NHS Highland boss sends an apology to patient
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A complaint against a GP-led hospital under the direction of NHS Highland has been upheld.
The complaint made on behalf of a patient raised concerns after there was a delay in getting the appropriate care for abdominal pain.
Scottish Public Service Ombudsman (SPSO) investigated and has asked NHS Highland to apologise to the patient’s family.
In a report, the names of those involved are anonymous with the complainer called “C” and the patient called “A”.
An SPSO spokeswoman said: “C complained about the care and treatment provided to their parent (A).
“A was reviewed in the A&E department of a GP–led community hospital with epigastric pain – pain or discomfort right below the ribs in the area of the upper abdomen.
“A doctor felt that the pain was coming from their gallbladder. Tests for a urinary tract infection (UTI) were carried out and A was admitted to a ward for fluids and treatment with an antibiotic.
“A few days later, the decision was taken to transfer A to another hospital. Further tests carried out there revealed A’s gallbladder had perforated, causing an abscess on their liver. They were then subsequently diagnosed with gallbladder cancer.”
The patient’s family complained about the care and treatment provided to A at the community hospital. The board said that gallbladder pain usually radiates to the shoulder which was why this was considered unlikely in A’s case. A was stable but diagnosis was unclear so they were admitted for observation and antibiotics for a UTI, which had been confirmed on testing.
The SPSO spokeswoman continued: “We took independent advice from an appropriately qualified clinical adviser. We found that A did not have specific clinical features of a UTI and urinalysis was not convincing for a bacterial infection.
“The clinical presentation of nausea, sweating and epigastric pain accompanied by the finding of the right upper quadrant tenderness was more in keeping with gallbladder pain and infection.
“We also noted that once A’s abnormal blood results were known, the decision should have been taken on that same day – the day following admission – to consider transferring A to secondary care, because their clinical condition and abnormal blood results suggested something that could not be managed properly or adequately in a GP-led community hospital.
“We also found that A was given too much IV fluid during their admission. Given A’s known history of heart failure, the administering of fluid should have been regularly reviewed.”
NHS Highland were told to apologise to C for its failures including administering too much IV fluid during A’s admission and for not reviewing this regularly, failure to take A’s abnormal blood result seriously, and failing to appropriately consider transferring A to an acute hospital once their blood results were known, given their clinical condition.
The board was also told to implement clear guidance within the GP-led community hospital to make clear who can be admitted along with clarity on the level of care that can be provided.
The board should share this decision with the doctors involved in a supportive manner, and ask that they reflect on A’s case.
A spokesman for NHS Highland said: “We have fully accepted the recommendations in the report from the SPSO and actions are being implemented. Pam Dudek, our chief executive, has written to the patient to apologise.”
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