The Dominion Post
Delays left skull injury untreated
A woman who waited nearly two months for treatment for an apparent skull fracture says the delays have left her facing complex surgery.
Merenia Donne, of Whanganui, was first referred to hospital by her GP on July 19 with what he suspected was an ‘‘outer table frontal skull fracture’’.
But more than three weeks later, Donne received a letter referring her back to her GP.
The back-and-forth meant that, when she finally saw a specialist, her bones had healed incorrectly, and she was facing complex reconstructive surgery, she said.
‘‘There’s really only one option. There would have been two options, had I been seen properly in a timely way.’’
Whanganui District Health Board says she has a depression in her forehead, rather than a fracture, and should have been referred to a plastic surgeon in Lower Hutt instead of general surgery. ‘‘The need to redirect it back through the GP caused some delay.’’
Donne has since been referred to an ear, nose and throat specialist for nosebleeds, and has a noticeable dent above her right eyebrow.
‘‘It’s huge, to the point where it’s giving me nightmares and I’m actually quite reluctant to go anywhere. I feel like those caricatures of Frankenstein with the big lump on the head,’’ she said.
‘‘Since the fracture, I have sustained over 15 massive nosebleeds and headaches, as well as the physical damage to the frontal part of my skull. The nosebleeds have progressively increased in frequency.’’
Donne said the DHB’s decision to refer her case back to the GP was ‘‘ludicrous’’, and hospitals were bouncing cases back to manage workloads.
She suffered her head injury while collecting firewood, bashing her head against the front of a horse float. ‘‘I’m not sure even whether I knocked myself out, because the world went black for a little while.’’
She accepted her original referral to hospital may have lacked detail, but the subject line clearly recorded her injury as an ‘‘outer table frontal skull fracture’’, which should have meant it was treated seriously.
Whanganui DHB chief executive Julie Patterson said the referral received was for a repair of a forehead depression, or dent, which Donne found cosmetically unacceptable, rather than a fractured skull.
Patterson said the referral had been sent to the DHB in error, and was meant for a Lower Hutt-based plastic surgeon – an error never mentioned to Donne. ‘‘The orthopaedic surgeon requested the referral be returned to the GP, and the GP advised that the referral had been sent to the incorrect location.
‘‘This was actioned and Ms Donne was sent a letter advising her referral was being discharged back to her GP.’’
The DHB never found itself ‘‘bouncing’’ patient referrals back to GPs. ‘‘The case in question is a rare event where the referral has been sent to the wrong speciality.’’
Tim Malloy, president of the Royal New Zealand College of General Practitioners, said the ability of hospitals to respond to referrals had been compromised by underfunding and staffing shortages. ‘‘I would argue this situation is not new. The onus is on us all to ensure those people who have the highest need, and the most acute need, are seen with the highest priority.’’
Malloy said Donne should either have been seen by the hospital, or the hospital should have made further inquiries before referring the case back to her doctor.
Donne said she was determined to speak about her experience because there were many others who either couldn’t, or weren’t willing, to stick their heads above the parapet.