A prisoner with a burst appendix claimed she was told to “ride out” painful and worsening symptoms a nurse said were just a stomach bug.

Seven days later, the female prisoner underwent emergency surgery to remove the burst appendix and a section of her intestine because of infection.

The Department of Corrections accepted the care was not up to standard and blamed staffing gaps at the prison’s health centre at the time.

The woman said she had struggled to comprehend the events and the associated trauma she would have to bear for the rest of her life.

She has since had a second operation, the Health & Disability Commissioner said in a report released today.

Insufficient systems in place

In the report, Deputy Commissioner Vanessa Caldwell said it was clear that insufficient systems and support were in place for the prison clinical staff to perform their roles.

This included a lack of clinical oversight, insufficient training on clinical documentation, and inadequate guidance regarding managing triage requests, she said.

“In a prison setting, [Ms A] was heavily reliant on clinical staff to assess and escalate her care so that she could receive the care required in an appropriate and timely manner,” Caldwell said.

Deputy Health and Disability Commissioner Dr Vanessa Caldwell recommended that the prison apologise to the woman, among a list of recommendations. Photo / James Gilberd Photography Ltd

She said that despite multiple reviews of the prisoner between June 29 and July 5, 2022, her symptoms were not assessed or managed appropriately.

Caldwell found Corrections was in breach of the health consumers’ rights code, by failing to provide appropriate care, and to escalate the woman’s care despite her symptoms and multiple presentations.

The department has since made a list of changes, including assigning a clinical quality assurance adviser to the region where the prison is located, to support the prison health team.

‘Possible viral illness’

According to the report, the woman first flagged she was unwell on June 29, 2022, and was seen twice by registered nurses after a standard morning medication round.

The nurses noted the woman had been vomiting for three days and had been unable to keep food down.

She later told the HDC one of the nurses said it was a stomach bug, and at a subsequent appointment, when she said her symptoms persisted, she was told to “ride it out”.

The prison denied clinical staff said this, and said treatment was focused on managing the woman’s nausea and vomiting and maintaining hydration.

It said nurse assessments indicated a possible viral illness and an absence of any red flag symptoms.

No record of observations

The woman was seen by multiple nurses over the next six days because of nausea, vomiting, and diarrhoea.

Caldwell said there were no records of observations such as temperature, blood pressure, pulse, abdominal examinations, and/or description of bowel movements taken at these assessments.

Neither was there evidence of any monitoring of fluid intake against loss of fluid through vomiting, nor any clear record of the effect of pain medication provided.

The nurses recorded that their clinical impression of the woman’s symptoms was the result of a viral infection.

Registered nurse, Barbara Cornor, who provided independent advice to Caldwell, said failure to do abdominal examinations and monitor vital signs, and failure to escalate the woman’s care in light of her symptoms was a “severe departure from accepted standards”.

On July 5, the woman was seen by a medical officer, who ordered blood tests and referred her to the local hospital emergency department.

Further assessment that day revealed a burst appendix, and urgent surgery followed to remove it, plus drain a pelvic abscess and remove a section of her large intestine, Caldwell said.

She was discharged just over a week later.

Staff turnover and absences led to shortages

Corrections accepted it had not met the standard, but at the time, there were a lot of vacancies in its health team because of turnover and unplanned absences.

It said at the time the prison had no permanent health centre manager, or access to a clinical quality assurance adviser.

Caldwell recommended that the prison apologise to the woman, plus provide evidence that all staff at the prison have completed the graduate certificate in nursing.

She also asked the prison to confirm that its online training module on pain management had been completed, and the prison’s monthly quality meetings and regional clinical governance meetings had been re-established.

Tracy Neal is a Nelson-based Open Justice reporter at NZME. She was previously RNZ’s regional reporter in Nelson-Marlborough and has covered general news, including court and local government for the Nelson Mail.