- Date published:
1:21 pm, October 8th, 2020 - 13 comments
Categories: covid-19, health - Tags: dhbs, HDCA, ministry of health, MoH, patient rights
Radio NZ are carrying the story of a woman in isolation who is being denied an appropriate covid test by the local DHB.
A woman who suffers from extreme nose bleeds may be forced to stay an extra week in managed isolation because health officials are refusing to let her have a Covid-19 throat swab.
Karolina Jordan has been told she must have a nasal test despite the potential for her to haemorrhage from it.
Her husband, Warwick Jordan, said she was happy to have as many throat swabs as needed and had even had one before she left Europe to be cautious.
She was becoming increasingly distressed at being labelled a test dodger, he said.
Toi Te Ora, the DHB is saying that the throat swab is less accurate therefore she needs the nasal swab or longer isolation. However,
… government information given to all guests at the Ibis in Rotorua said though the more sensitive nasal swab was preferred, a throat swab was an option for those who could not tolerate one.
It only mentioned people needing to stay longer if they could not, or would not, have either a throat or nose test.
The problem I have here is not that a longer isolation time might be needed, but that there appears to be no taking into account her medical condition despite information saying that it can be. It’s possibly this is just poor communication/reporting, or maybe it is actual coercion and bullying.
Meanwhile, the Ministry of Health appears to be saying that DHBs can make their own decisions on this,
In a statement to RNZ, a Ministry of Health spokesperson said the ultimate decision was Te Toi Ora’s.
This is extraordinary. We need nationwide standards for both testing and communication with people in a stressful situation where health care is involved.
We have legislation in place to protect patients, the Code of Health and Disability Services Consumers’ Rights (regulations via the Health and Disability Commissioner Act).
Some of the pertinent parts of that here,
There’s no way to know from that short RNZ piece what is actually going on, but the Code says,
The onus is on the provider to prove it took reasonable actions.
so the ball is firmly in the DHB and MoH’s court here.
At the least the MoH needs to front up and explain national policy, where there is discretion and why, and what kind of situations a throat swab is deemed acceptable, including for children and people with specific disabilities. They also need to sort out the discrepancies between information being given to patients and practice. A sound bit response to MSM is entirely inadequate.
Questions for the DBH to answer are why is the throat test being refused? Is it a general policy? ie they will never let anyone have a throat swab? Or is it assessed on a case by case basis, and if so, what are the criteria? Is any of this being explained to the patients affected?
Maybe the MoH and the DHB need to talk to each and make sure that their patient information matches what is happening in practice.
Zero evidence that someone who "suffers from extreme nosebleeds" would be harmed by a nasal swab. So we abandon evidence based practice and put the wider population at risk by doing a more likely false negative throat swab ?
fortunately she doesn't have to rely on someone who went to the Grafton Gully Med School and instead has a certificate from her GP who went to an actual med school, learnt how to assess the evidence, graduated and then went into practice.
Zero evidence that someone who "suffers from extreme nosebleeds" would be harmed by a nasal swab.
Tell that to the poor buggers who have been harmed.
Hi – don't normally comment here. A history of nosebleeds does not prevent safely doing a nasal swab.
It's rubbish to demand a throat swab instead. The accuracy rates of a postnasal swab are generally well documented but that of a throat swab for COVID testing is less clear.
The swab itself may go through the nose but it's small and easily fits in. The sample is taken from the postnasal space (very back of the nose, above the back of the throat) which is well away from any danger areas for nosebleeds. If there was any concern, then a paediatric (much smaller) swab could be used and for extra safety a check of the nostrils for any potential bleeding area could be done, as well as moistening the swab to let it pass with less trauma.
Declaration of interest: a frequent swab-taker.
rather than your expertise as swab taker (and I'm glad I haven't come across you…)
don't you think that what is relevant in this story is " a throat swab was an option for those who could not tolerate one [a nasal swab]" and this is clearly being refused. And if this couple has the energy left, a formal complaint to the Consumers Rights Act is an option for them to consider.
I hear what you are saying weka, I also hear the pain coming from other regular commenters here on TS, the arrogance, bureaucracy and inflexibility of MoH.
I heard the husband on RNZ and he did his wife no favours. What I heard was a person who didn't want to take the test. The use of the words epistaxis, haemorrhage, (as opposed to nose bleed and bleed), the image of military uniforms coming to the room…
It is possible there is a case of entitlitis at play too.
Not that we will the other, there are two sides to every story.
I'm not hearing any entitllitis in this interview at all….Warrick Jordan is merely stating the facts.
In the study I referenced above, 8 out of 96 recipients of the commercial nasal swab test suffered epistaxis.
However, the ~5%–10% incidence of epistaxis after nasal swabbing with either commercial or 3D swabs warrants caution in testing individuals at increased risk for bleeding.
According to this study… https://www.sciencedaily.com/releases/2020/08/200821094844.htm
…and this study… https://www.nejm.org/doi/full/10.1056/NEJMc2016321
(and possibly more but who has the time?) throat vs deep nasal swab makes little difference to accurately detecting Te Virus.
Why on earth would these health officials subject a person to a procedure known to cause epistaxis when that person has a diagnosed higher risk?
Unless they're just being officious little arseholes?
I suggest us hearing different things in the interview comes down to our differing life experiences, especially in regards MoB.
Am getting sick of the "why we need special treatment" stories. This is a killer disease that the population of NZ needs protection from. My parents had TB and they were move between hospitals and were required to talk to family through windows for two years! They were compulsory used as test subjects for all kinds of cures including cutting away bits of lung, experimental drug therapies, cigarette smoking to kill bits of the lung, inflating lung with ping pong balls. My dad said he went along with the crazy because he was dying anyway! We have had a health crisis were infected people lost all rights, this one infected people are treated with dignity and still complain about the food, not getting exercise, the testing regime – everything that the country is doing for them.
according to the information given to people in isolation, it's not special treatment.
No special treatment at all – its an option for swab taking and that's being refused. More like refusing to give medical assistance.
For me this case is straight forward as the lady does not need to consent to a nasal swab, she has to consent to an extra week in isolation to insure she will not set off community transmission of Covid – 19 because of not having a nasal swab.
Yes Treetop I cannot see what the problem is either. No nasal swab then extra week in isolation. It seems that throat & nasal swabs are not created equal and perhaps once again the paper work has not kept up with the practice. The practice being that having a nasal swab is preferable. But there is an alternative and that is to stay the extra week. so we are completely sure.
Thanks to Stan for a voice from the swabbers. Just as blood test takers will work around any unusual situations (& I have experience in this) I am sure that swab takers will be well versed, as you seem to be, in minimising anything happening amiss in such a situation.