist said they were happy to put the consumer through the preliminary questionnaire - once developed - to screen if they were a suitable candidate for the technique and if so, they would then make an application to the DHB to consider funding the consumer to have the technique performed at another DHB. The consumer was very happy with this suggestion and was encouraged by the specialist to re-contact them in person if they were concerned about delays. 

At the conclusion of the appointment the consumer advised they had been pleased to have advocacy support to accompany them to the appointment and ask their questions and but now felt able to self advocate if required. 

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Writing a complaint to a DHB
DHB ~ Emergency Department  ~ Right 10 ~ right to complain
The consumer had identified prior to his call to the advocacy service that he wanted to make a written complaint. He wanted to talk to an advocate about his complaint and how to go about writing his complaint. Due to the consumer's condition he was unable to travel in comfort so the advocate arranged to meet him at his home.
During the visit, the consumer talked about his recent experience at the Emergency Department.  He felt that his condition, although documented, was not understood by the emergency staff.  He felt that he was not thoroughly assessed and that he was sent home far too soon.
The advocate informed the consumer of his options and described the DHB complaints process and their contact details.  The consumer opted to write but needed help to do this and together they drafted up a letter. The advocate typed it up and sent it to the consumer in draft form asking him to make any changes he felt necessary and once done to contact the advocate with his amendments. After amending the letter, the advocate printed two copies and sent them to him - one to sign and post to the DHB and one for him to keep as his copy.  
He was happy with this and said that he felt in control of his complaint.  He advised the advocate some time later that he had received a response from the DHB acknowledging communication could have been better and they apologised. He was very happy with this outcome.
 

Writing a complaint to a DHB

DHB ~ Emergency Department  ~ Right 10 ~ Right to complain

A consumer had identified prior to his call to the advocacy service that he wanted to make a written complaint. He wanted to talk to an advocate about his complaint and how to go about writing it. Due to the consumer's condition he was unable to travel in comfort so the advocate arranged to meet him at his home.

During the visit, the consumer talked about his recent experience at an Emergency Department. He felt that his condition, although documented, was not understood by the emergency staff. He felt that he was not thoroughly assessed and that he was sent home far too soon.

The advocate informed the consumer of his options, described the DHB complaints process and provided their contact details. The consumer opted to write but needed help to do this and together they drafted a letter. The advocate typed it up and sent it to the consumer in draft form asking him to make any changes he felt necessary and once done to contact the advocate with his amendments. After amending the letter, the advocate printed two copies and sent them to him - one to sign and post to the DHB and one for him to keep as his copy.  

He was happy with this and said that he felt in control of his complaint. He advised the advocate some time later that he had received a response from the DHB acknowledging communication could have been better and they apologised. He was very happy with this outcome.

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A simple pain management solution

DHB ~ Emergency Department ~ Pain Management ~ Right 4 ~ Appropriate standards

A consumer with a chronic pain syndrome following an operation a few years previous, contacted an advocate for help. At times his pain became unbearable and he was either taken to the Emergency Department by ambulance or presented there himself with his partner or parents.  Even though he had a well documented pain management plan, each medical officer he saw made changes and he felt his overall wellbeing was compromised.

After considering the options available, the consumer decided he would like the advocate to assist him to write a letter to the Chief Medical Advisor regarding his concerns and requesting a meeting with the Manager of the Emergency Department. The consumer received a response and a meeting date was set.

The ED Manager, Chief Medical Advisor, and the Patient Safety & Quality Manager represented the DHB at the meeting. The consumer, supported by his partner parents and the advocate, was able to express his concerns and provide details of what happened when he was admitted to ED.  He gave a brief history of his pain and how he managed to cope at home and what his expectations are when he arrived at ED.

The ED Manager was very sympathetic towards the consumer's issues and discussed options that were available to manage the situation.  The meeting closed with the ED Manager stating he would contact the consumer. That afternoon the consumer received an email from the Manager with a baseline Pain Management Plan which the consumer was able to have input into.  The consumer stated that between them, they ensured the plan was outlined in such a way that it would be difficult for anyone to misinterpret the medication, doses and times. He said he had ensured there weren't any loopholes.

