Photo: 123RF
A man says delays in diagnosing a lesion on his right finger as a type of skin cancer led to the removal of his finger, lymph nodes and radiation therapy.
The deputy health and disability commissioner Vanessa Caldwell made a decision on the care the man, who was not named, received after his surgery to remove a finger was delayed.
The man complained to the Health and Disability Commission (HDC) about the care he was given by Health NZ, his general practitioner (GP) and the medical centre the GP worked at.
Caldwell noted the man said he asked his doctor for at least eight years about a lesion on one of his fingers and was repeatedly told it was a wart.
But his doctor, who was also unnamed, denied this and said he was first alerted to the lesion in 2018. The doctor thought it looked benign and gave him cryotherapy.
Caldwell said there was a "substantial variation" in how the doctor and the man recalled these events but there were no clinical notes about the lesion before 2018.
Photo: James Gilberd Photography Ltd
By August 2019, the man mentioned to his doctor the lesion had grown and the doctor decided a surgical review of the finger was needed.
The man was referred to DHB plastic surgery services with an attached photograph that showed an obvious hole in his finger.
Despite being marked as urgent, Caldwell said it took two months for the doctor to send the referral.
The doctor acknowledged this was partly an administrative error on their own part along with an issue the centre was having for eight weeks with attaching photos.
"For this I am truly sorry," the doctor told the HDC.
The man was seen by a specialist in March 2020 where the cancer was confirmed and a surgery was set for April, but due to the Covid-19 lockdown this was pushed back to May.
On the day of his surgery the doctor performing it said he was "clearly unwell" and had a skin infection - the surgery was abandoned due to his condition and he was hospitalised.
The man was hospitalised due to a skin infection. Photo: 123RF
The lesion was excised the next day and on 27 May, the finger was amputated.
Caldwell noted the man skipped some post-surgery check ups and came in during October where a mass in his armpit was found.
It was found to be the cancer and this was removed the following month. After this, the man had several weeks of radiation therapy.
The doctor at the hospital told the HDC the delay in surgery was "unfortunate" and was due to the heavy workload.
Health NZ recognised it would have been ideal for him to have been seen earlier but noted Covid-19 and patient factors impacted this.
It believed the service given had been reasonable.
Caldwell said the man's GP should have told him what to do if the plastic surgery service did not contact him and he should have been told of the delay in sending the referral.
"I am critical that the doctor didn't submit the referral sooner, but he has since changed his practice to make sure delays do not happen again."
She did not consider the doctor or Health NZ had breached the Code of Health and Disability Services Consumers' Rights.
Health NZ told Caldwell as of March 2023, the status of the skin cancer waiting list was
worse than it was in 2020.
Caldwell said the plastics and reconstructive surgery service highlighted its concerns regarding long waits for skin cancer to both the previous chief executive and the current management of Health NZ.
She asked Health NZ, the medical centre and the GP to apologise to the man.
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