Report reveals complaints about chemotherapy misdiagnosis the tip of the iceberg

DOCTORS at a NSW hospital gave chemo drugs to a patient without cancer. They failed her at every point, and she’s not the only one.

Cancer patient and pregnant mum Katy Reitch undergoes chemo therapy. Katy receives chemo in Sale. Picture: Jake Nowakowski

IT’S been a horror year for hospitals in Australia’s most populous state.

There was the baby cremation mix-up at Sydney’s Royal North Shore Hospital and the accidental gassing of another newborn at Bankstown-Lidcombe Hospital.

There was the underdosing of cancer patients in the NSW central west and at the inner-city St Vincent’s Hospital.

As that scandal unfolded, it was revealed 14 patients who received incorrect doses of cancer drugs during chemotherapy are now dead.

Now, an equally-disturbing story has emerged, one where a patient was given six months’ worth of chemotherapy drugs despite not having cancer.

The story is coupled with alarming figures in a new report that shows complaints from patients have jumped significantly.

Things just got worse for the scandal-plagued health system overseen by NSW Health Minister Jillian Skinner.

Wendy Lyons lost her partner in 2014 after a three-year battle with cancer. Picture: Brad Newman

CRITICAL STEPS MISSED IN CANCER DIAGNOSIS

On Friday, the NSW Health Care Commission released its annual report. It showed a 37 per cent rise in complaints in the five years Ms Skinner has been Health Minister.

But perhaps most concerning was the story of a misdiagnosis gone horribly wrong. The case study gave a detailed analysis of what went wrong, but did not name the hospital, the victim or the staff members involved.

“A woman had a cancerous tumour removed from her bowel and was reviewed by her surgeon three years later,” the report states.

“The surgeon was concerned about the possibility of metastasis in the liver and referred her for a CT scan and CEO tumour marker levels. The surgeon reviewed these findings and, without repeating or ordering any other tests, diagnosed the woman with stage 4 liver cancer.

“The surgeon referred the woman to an oncologist, who recommended a course of chemotherapy. The oncologist did not conduct any further test to confirm the surgeon’s diagnosis of stage 4 liver cancer.”

The report reveals the woman received chemotherapy for a full six months before doctors discovered their error. By that stage, she was suffering chemotherapy toxicity.

“The woman received chemotherapy for six months, but during this time the tumours in her liver did not show any sign of improvement. The oncologist ceased the chemotherapy due to her toxic levels of the chemotherapy drugs and the atypical response of the tumours to the chemotherapy.”

A review was ordered and the results revealed “the woman had benign tumours in her liver rather than stage 4 liver cancer”.

The Commission said both the surgeon and the oncologist failed to exercise adequate care and skill in the provision of the woman’s treatment. They were both referred to the Medical Council of New South Wales, but the Council has not revealed whether sanctions were handed down.

A woman was given chemotherapy treatment for six months after an incorrect cancer diagnosis.

COMPLAINTS ON THE RISE

The HCCC report states that complaints are on the rise around the world, but in NSW they grew by more over the past year than during any of the previous five.

The number of complaints received in 2011-12 was 4130. It rose by more than 400 the year after, 300 the year after that and almost 500 in 2014-15. But in 2015-16, there were 6075 complains received, 809 more than the previous year.

One complaint received by the Commission involved a personal and sexual relationship between a registered psychologist and a patient transitioning through gender reassignment surgery.

The HCCC report reveals how the pair met while the patient was seeking treatment for Dissociative Identity Disorder, including gender identity issues.

An investigation into the pair’s relationship found the psychologist moved into the patient’s home and that they later moved into a second home together.

The Commission found the practitioner failed to seek supervision regarding treatment, which saw the patient transition from male to female, having previously transitioned from female to male.

The Commission also found the psychologist took out a loan to “pay for surgery to feminise her appearance”.

He was prosecuted in the NSW Civil and Administrative Tribunal and found guilty of professional misconduct.

A third case study revealed in the report involved a registered nurse who inappropriately touched an 89-year-old female patient at Nepean Hospital.

NSW Health Minister Jillian Skinner. Picture: Dan Himbrechts/AAP

He was prosecuted by the same Tribunal but the patient died before the matter was heard.

In April, the Tribunal published findings including that the nurse was guilty of professional misconduct of the most serious kind.

The case studies help form a broader picture of the NSW Health system, but Assistant Health Minister Pru Goward said there were other factors to consider.

She told The Daily Telegraph mandatory reporting, better informed consumers and better awareness of the complaints system in NSW were behind a spike in complaints.

In August, Ms Skinner admitted two dead babies became mixed up and one was cremated against its family’s wishes. The bungle occurred in 2015 on Sydney’s north shore.

It was also reported in August that a series of events led to an oxygen mix-up at Bankstown-Lidcombe Hospital.

A baby boy died and a baby girl suffered suspected brain damage after they were given nitrous oxide — otherwise known as laughing gas — instead of oxygen.

The Australian reported a “series of tragic events” were behind the errors.

NSW Opposition Leader Luke Foley said Ms Skinner should immediately stand down or be sacked, but the Health Minister has defended her position.

“I am deeply sorry for the pain and suffering caused to the families of the two babies,” she said in a statement.

News.com.au has approached the minister for comment.