The consumer was amazed that this had happened so fast and contacted the advocate to say thanks.

"Once again, thank you so much for all your help and support, I really didn't know where to turn or how to get help and what steps to take and you made this so much more manageable for me, and my family. 

All the best, hopefully I won't be having any more issues but if I do you'll be number one on my list to call :)"

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Complaint from a diabetes exercise group

DHB ~ Diabetes ~ Exercise ~ Hypoglycemia ~ Communication ~ Safe care

A consumer wanted information about how to make a complaint as they felt that the action of withdrawing refreshments could impact on their own and others' wellbeing. 

The consumer stated that they had been part of a diabetes exercise group run by the local hospital. The consumers who attended did two hours of exercise which was followed by a drink and a biscuit to minimise the risk of hypoglycemia. Management had decided to withdraw the refreshments and the consumers had discovered that the staff running the programme were funding this themselves as they were concerned about the health of those attending if this service was withdrawn.

After discussing the Code and ways in which an advocate could assist with resolving concerns the consumer chose to write to the chief medical officer expressing their concern. The initial response was that the refreshments would not be reinstated. Unhappy with the response the consumer sought support from the advocate to arrange a meeting with the medical officer to discuss the situation.

The meeting duly took place and after listening to the consumer the medical officer agreed that the overall health benefits from the exercise programme outweighed the minimal cost associated with providing the refreshments and so they were reinstated. The consumer was delighted with the outcome and the support provided by the advocacy service.

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What happened to our Dad?

DHB ~ Intensive Care Unit ~ Dialysis ~ Hip replacement ~ Right 4 ~ Appropriate standards ~ Right 5 ~ Effective communication

The family of a man who had died expressed concern about the care their father had received. The consumer was receiving dialysis and had had a hip replacement. The morning after the surgery he became unwell, lapsed into unconsciousness and was transferred to the Intensive Care Unit. He passed away the following morning.

They had the following questions they expected to receive answers to at a meeting with the provider:

  • What had caused the consumer's death
  • Why was he initially being treated for heart failure?
  • What were the medications given post operatively and had they contributed to the consumer's deterioration?
  • Could the delay in the consumer having dialysis have caused his deterioration?
  • Why was there such poor communication with the family when the consumer became unwell and also when in the ICU?
  • Why was there a lack of communication regarding the need for a post mortem examination resulting in the family waiting in the mortuary for many hours with no information, consultation or communication?

The advocate arranged to meet with the daughter of the consumer to discuss the issues and what would be helpful in assisting the family to move forward. The advocate assisted the daughter to write to the DHB outlining the issues, their desired outcome and stating who they would like to have present at the meeting.

Those attending the meeting were: the consumer's wife, four daughters, one brother and sister-in-law and the advocate. The provider was represented by the renal specialist, medical specialist, orthopaedic specialist and charge nurse.

The family began by outlining their concerns and putting forward the questions they needed to have answered.

The providers responded by saying they had not been able to identify what had happened to cause the consumer's deterioration and unexplained death and that post mortem had not established the cause.
They explained what treatment the consumer received at the time of his deterioration and who was caring for him.

They advised that the consumer had initially choked on his medication but came right straight away and then had subsequently deteriorated. They said his drowsiness would have been as a result of a lack of oxygen to his brain rather than the Morphine he had been given. Initially it was thought the consumer was having a heart attack and so he had been treated for that. However the post mortem had confirmed this was not the case.  The family were assured that the morphine would not have caused the consumer to react in the way he had.

The providers advised the family that their father had not been left alone and struggling without treatment. The renal specialist advised that not having dialysis had not contributed to the consumer's condition as he would not have been scheduled to restart dialysis until two days following the surgery. He went on to say that he had attended the consumer shortly after the event that led to his transfer to ICU.

The providers apologised for not communicating with the family in a way that met their needs when the consumer was in ICU. They advised that the discussion around the post mortem examination would need to be with the Coroner and that they would be happy to follow this up on the family's behalf. They undertook to send the family a written summary of the discussions that had taken place in the meeting. They would also include the outcome of the discussion with the Coroner.

