"ED and Orthopaedics"

About: Fiona Stanley Hospital Fremantle Hospital and Health Service

(as the patient),

Early last year I fell down a 1m x 0.5m pothole, and my ankle was in serious pain, swelled straight away and was black and blue. I managed to get up and hobble to my car and drive to Fiona Stanley Hospital. 

I hobbled into the hospital to be informed that ED was a very long walk away. I was assisted back into my car and told to drive to the front of ED, honk the horn and someone will come out and get me (I was a self-drive injury). I sat in the car for ages. I even rang ED to inform them that I was outside. There was a person sitting outside in an FSH uniform watching this. I was just about to ring my friends who I was calling to come and get my car, as the parking was only 10mins as well and I was informed that even with a note I would still get fined. As I was just about to talk to my friends, the lovely lady at the other end of the hospital was knocking on my window. She informed me that she had rung ED to get someone to come and get me and was informed that it wasn't in their job description, so she had taken her lunch early and was 'volunteering' to assist me into ED. I thanked her and waited to be seen and for my friends to turn up to take my car.  I waited and eventually was taken into the ED, where I was seen by a nice lady who sent me off for an X-ray.

The X-ray was difficult to get as my ankle was more swollen and it hurt even more. I was informed that it wasn't broken and just a severe sprain and my ankle was taped up and I was sent home on crutches for three days. I was informed that on the third day I should remove the tape and begin walking on my ankle.

I took the tape off and it was even more blue/black/purple and still very swollen and sore. I tried to walk on it as instructed and it hurt a lot, so the only way I was able to move around was to drag my foot as I was unable to bend it without it being in serious pain. I returned to work and showed it to a friend who is a highly ranked nurse who said that looks more broken than sprained.

A week later, Monday morning, I was rung by a doctor from FSH and informed that they reviewed X-rays taken over the weekend and that I needed to return to FSH as there was a fracture, and not to walk on it. Interesting, as I was informed to walk on it earlier. I rang to get into Orthopaedics as directed on Monday and was informed that there would be at least a two-week wait. This was unacceptable so I rang the ED to talk to the doctor that rung me. As it was not recorded on my file it proved difficult to track down the doctor that rung me. The solution was to return through ED. So, I left work and returned to FSH ED. 

Again I waited, even when informed that I had been called to return. I was seen by an orthopaedic doctor who took one look at me and said that it can't be that bad as I was walking on it and don't seem to be in a lot of pain. Both the nurse and doctor walked away and then when the nurse returned I was placed in a moon boot and sent home.  I was not told not to walk on it. 

I remained in the moon boot until my next appointment a week later. At this appointment, I saw a different doctor, who asked why I was in a moon boot as it was only a sprained ankle. I was taken out of the moon boot and sent home, with a referral for physio. At my next appointment, I saw a different doctor who asked why I was out of the moon boot and that I had an avulsion fracture and need to be in it. So, I was placed back in the moon boot. At the next appointment, I saw a different doctor who stated that yes it was an avulsion fracture but that they treat it like a sprained ankle and that I was being discharged on an SOS discharge and that at my age there were some things that they can't do anymore. During the SOS discharge, my ankle was not getting any better and I went and bought my own brace for the ankle and this seemed to provide support. I was also doing physio regularly, however, this was having little impact and at regular intervals was making the ankle worse. So, I went back to FSH and was told that this what my ankle was like now. I said I would like to be referred to a specialist, so the new doctor I saw referred me to the orthopaedic specialist at FSH. 

On my first visit with this doctor, I was informed that the diagnosis was incorrect and that the radiographers had just got overly excited with the images. As I was still in severe pain I was sent for an MRI. I was sent downstairs to get it done on the same day, but this was unable to happen. I then waited around a couple of months for the MRI and then had to wait for an appointment with the specialist. When I saw the specialist I was given a copy of the report and I stated it would have been better if I had smashed my bones as I would have healed quicker. They smiled and said yes. I was informed then that I wouldn't need an ankle reconstruction to which I said good I won't need an operation. I was informed that no that I won't need a reconstruction but that I may still need an operation if the torn cartilage and damaged bone underneath doesn't recover. I was sent away for another three months. I asked what I needed to do about the pain and was informed I just needed to take anti-inflammatories and painkillers.  I explained that the anti-inflammatories made me sick.  I was given no alternative. 

Three months later I was up for review and went for my appointment at FSH with the specialist. Again I waited and I noticed that the specialist was in the orthopaedic area. On my turn to see the specialist, I saw another doctor and was informed that the specialist had to go to a meeting. I explained that my ankle was getting more painful, I was unable to sit with any weight on my ankle, it was affecting how I was walking and that the ankle every now and again would 'blow out'. The doctor said they would make a call to the specialist. They came back and sent me downstairs for an MRI. The paperwork, that was sent electronically, hadn't reached them so I was directed back upstairs to see what was happening with the paperwork. I was then sent back downstairs, where I was informed that my paperwork had been taken and the doctors where allocating it on priority and that I could leave. I asked if the MRI would happen today and was informed no.

