An Aberdeen medical practice has been ordered to apologise after wrongly diagnosing a patient who then died of cancer.
Patient A – who had a history of the disease – was originally told they had polymyalgia rheutmatica, a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips.
They were put on steroids.
After five weeks without improvement, Patient A was referred for an ultrasound scan, which found a spread of cancer from the primary tumour in the liver and bladder mass.
They were sent to urology, but the cancer had spread too much for treatment. Patient A died a short time later.
Patient A’s child, known only as C, complained to the Scottish Public Service Ombudsman (SPSO), and claimed the medical practice had failed to recognise the cancer and as a result had delayed appropriate treatment.
Now the watchdog has upheld the complaint, and concluded the medical practice’s failings led to the avoidable death of Patient A.
Their report states: “Given A’s history of cancer, we considered that referral for ultrasound should have happened sooner.”
Cancer diagnosis should have been considered sooner
To help investigate the course of action which was undertaken by the practice, the SPSO sought an independent advice from a GP adviser.
It was concluded that although it was “reasonable” to put A on a trial of steroids in the first instance, the practice – run by Aberdeen City Health and Social Care Partnership (ACHSCP) – should have considered another diagnosis sooner.
The panel’s report states: “While it was reasonable for the practice to commence a trial of prednisolone (medication used to treat a wide range of health problems including allergies, blood disorders, skin diseases, infections and certain cancers) to treat the working diagnosis of polymyalgia rheumatica, the lack of immediate improvement should have made the practice consider another diagnosis.”
The SPSO also found that there was an “unreasonable delay” in responding to the family’s initial complaint lodged with the practice without any proper explanation when further correspondence can be expected.
Practice told to apologise and improve
The practice was also criticised for failing to inform A or C that the ultrasound scan showed possible liver metastatic disease and for not referring the patient for an urgent ultrasound or CT scan to investigate the possible recurrence of cancer.
However, ACHSCP told the watchdog that A had received “the best possible care the practice could offer” and that records showed their condition had been discussed with a sibling – although the SPSO was unable to find any record to confirm that.
The report continues: “The relevant clinicians should be reminded of the need to ensure that patients should be kept fully informed about their diagnosis and involved in decisions about their treatment and that patients are presumed to have capacity to make decisions about their treatment.
“If it is considered that a patient is unable to understand and/or retain information given to them, an assessment of capacity should be carried out.”
This complaint was ultimately upheld by the SPSO, who asked the organisation should apologise to C and make improvements to ensure that cases of possible recurrent cancer are investigated as soon as possible.
Aberdeen City Health and Social Care Partnership have been approached for a comment.
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