When the advocate debriefed with the family they advised they were satisfied that they had received the information they required and as a result they all felt much lighter after the meeting.

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Being ignored for 50 hours following surgery

DHB ~ Surgery ~ Right 4 ~ Appropriate standards ~ Right 5 ~ Effective communication ~ Infection ~ Hospital training team

A consumer described being in excruciating pain with vomiting and a high fever following routine surgery. She said that she discussed this with two doctors but was told that these were normal symptoms after surgery. She had also spoken to a number of nurses about how she was feeling but was told not to worry. She said that she was about to be discharged but her sister insisted that she be tested before being sent home.

Fifty hours following surgery, a CT scan and blood tests were done.  She was then sent into emergency surgery as the tests showed that she was suffering from peritonitis caused by a nick in her bowel that had occurred during the first operation, causing an infection. The emergency surgery left an 18cm scar down her stomach, ongoing bowel issues and the possibility of infertility.  She said that she also had to leave her employment due to ongoing pain.
 
The young woman decided that she would like to find out why the doctor and nurses did not listen to her. She wanted to know why it took fifty hours to be tested when she was displaying all of the signs of an infection.  She wanted the staff to be made aware of the huge impact that it has had on her life just  from them not listening to her.
 
An advocate assisted the consumer to arrange a meeting with the surgeon and the hospital customer services representative. At the meeting she questioned how this could have happened and why she wasn't listened to.  The surgeon apologised several times and said that the staff should have listened to her and that the nick to her bowel was human error.  The consumer offered her support to anyone else should this ever happen again. The customer services representative asked if the consumer would like to be part of the hospital in-house training team so staff could hear and see what she been through and the importance of listening to their patients.  The consumer thought that this was a great idea.
 
After the meeting the consumer thanked the advocate for the support and said that she had had her questions answered and felt the meeting had given her closure. She said that the offer to participate in staff training made her confident that staff could learn from her experience and hoped that this wouldn't happen to anyone else. 

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Discharged without medication

DHB ~ Right 4 ~ Appropriate standards ~ Medication not returned ~ Diagnostic tests not carried out ~ Right 6 ~ Fully informed

A consumer approached an advocate for support following his discharge from hospital without his medication or the tests he had been told he would be having. He felt he had not been given adequate information and that his medication should have been returned to him when he was discharged.

After considering his options he asked the advocate to phone the complaint officer at the hospital as he required his medication that day. The consumer was very happy with this approach as he was able to discuss his concerns directly with the person who could look into the matter. The complaint officer advised they would phone him back after looking into his concerns. When she called back, she advised him a prescription had already been faxed to his local chemist. She also provided him with an explanation of why he had received less than ideal service.

The consumer was pleased that his contact with the advocate had resulted in such a quick response to his concerns.

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Doctor needed a reminder about seeking permission for student
 
DHB ~ Right 5 ~ Effective communication ~ Right 9 ~ Teaching ~ Student

A consumer sought advocacy support at her next appointment at the DHB as she felt she had been given conflicting and confusing information leaving her very worried about a breast lump. She had received reports that contained medical jargon that she did not understand. The advocate suggested the consumer advise DHB staff that she would be accompanied to her appointment by an advocate, which she did.
 
At the appointment, the doctor entered the room with a nurse and a male medical student. He didn't introduce himself or the others and proceeded to read the notes.  The advocate politely interrupted to introduce herself and explain that her role was to support the consumer with her concerns. As the doctor had not sought permission to have the medical student present, the advocate asked if the consumer was happy to have a student present during the examination as the advocate had picked up on the consumer's anxiety. The consumer said that she did not feel comfortable so the medical student left.

The consumer told the doctor her grandmother had recently died from breast cancer and expressed her ongoing concern about her breast lump.  Using terms the consumer understood the doctor explained why he was not concerned about her lump.  He offered the consumer an MRI scan to fully rule out any possibility of cancer which she accepted.
 
