NHS Grampian has been told to conduct a review after a patient died from cancer after frequent visits to the GP with urine infections were dismissed.
Patient A went to the doctor with three urine infections in four months, and each time was given antibiotics which did not work.
Finally, after 10 months, they were sent to a specialist.
However, the patient was diagnosed with “invasive” bladder cancer and died – which their partner, known only as C, believes could have been prevented with swifter action by the GP surgery.
Now the Scottish Public Service Ombudsman (SPSO) has upheld their complaint, and ordered a thorough investigation into of clinical procedures.
The watchdog said NHS Grampian must carry out a serious adverse event review (SAER) of the case after failing to refer the patient after they presented with three urine infections in four months.
The threshold for further clinical investigation is three infections in a year, especially when abnormalities such as pus and blood are found, as it was in this case.
The report states: “Patient A died due to invasive bladder cancer and urinary sepsis (blood infection).
“C complained that the practice unreasonably delayed referring A to secondary care for investigation. This was despite presenting with recurrent urinary tract infections (UTIs) that did not respond to antibiotic treatment.
“C considered that A’s bladder cancer may have been identified earlier, and that their death avoided, had the practice referred them for investigation much sooner.”
The GP practice told the ombudsman A had a long history of intermittent UTIs, which were usually treated with antibiotics.
Urine samples showed pus and blood
At one point, all of A’s urine samples showed pus cells but a normal range of red cells, which was suggestive of simple UTIs.
The early signs of bladder cancer such as blood in the urine was not apparent in A’s case until a relatively late stage.
At the time of the blood in urine, it considered that abnormalities in A’s blood results (increased platelet and white cell count) were caused by an unrelated kidney infection.
A spokeswoman for the SPSO said: “We took independent advice from a general practitioner adviser.
“We noted that patients over a certain age with recurrent or persistent UTIs – three episodes in 12 months, associated with blood in the urine (haematuria) should be referred for urgent investigation in accordance with national guidelines.
“In A’s case, they had attended the practice three times in four months with recurrent UTIs and haematuria found on dipstick testing.
“At this point, we found that A should have been referred on an urgent basis in line with the guidance. But the practice did not do so for a further 10 months.
“We found that the practice had failed to identify that A’s blood results showed signs of recognised malignancy and that they had repeatedly failed to record A’s clinical history and review the results of investigations performed.”
Urgent investigation merited
NHS Grampian was told to carry out a serious adverse event review (SAER) of the case.
Part of the review would include why there had been a failure to refer the patient for further investigations.
It was also to include a review of the practice’s result handling processes and, where issues were identified, how these are monitored and actioned by a responsible clinician.
There was also to be a review of the guidelines for early referral of suspected urological cancers, and a review of the failure to exclude a urine infection in relation to the care and treatment the patient had received for a kidney infection.
The ombudsman said an apology should be made to C for the health board’s failings.
An NHS Grampian spokeswoman said: “We note the decision of the ombudsman in this case and can confirm all recommendations made have been complied with.”
Conversation