GP Fails To Provide Services To Patient With Reasonable Skill And Care

Deputy Health and Disability Commissioner, Dr Vanessa Caldwell today released a report finding a General Practitioner (GP) in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) by failing to provide services to a patient with reasonable skill and care.

A man in his seventies, with a long-standing diagnosis of bipolar affective disorder was following a treatment plan that included lithium. In December 2018 the man moved to a new medical centre, where he was tested three times by the GP, in line with three-monthly blood testing requirements for lithium. Each of these tests showed a gradual increase in lithium levels that was not acted on. Subsequently, the man was hospitalised with lithium toxicity.

Lithium levels require regular and frequent monitoring to ensure that they remain within a patient’s therapeutic range. At the outset, the GP did not establish the therapeutic normal level for the man and did not respond to increasing lithium results appropriately.

The GP failed to inform the man that his lithium levels were outside of the normal treatment range. This did not give the man the opportunity to participate in his own care, such as stopping the intake of lithium immediately or seeking earlier medical attention. The high lithium level results was information that in these circumstances, the man would have expected to have received, particularly in light of his deteriorating condition.

In her report, Deputy Commissioner, Dr Caldwell found that repeated acceptance of increasing lithium levels by the GP without undertaking further investigations constituted a failure to provide services with reasonable skill and care.

"The GP’s failure to inform the man when his lithium levels were outside the normal range constituted a failure to provide the man with the information that a reasonable consumer in his circumstances would have expected to receive," said Dr Caldwell.

"The fact that the lithium result was out of the therapeutic range, combined with the dramatic deterioration in the man’s general condition, should have prompted the GP to reconsider his acceptance of the man’s high lithium results.

"The GP should have organised a repeat test promptly for comparison. Furthermore, the man should have been informed of his elevated lithium levels."

Dr Caldwell also made an adverse comment about the GP’s decision not to check previous test results when it was discovered that some of the man’s health information was not transferred to the medical centre.

"As soon as the GP knew that his patient was prescribed lithium, he should have requested the most recent history on these tests. This was particularly important because a baseline value is required in order to monitor a patient’s lithium levels reliably," she said.

"I note the importance of reviewing a new patient’s recent medical history, which includes recent laboratory results. This is particularly true in cases where surveillance testing is being undertaken and establishing a baseline may be useful."

The report acknowledges the challenge in assessing and managing complex conditions and that the GP became situationally blind with some symptoms that he observed in the man, and did not consider information obtained from successive lithium tests sufficiently in forming his diagnosis.

HDC have since been advised by the GP that several changes following Dr Caldwell’s recommendations have been implemented at the medical centre as part of his drive to provide quality care and to minimise unwanted outcomes for his patients. The changes have been introduced as part of the medical centre’s continuing improvement in patient communications.

The full report for case 20HDC00482 is available on the HDC Website.

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