Monitoring of repeat PSA testing
Source: Health and Disability Commissioner
EMBARGOED UNTIL 2:00pm, Monday 6 May 2019
Health and Disability Commissioner Anthony Hill today released a report finding a General Practitioner (GP), and the medical centre he worked for, in breach of the Code of Health and Disability Services Consumers’ Rights for failing to carry out necessary testing in a timely way.
A man’s prostate specific antigen (PSA) was tested and then retested a month later, both showing slightly elevated results. His GP told him that his prostate levels were very slightly over normal but seemed stable, that the GP could arrange specialist review if there were any urinary problems, and that otherwise his PSA levels needed to be tested 6-12 monthly. However, the GP did not set a recall for the testing to be done.
The man requested repeat prescriptions, using an online tool that the medical practice had just started using. At that time, the practice had not recognised how easily patients were able to request prescriptions without having a face-to-face consultation. The GP requested blood tests for the man approximately a year after the elevated PSA tests, but a PSA test was not included, and the GP told the man by email that he shouldn’t need PSA testing for another year. The GP issued further repeat prescriptions.
Some 20 months after the first tests were done, the man saw his GP with urinary retention, and was later diagnosed with prostate cancer.
Mr Hill considered that both the GP and the medical centre did not provide the man with reasonable care and skill in providing health care services. Mr Hill found that the GP failed to meet his obligation to ensure the man’s PSA levels were managed appropriately and that the medical centre did not have adequate processes in place to pick up that the man was due for a PSA test. However, he acknowledged that since these events the medical centre has made changes to reduce the likelihood of a similar error occurring again. The GP has also made changes to his practice.
Mr Hill recommended that the GP provide a letter of apology to the man. Mr Hill also recommended that the medical centre carry out an audit to identify compliance with its amended repeat prescribing and results management processes. He asked for a report of this audit and any changes made as a result of the audit, to be provided to him.
The report for case 17HDC01992 is available on the HDC website.