Nijole and Kent Vickerman pictured just after her cancer diagnosis. Photo: Westport News / Ellen Curnow
A former Karamea man is furious at the outcome of an investigation by the Deputy Health and Disability Commissioner into his wife's death from lung cancer.
Kent Vickerman said the commissioner's report provided no accountability for his wife Nijole's misdiagnosis.
"My wife died, she never had to ... it's gutting ... It [the report] is just a bloody great cover-up."
Nijole, a fit and active non-smoker, runner, and horticulturalist, was diagnosed with terminal lung cancer by West Coast District Health Board (now Health NZ West Coast) in March 2020. She had been unwell for more than 10 months, had had dozens of tests and doctors' appointments, and been treated for sinus disease.
She died on 22 December, 2022, aged 64.
Deputy Health and Disability Commissioner Carolyn Cooper found Health West Coast did not breach the Code of Health and Disability Services Consumers' Rights.
But she was concerned Karamea Health Centre staff had not considered an X-ray and an alternative diagnosis earlier, given Nijole's symptoms had failed to fully resolve.
Cooper was also concerned Nijole's pattern of presentations might not have been considered at each consultation. She reminded Heath West Coast of the importance of overall co-ordination and clinical oversight in patient care.
However, Cooper found most of the care provided to Nijole was appropriate, especially considering mitigating factors. These included no "red flag" symptoms and a CT sinus scan apparently supporting the sinusitis diagnosis.
Health West Coast told her its primary care clinical staff had been informed of the risks around dual diagnosis and confirmation bias. Clinical teams had discussed the limitations of the HealthPathways tool.
Health West Coast also said it continued to work on improving staffing and strengthening its team-based care to provide greater continuity in patient care.
Kent said his wife should have received a chest X-ray within two months of her first presentation at Karamea Health Centre.
He described the deputy commissioner's investigation as "appalling" and said it was too limited in scope.
Cooper looked at whether West Coast District Health Board (now Health NZ West Coast) had provided appropriate care for Nijole between April 2019 and March 2020, inclusive.
Cooper's report said Nijole had presented to Karamea Health Centre 15 times between 23 April, 2019 and 6 March, 2020 with an on-going cough, skin lesions, recurrent sinus issues and a persistent post-nasal drip. She was seen by seven different clinicians, four of whom were GPs. Her symptoms were treated as sinusitis, the report said.
"I am concerned that overall responsibility for Mrs Vickerman's care does not appear to have been 'owned' by any one clinician. It is also not clear whether any of the seven different clinicians looked at Mrs Vickerman's pattern of presentations in its totality...
"I am concerned that Mrs Vickerman's care lacked overall co-ordination and clinical oversight."
Nijole's own notes throughout the time say the various medications she was prescribed made little difference. She felt fobbed off and frustrated.
In February 2020, after Kent demanded his wife have a chest X-ray, a GP ordered one to be completed within four weeks.
In March 2020, following a chest X-ray and CT scan, Vickerman was diagnosed with stage four lung cancer.
Nijole wrote in her notes: "It had taken 10 [months] of having a chronic cough, extreme fatige [sic], and many other ailments to finally get a result".
Kent disputed much of the information provided by clinicians to the deputy commissioner, in particular that Nijole did not continually complain of a cough and that her symptoms were improving, Cooper's report said.
He said Nijole had "continually complained about her cough" which "only got worse" and she was repeatedly given medication which did not help. He was concerned doctors spent 10 months trying to diagnose a sinus issue instead.
He said if his wife's cancer had been found early enough, instead of her being given constant prescriptions for antibiotics, her type of cancer had a 90 percent recovery rate.
Health West Coast accepted a chest X-ray could have been performed earlier, and that this would likely have produced an earlier diagnosis, the report said.
But Health West Coast said there were no "red flags" for serious lung disease, such as a productive cough, coughing up blood, shortness of breath, chest pains, weight loss or fever.
"Unfortunately, Mrs Vickerman had two different conditions presenting with the same symptom constellation at the same time," Health West Coast said.
ACC accepted a treatment injury claim from Nijole in January 2021. It agreed to pay about 90 percent of her usual income weekly, as well as a lump sum and ongoing medical, care and travel costs.
The support was backdated to 19 September, 2019, when ACC said a chest X-ray should have been taken and a diagnosis made.
Cooper's recommended Health West Coast:
- Provide a written apology to Kent and his family within three weeks of her report, dated 17 April. [The West Coast District Health Board previously provided an apology to the Vickermans, in July 2020, for the delayed diagnosis];
- Provide evidence, within three months of her report, that Karamea Health Centre clinicians had reviewed the HealthPathways 'Diagnostic Error; learning resource for clinicians' and any lessons recorded by staff following their review;
- Provide an update, within three months, on any changes made as a result of the complaint, and provide evidence an anonymised case study had been used as a learning opportunity for staff.
Westport News has sought comment from Health West Coast.
In a covering letter to Kent, Cooper commended him for his consistent efforts to advocate on his wife's behalf and for seeking a resolution to the complaint.
But she said his concerns about his wife's care after her diagnosis on 12 March, 2020, were outside the scope of her investigation.
Kent has remarried and now lives in Thailand.