About four weeks later I was sent a letter about an appointment with the specialist at Fremantle Hospital. As that was where I had my last MRI, I assumed that I would be having the MRI and then be seeing the specialist. I was rung the day before the appointment and was asked when I had my MRI. I informed them that I had not had it yet. At that point, they were going to cancel the appointment. I stated that I hadn't seen the specialist at the last appointment, so I wanted to see them, so keep the appointment.

When I got to FH again I was asked about the MRI and explained I hadn’t had it, so was sent down to radiology to have an MRI.  Again, I was sent back to Orthopaedics at FH, as the specialist had not completed the paperwork correctly. Rather than complete it and send me back for the MRI, I was brought in to see the specialist. The nurse took me in and I was left with the specialist. I explained to them that the pain was increasing, I had difficulty walking, no shoes took away all the pain, the difficulty in getting an MRI, and asked where to next as they had explained that they could operate on it and scrape the cartilage etc. The specialist hardly looked up from their desk and said that I had a diagnosis and there was nothing that could be done. I stated that that was not good enough as they had said there were options and that they couldn't just leave me in pain. Their response was that I will be in pain forever and that the only option would be to fuse the ankle in the future. I again stated that that wasn't acceptable and became upset with this, as it had been going on for an extremely long time. I did not swear at them, I did not verbally or physically abuse them. I did ring for my options while in their office. The reason I did this is, as stated in the FSH Patient Information, all patients have the right to receive treatment based on specific health needs, be treated with respect, receive safe and high-quality healthcare provided with professional care, skill and competence dignity, seek a second opinion and be given information about their continuing health care before they leave the hospital. I do not believe that I received any of this from FSH/FH Orthopaedics or the specialist specifically.

I was then discharged with no referral for a second opinion, no referral for pain management and a letter was sent to my doctor stating that options where discussed (they weren't) and that I had become abusive in front of a nurse and registrar (I didn't swear, verbally threaten, or physically threaten). I rang around and was able to get into a private ankle orthopaedic specialist, who I saw recently and has stated that my ankle is not stable (I had been informed that it is stable), that I have had two more 'blowouts', damaged torn cartilage, sustained damage to the bone underneath, an avulsion fracture and that all these are causing the pain and swelling still, almost a year and a half later. The options given were to clean up the ligaments and reattach them, clean up the torn cartilage and sort out the damaged bone, which will now take 4 months more recovery and physio to regain the quality of life and activity level I experienced before the injury and treatment at FSH.

The reason why I am sharing this story and what would I like to see is:

1. That all sprains have more than just an X-ray to determine what is going on. 

2. That staff treat all ankle injuries as serious, regardless of whether their determination is that as someone is walking on it that it can't be serious or broken.

3. That the doctors in this situation have further training on ankle injuries and how to deal with patients in a more respectful manner. 

4. That if staff see that only option is to do nothing, or fuse the ankle, that they attend relevant training in the treatment of ankle injuries that provide further options, and that these are explained fully to the patient for the patient to decide, as it is their body. 

5. That the doctors do not make life judgements based on a person’s age, as it is my opinion that this is what occurred to me. 

6. That I receive monetary compensation for the surgery that I will face due to the lack of correct medical services delivered by the hospital and doctors/specialists, and compensation for the 6 weeks I will require off work and lost standard of living. 

7. That the specialist has their operating procedures for their clinics observed and reviewed to improve their performance and how they interact with patients.

8. That I receive a written apology for the defamation of my character, as I have been accused of being abusive to medical staff in the public system.

9. That I receive a written response to the outcome of the review and what actions FSH/FH Orthopaedics have put in place to prevent this sort of treatment occurring in the future.

Thank you.

Responses

Response from Janet Zagari, Executive Director Transformation, South Metropolitan Health Service, South Metropolitan Health Service

picture of Janet Zagari

Dear sunjw78

Your story raises significant clinical and process issues and we would welcome the opportunity to provide a detailed response.

We encourage you to please contact the Fiona Stanley Hospital Patient Family Liaison service via phone on 6152 4013 or email: FSHFeedback@health.wa.gov.au, so we can investigate fully.

Kind regards

Janet Zagari, Executive Director, Fiona Stanley Fremantle Hospitals Group

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    {{helpful}} other {{helpful == 1 ? "person thinks" : "people think"}} it is helpful

Update posted by sunjw78 (the patient)

Thank you Janet for your reply. I am interested to hear more about the significant concerns around clinical and process issues and what you think about that.

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