At the end of the appointment the consumer said she was pleased to have had the explanation and the offer of an MRI  to put her mind at ease.  She thanked the advocate for asking her about the medical student being present during the examination as she had been too anxious to say anything and didn't want to offend anyone.

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Frustration at ongoing pain

DHB ~ Orthopaedic Surgeon ~ Right 6 ~ Fully informed ~ Fractures ~ Pain relief

A consumer with compound fractures of the lower tibia and fibula from a motorcycle accident had them fixed with a steel rod and screws. Over the next three months whenever he saw the orthopaedic surgeon he complained about ongoing pain in his knee cap. He returned to work and commenced physiotherapy but had to stop as it was too painful. He had the rod removed by a different surgeon and was sent again for physiotherapy. However he was still in pain which restricted his movement. In frustration at not getting adequate pain relief and the answers he needed about why his recovery was taking so long, he contacted an advocate for help.

After considering the options he chose to write to the Orthopaedic Department to request a meeting. At the meeting he wanted a detailed explanation of why the insertion of the rod had been chosen over other options that may have been available, and whether a different option would have resulted in a different outcome. The consumer asked the advocate to support him at the meeting.

The meeting went very well and the consumer had all his questions fully answered. He was provided with an explanation about the ongoing pain and the expected time it would take for the bone bruising to heal. He was also reassured the length of the metal rod used had not contributed to his pain and was offered an alternative treatment to provide pain relief.

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Preventing a recurrence of poor care

DHB - Urology - Right 4 ~ Appropriate Standards - Consistent with needs

An advocate was approached by family members who had attempted to address their concerns directly with the hospital,  but were not satisfied with the response. The family felt their father had died in pain as a result of inadequate monitoring and treatment of his cancer. They sought a review of the urologist's practice as they did not want anyone else to be put in a position of unnecessary suffering.

After considering their options, a letter was sent to the hospital outlining their concerns. In addition, they requested a review of their father's case by the urologist's peers, as well as a meeting to discuss this review, with the advocate supporting them.

At the meeting with hospital staff it was acknowledged there had been early diagnostic errors. As a result of the peer review the urologist was on a supervision programme to prevent a similar occurrence.

The family were very pleased to hear this and accepted the acknowledgement and apology from the urologist. They were happy to know that their most important concerns about the serious care issues had been addressed and that steps were being taken to prevent this happening to someone else.

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Meeting helps answer questions

DHB ~ Dementia ~ Assessment ~ Right 5 ~ Effective Communication ~ Right 6 ~ Full information

A woman phoned the advocacy service with concerns about the assessment process and care of her husband.  He was still in hospital following a recent diagnosis of dementia.  She was confused by conflicting information about her husband's current status and future needs.

She also said she felt staff were not listening to her in relation to her husband's medical history. She had asked for a meeting with the staff involved in her husband's care but felt she needed advocacy support because of the previous communication and information difficulties she had experienced.

Prior to meeting the providers the woman met with the advocate to formulate a list of questions she wanted answers to. The advocate discussed the process for the meeting and how she could support her to achieve a successful outcome.

At the meeting the woman confidently and clearly put forward her questions and was satisfied with the response she received. She found the discussion gave her a much clearer picture about how her husband's care needs would be met and how she could be involved in decisions affecting his future care.

The advocate followed up several weeks later to see how things were going. The woman said she was pleased the agreed actions had been followed through. She had chosen a care facility which met her husband's needs.

She was pleased to have the strain of the previous miscommunications and conflicting information behind her and was confident that decisions were being made in an open process.

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Assisting a non-English consumer to communicate with a DHB

DHB ~ Surgery ~ Refugee ~ Non-English speaker ~ Right 5 ~ Effective communication

A consumer, who was newly arrived in NZ from a refugee background and unable to speak English, contacted an advocate. He was confused and concerned about delays with his surgery. He couldn't understand why his procedure had been cancelled three times and felt anxious about the impact of the delay on his health. His GP had told him he needed an urgent biopsy.

