Adelaide health clinics failed to diagnose tuberculosis in two patients before they died, investigation finds

Tuberculosis cases on the rise in Australia, but two health clinics in Adelaide ‘failed’ to diagnose and treat infectious respiratory disease in their patients before it was too late, coronary inquest heard .

Monineath Chum, 9, died in February 2017 and Rehema Shariff Kangethe, 29, died in March 2018 after contracting tuberculosis.

An investigation into their deaths – which are unrelated – found that their respective treating physicians at Elizabeth Family Health Clinic and Uni SA Health Medical Clinic failed to acknowledge the “severe decline” in their patients.

Although cases of tuberculosis are low in Australia, it can be fatal if left untreated and remains one of the leading causes of death worldwide.

The investigation found that the number of cases in Australia increased between 2015 and 2018, with 1,438 cases registered across the country in 2018.

Miss Chum, who was a pupil at Playford Primary School, had spent a year in Cambodia and became “seriously ill” in hospital.

Investigation learned that she first visited Elizabeth Family Health Clinic in northern Adelaide in September 2015 and that over the next 17 months she was seen by two general practitioners. from the clinic.

Her condition deteriorated until she was referred to the Hospital for Women and Children in February 2017, “absolutely emaciated” having lost 6 kilograms in one month, with fever and cough.

In his opening speech, attorney assisting coroner Stephen Plummer said that an expert general practitioner, Dr Peter Joyner, was “critical” of the care received by Miss Chum at the Elizabeth Family Health Clinic.

“He notably refers to an apparent lack of a structured follow-up process, a lack of appropriate clinical information on the electronic patient record, a lack of response to Miss Chum’s presentation and her underlying disease,” Mr Plummer told the inquiry.

Second TB victim visited clinic six times before dying at home

The investigation learned that Rehema Shariff Kangethe left Kenya for Australia in 2015 to study and was working as a nursing home assistant when she was found dead in her room in an international student flatshare in Hope Valley.

The investigation learned that she did not have tuberculosis when she moved to Australia.

An autopsy revealed that Ms Kangethe had lost around 30% of her body weight due to disseminated tuberculosis.

She had presented to the Uni SA Medical Health Clinic six times between 2016 and 2017 with symptoms including a lower respiratory infection, significant weight loss and low iron levels.

“Dr Joyner says that from a review of the medical records it was evident that at all times the diagnosis of resistant iron deficiency was paramount in the mind of Dr (Charles) Christie.

“Although tuberculosis did not present itself in a conventional setting – and therefore would not have been considered at the onset of the disease – Dr Christie clearly did not recognize the severe decline in Ms Kangethe’s health over the years. last months of his life. “

The survey found that a quarter of tuberculosis deaths in Australia in 2017 were in South Australia.

The investigation is continuing.