The Christie NHS Foundation Trust

3. Ms R complains the Christie NHS Foundation Trust (the Trust) misdiagnosed her in July 2020 following a scan by saying her melanoma had returned and the cancer had spread to her left tibia.

4. Ms R says she has not yet recovered and has suffered unnecessary and avoidable lifelong harm due to the Trust’s medical decisions and the treatment it gave her. She says the treatment damaged her adrenal glands, resulting in Addison’s disease. She says she also caught hepatitis and that the Trust informed her that her survival prognosis would be a year without the treatment. She says this has affected her children, marriage, mental health and finances.

5. As an outcome, Ms R wants the Trust to admit the diagnosis should have been different and she wants an explanation of what went wrong. She wants the Trust to develop an action plan for improvement, include the option of bone biopsy in a different stage of treatment and educate its staff on what bone biopsy entails.

6. Ms R also wants financial compensation at a level that reflects the impact her condition will continue to have on her life and the risk she faces of developing other conditions as a result.

7. In 2018, Ms R was treated for malignant melanoma.

8. In April 2020, Ms R discovered lumps under the skin on the front of her left thigh, which was where her original cancer was in 2018. She attended an appointment with the Trust in June 2020 and it arranged for an urgent ultrasound and fine needle biopsy. In the ultrasound, a radiologist confirmed there were lumps.

9. In July 2020, Ms R attended another appointment with the Trust and had a whole-body positron emission tomography (PET) CT scan (a type of X-ray which shows up dye attracted to tumours which has been injected into the body). The Trust informed Ms R that the cancer in her thigh had returned and had spread to the bone in her leg.

10. Ms R had further consultations and a magnetic resonance imaging (MRI) scan (a type of scan which shows precise details of body parts). Doctors informed Ms R that there was evidence of bone metastasis (the cancer had spread to the bone) and recommended combination therapy. The Trust ordered four cycles of combination immunotherapy, beginning in September 2020. Immunotherapy is a treatment for cancer which targets cells in the immune system.

11. Ms R asked for a bone biopsy in September 2020 but the Trust told her it would not do an additional biopsy as the appearance of her condition was typical of a bone metastasis.

12. In October 2020, Ms R began to feel unwell after her second dose of immunotherapy. The Trust admitted her to hospital and diagnosed her with an infection. Shortly afterwards, when she was still unwell, the Trust diagnosed her with hepatitis.

13. In December 2020, Ms R had an MRI scan and three days later was diagnosed with Addison’s disease. This is a long-term condition which affects the adrenal glands (glands which make some hormones in the body).

14. By February 2021, Ms R was also diagnosed with immunotherapy-related hypophysitis (inflammation of the pituitary gland in the brain). This is known to be a possible side effect of immunotherapy. Ms R had further MRI scans and blood tests in March 2021 to see where the cancer was on her left tibia. Afterwards, the Trust informed her that it thought ‘it might not be cancer’ but the doctors stated this would not change her treatment.

15. In April 2021, the Trust met with Ms R and told her it ‘assumed cancer was on the leg, without a definitive confirmation’ and in June 2021, she had a bone biopsy. Later that month, the Trust told her the cancer in her thigh was in remission (under control).

16. In July 2021, the bone biopsy results came back and the Trust informed Ms R that the results were clear, with no sign of metastasis. They told her it was a fibrous dysplasia (scar tissue on the bone).

18. The law says we cannot investigate a complaint where a person has (or had) the option to take legal action, unless we consider this is (or was) unreasonable in the circumstance. We have discussed this with Ms R to understand the outcomes she wanted and her circumstances. We do not consider whether legal action would succeed but whether it would be a reasonable option to look into.

19. Ms R claims the Trust misdiagnosed her, informing her that her cancer had spread to her bone and later telling her this was not the case. Ms R had a double dose of immunotherapy treatment, during which she developed hepatitis. The treatment also damaged her adrenal glands and caused Addison’s disease. This means she needs to take hydrocortisone medication for the rest of her life, as her adrenal glands do not now produce chemicals naturally. Ms R says this could have been avoided if the Trust had done a bone biopsy in the beginning stages of her treatment.

20. Ms R says this has had a significant impact on her family, finances and physical and mental health. She says it has changed her forever and will have an ongoing negative impact for the rest of her life as she is now living with Addison’s disease.

21. Ms R says she does not yet know what long-term effects Addison’s disease will have on her health but that it means she could develop other health conditions such as diabetes.

22. Ms R feels she has suffered unnecessary and avoidable harm due to the medical decisions the Trust made and the treatment it gave her. She is therefore claiming that the Trust’s failings caused her physical injury which will have a significant impact on her life. The failings Ms R describes may offer her a route to take legal action for clinical negligence.

23. We asked Ms R what outcome she wants from her complaint. She told us she is looking for substantial financial compensation, an explanation of what went wrong and service improvements. We told her that if legal action is successful, the courts will be able to award far more in compensation than we would probably achieve.

24. Ms R told us she had approached a solicitor before raising her complaint with us. She said the solicitor had declined her case and that she has not contacted any other solicitors since. Ms R says she was unaware she could pursue her legal claim with another solicitor. We consider that as Ms R had already tried to seek legal advice, she is interested in pursuing a claim through the court.

25. There may be funding options available to Ms R, such as no win no fee arrangements, and so we consider she should not have any difficulty funding a claim. Ms R has not told us about any issues which would stop her taking legal action. She told us she is happy to look into taking a legal route.

26. Because the impact Ms R complains about is significant, we consider legal action is a better route to achieving the financial compensation she is looking for. We consider she may also be able to achieve the other outcomes she wants in the process of making this claim. If Ms R cannot achieve these outcomes, she can bring her complaint back to us and we will consider it again. If she chooses to do this, she should be mindful of our time limit and come back to us without delay.

27. We are sorry to hear about Ms R’s experience and hope she can achieve the outcomes she wants. We wish her well in managing her ongoing condition. As there is a possible legal route available to her, we cannot consider Ms R’s complaint further.

28. We thank Ms R for bringing her complaint to us.

1. The Parliamentary and Health Service Ombudsman has carefully considered Ms R’s complaint about the Christie NHS Foundation Trust. We understand the issues surrounding this complaint have been very difficult for Ms R. We recognise how important this complaint is to her and how challenging it has been for Ms R and her family during this time. We are extremely sorry to hear about her experience.

2. We have seen there is a route to take legal action available to her. We consider it is reasonable for her to explore this legal option and will explain the reasons for our decision.