After discussing his concerns with the advocate and hearing of the assistance an advocate can provide,  he asked the advocate to contact the DHB on his behalf to alert them to his concerns and request an urgent response to them.

The advocate rang the Customer Service Manager straight away alerting her to the consumer's situation. Later that day the consumer was advised his procedure had been scheduled for the following day. This time it went ahead without any hitches.

He was delighted with how quickly his concerns had been resolved once an advocate became involved.

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'Bad luck' at the Glaucoma Clinic

DHB ~ Eye Department ~ Treatment complication ~ Right 6 ~ Fully informed about side effects

A consumer attended a regular check-up at the glaucoma clinic. As usual she removed her contacts and had drops instilled. The doctor said he was happy with the examination and told her to make an appointment in four months' time. Later the same day she put her contact lenses back in which resulted in excruciating pain and her eyes streaming. Her husband called the eye clinic to be told to go to the chemist and get some chloramphenicol eye drops as she had probably just scratched her eyes when removing the contacts.

She was taken to an emergency clinic when the drops failed to provide any relief. The doctor there explained the drops used had caused her eyes to dry out and when she put her contacts back in they stuck to her eyes "like super glue".  When they were removed due to discomfort, it had removed the top layer of skin from her eyes. This had never happened before on any of her previous visits to the clinic. The consumer was given pain relief and after twenty minutes the pain returned and she was rushed to hospital. On examination she was told "Its just bad luck". She was given pain relief and told to return home "as there was nothing else that could be done".

The consumer was upset about the cavalier way in which she had been treated. She and her husband met with an advocate to discuss the complaint options.

The couple decided to write a complaint letter with assistance from the advocate. They were not satisfied with the response they received and requested a meeting be arranged with the provider.

The consumer received an apology and an acknowledgement of what had happened. The request for compensation and reimbursement of costs incurred were sent to the provider's legal team and some costs were refunded. The service also arranged training and up-skilling of staff. Staff were instructed to provide information to consumers that a reaction such as this consumer had experienced is a possible side effect.

The consumer was happy with the outcome as she felt raising her concerns might prevent a similar situation for another consumer.

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Advocacy at the consumer's pace

Hospital service ~ Consumer centred ~ Strength-based practice ~ 5 column approach 

A support worker contacted an advocate after attending an advocacy education session. She had concerns about the local hospital and was initially excited to know that someone was there to assist her in raising her concerns.

The advocate explained the options and posted information to her.  The advocate also arranged to contact the consumer again in a week's time to further discuss the action she would like to take.

Several days later the consumer rang to say everything felt 'too hard' and she had changed her mind.  The advocate told her about the 5 column approach used by advocates when assisting consumers to clarify their issues, and offered to meet with her to do this. The advocate suggested that if after this process she did not wish to go any further, then the matter would be closed with no action or further questions asked.

By the time the advocate visited the consumer several days later the consumer was again excited to receive the assistance to progress her complaint. She had made notes about her issue and found the 5 column approach very helpful. With the advocate's help she was able to put together a comprehensive letter of complaint which was sent to the provider.

With a little time and encouragement the advocate was able to support the consumer by working at her pace without overwhelming her.

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Meeting helps answer questions

DHB ~ Dementia ~ Assessment ~ Right 5 ~ Effective Communication ~ Right 6 ~ Full information

A woman phoned the advocacy service with concerns about the assessment process and care of her husband.  He was still in hospital following a recent diagnosis of dementia.  She was confused by conflicting information about her husband's current status and future needs. She also said she felt staff were not listening to her in relation to her husband's medical history. She had asked for a meeting with the staff involved in her husband's care but felt she needed advocacy support because of the previous communication and information difficulties she had experienced.

Prior to meeting the providers the woman met with the advocate to formulate a list of questions she wanted answers to. The advocate discussed the process for the meeting and how she could support her to achieve a successful outcome.

At the meeting the woman confidently and clearly put forward her questions and was satisfied with the response she received. She found the discussion gave her a much clearer picture about how her husband's care needs would be met and how she could be involved in decisions affecting his future care.

