The four-year-old girl had to be taken to the emergency department after doctors overlooked her abnormal urine test results. Photo: RNZ / Marika Khabazi
The health and disability watchdog has found breaches in two doctors' care of a four-year-old girl who was hospitalised with diabetes.
The girl's parents took her to two clinics owned by the same company on four occasions in November 2020, where she was seen by several nurses and doctors.
The Health and Disability Commission (HDC) found the two doctors overlooked her abnormal urine results obtained by triage nurses and missed an opportunity to diagnose her with type 1 diabetes.
She was eventually diagnosed by another doctor and spent five days in hospital, which stressed the family.
In a report published on Monday, health and disability deputy commissioner Vanessa Caldwell found the doctors' omissions led to a delay in the girl's diagnosis.
"The accepted practice is for a GP to review triage observations as part of patient assessment," Caldwell said.
"I am critical that both doctors overlooked the urine results during their appointments with the girl. In my view, the doctors' omissions led to a delay in the girl being diagnosed with type 1 diabetes."
The girl's parents first took her to the doctor because she was suffering from abdominal pain, vomiting and a fever.
The HDC report said a triage nurse did a urine test showing abnormally high levels of glucose and ketones, but the doctor overlooked the notes.
Her parents took her back to the second clinic two weeks' later because she was still in pain and had developed a rash.
The triage nurse read the earlier consultation notes, and together with the girl's symptoms, thought of a possible diabetes diagnosis.
She did another urine test, which again showed an abnormally high level of sugar.
The second doctor who saw the girl diagnosed her with insect bites and nappy rash.
When the girl still felt sick and was not eating properly four days later, her parents took her back to the same clinic, but she was not seen because the centre said it did not have time to check her.
The HDC heard the girl could have been diverted to the other clinic following a nurse assessment and discussion with a doctor, but this did not happen because the family had already left.
The girl's parents took her to that clinic the following day, when the nurse noted a family history of diabetes.
The doctor who saw her noted the abnormal urine tests from previous visits and requested a blood sugar test that "exceeded the limits".
He noted the likely diagnosis was type 1 diabetes and told the girl's family to take her to the hospital's emergency department.
The girl was admitted to hospital for monitoring and administered IV fluids and insulin, before being discharged five days later.
Her father told the HDC his daughter was now taking insulin three times a day for diabetes and the delayed diagnosis caused his family severe stress.
An investigation by the medical centre company found the two doctors had both overlooked the urine results.
The company told the HDC it was usual practice for doctors to take responsibility for checking and confirming all information gathered by triage nurses.
Caldwell found the doctors breached the consumer rights code by failing to appropriately review and act on the girl's abnormal urine results.
She said deficiencies in the doctors' care amounted to individual clinical failures, but she expressed concern about a lack of clear triage guidelines for nursing staff dealing with at-risk children.
Caldwell recommended both doctors provide a written apology to the girl's family.
She also made a number of recommendations to the company, including updating the commission about improvements to triage resources and using the case to educate staff.
The HDC said the company and two doctors had changed their practice to prevent further omissions and created new policies and tools to better identify risks to young patients.