Apology issued to patient after ‘avoidable’ delay in diagnosis

AN apology has been issued to a man who underwent emergency surgery after a Borders medical practice failed to spot his bowel disease symptoms.

Scottish Public Services Ombudsman Jim Martin said there was “avoidable delay” in investigating and diagnosing the condition of the man, named Mr A in the report, who was said to have been left traumatised.

John Lamont, MSP for Ettrick, Roxburgh and Berwickshire, described the case as a worrying oversight by the doctors involved.

He added: “When patients visit their local GP they expect and deserve the best possible care and attention, and it is evident that in this instance this was not the case.

“The patient involved had to undergo significant surgery and despite having a serious illness it was not picked up. There was undoubtedly an avoidable delay and I am glad that the practice involved will be writing a letter of apology to the patient for holding up his treatment.

“What is important now, however, is that lessons are learned from this case.

“The full investigation that has been ordered is vital if we are to get to the bottom of this case and make sure that these mistakes are not allowed to happen again.”

Mr A, a 57-year-old who had a history of irritable bowel syndrome (IBS), first visited a GP at the Borders surgery on December 29, 2010.

There were several more visits as the bowel complaint continued until February 17, 2011, when Mr A reported pain in his groin.

While there was an examination of the groin by the GP, no check of the abdomen was made.

And an SPSO adviser was left confused when he heard an ultrasound scan was ordered, claiming a suspected painful hernia should have prompted an urgent surgical assessment.

Four days later, on February 21, another GP saw Mr A, who was in agony and “hardly able to move”.

Despite Mr A’s pain, the GP said they would await a scan and “review if symptoms persist or if concerned”.

February 26 saw an out-of-hours doctor visit Mr A – who had lost two stones in weight – and recorded unusual symptoms which needed to be reviewed.

After another appointment at the medical practice on February 28, it was decided to include a bladder scan in the ultrasound, but Mr A was not admitted to hospital.

Mr Martin said: “The adviser stated it was his view that admission to hospital on February 28 would have been entirely reasonable and logical.

“He said that given the symptoms presented, he could see no rationale for the decision to wait several days for the scan results.”

Within an hour of the scans on March 4, Mr A was prepared for surgery, having been diagnosed with diverticular disease.

He had an abscess drained, repairs to his bladder and a section of his bowel removed, resulting in a near two-week stay in hospital until he was discharged with a stoma bag.

Mr Martin noted: “The adviser said it was his view that the practice should have investigated Mr A’s symptoms more thoroughly.

“The adviser said he would expect abdominal and rectal examination findings to have been recorded in a man in his 50s with chronic bowel symptoms and weight loss, even if a history of IBS was known.”

Mr Martin continued: “The adviser stated that it was a particular concern that Mr A’s changing symptoms in February were not placed together in context.

“He said that by this time, Mr A had ongoing bowel symptoms, a feeling of incomplete evacuation, excess bowel gas, weight loss, loss of appetite, fever symptoms and left groin pain, which made it difficult to stand straight.

“He commented that there is nothing recorded in the notes about consideration of referral for these symptoms of whether an acute admission is required.”

Mr Martin upheld Mr A’s complaint and recommended a written apology from the practice, and a significant event audit to be carried out, which the surgery accepted.

Jane Davidson, chief operating officer for NHS Borders, said: “We have raised these issues directly with the practice and have been assured that the recommendations in the report will be followed through.”