The advocate followed up several weeks later to see how things were going. The woman said she was pleased the agreed actions had been followed through. She had chosen a care facility which met her husband's needs.

She was pleased to have the strain of the previous miscommunications and conflicting information behind her and was confident that decisions were being made in an open process.

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Lack of co-operation leads to frustration

DHB ~ Maori Health ~  Mental Health ~Right 4(5) ~ Co-operation ~ Right 5 ~ Effective communication

A woman and her whanau were frustrated and confused by inconsistencies between the Maori health and mental health services the consumer was using for her treatment. They approached an advocate for help. After considering the options the consumer opted for a meeting with the two providers. She wanted her whanau present, as well as the advocate for support. The advocate assisted by arranging the meeting, helping the consumer prepare her questions as well as discussing the meeting process.

Due to this preparation and support the consumer was able to address all of her concerns and receive responses to them. The woman and her whanau felt the meeting went very well and appreciated the role of the advocate to enable them to find their own solutions. Since the meeting the woman and her whanau have found significant improvements with the communication and both departments are working cooperatively.

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Confusion at the hospital

DHB ~ Chest pain ~ Cancelled test ~ Right 5 ~ Effective communication

A man contacted an advocate for support to make a complaint about an upsetting encounter with the local hospital. He had been sent to the hospital by his GP for investigation of his chest pain.. Once admitted he was told he would be tested the following morning. He was woken early by staff the next day. However, after waiting half the day he was informed the test would not be done and he could leave. He was upset by this and had "words" with the staff which resulted in him being given a self discharge form to sign. Once home he realised he had not been prescribed any medication. When he contacted the hospital he was told that as he had self-discharged he would need to go through the whole admission process again.

The man wanted the advocate to support him to find out why his test was cancelled, why he was not given any medication and why no-one told him that the form he had signed was a self-discharge form. After considering the options he asked the advocate to make contact with the hospital's complaint liaison officer and request that they phone him to discuss his concerns.

He contacted the advocate after speaking with the complaint liaison officer. He said she had provided him with an explanation and organised for a prescription to be faxed to a nearby pharmacy for him to collect. He was satisfied with such a positive outcome and was grateful the advocate had supported him to raise his concerns.

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Preventable death of a medical practitioner

DHB ~ Right 4 ~ Standard of care ~ Hand washing and hygiene ~ Infected luer ~ Pneumonia ~ Right 6 ~  Fully informed ~ System failures

A family complained about the care provided to their family member as they believed his death was a preventable one resulting from poor care. They were particularly upset because he was considered an expert in quality management systems and patient care.

Prior to his death, on a number of occasions, he had spoken with his family about the poor standard of care, his concern about staff not washing their hands, the lack of information and explanations given to him as well as other patients. Due to his experience as a medical practitioner the consumer was conscious that the poor hygiene could impact on his health and he was very aware of the side effects of antibiotics. His family were angry and upset when he got septicaemia from an infected luer, developed pneumonia complications and subsequently died.

A family representative contacted the local advocate to discuss the process for making a complaint to the hospital. After considering the information and their options, the family decided to write a letter stating what their concerns were, asking for a meeting to discuss them. They requested the advocate be copied in to any written correspondence.

Prior to the meeting they met with the advocate to discuss the process of the resolution meeting. This included documenting the issues and outcomes they hoped for. They wanted recognition that system failures had contributed to the consumer's death. They also wanted a review of the staff numbers working in such a busy unit due to the complexity of the care required, a review of their protocols for managing a luer to ensure it complied with current best practice, training for staff about administration of medication via a luer and for staff to be more accessible. A copy of these expectations were forwarded to the Quality and Risk Manager so those attending from the DHB would be able to come prepared.

The family attending the meeting found it helpful and informative as there was open discussion and sharing of information. The DHB staff acknowledged the issues raised and assured the family their concerns were being taken seriously. They sought permission to use the consumer's and family's observations in a case study for staff training and advised they were now part of the World Health Organisation initiative to improve hygiene and infection control.

The family members present felt the meeting had been productive and well worth attending. They were pleased with the outcome.

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