Nimbuscare Limited

Practice A

5. Miss L complains about the treatment she received from Practice A on 7 January 2025. She says the Practice misdiagnosed her with muscle pains attributed to childbirth.

6. Miss L says Practice A’s failings left her in pain for long and ultimately led to her suffering a pulmonary embolism and developing a large pleural effusion.

7. As an outcome to her complaint Miss L would like evidence of service improvements and a financial remedy to recognise her experience.

Practice B

8. Miss L complains about the treatment she received from Practice B on 5 February 2025. She says the Practice misdiagnosed her symptoms.

9. Miss L says Practice B’s failings led to her suffering a pulmonary embolism and developing a large pleural effusion. She also suffered pneumonia and says her heart was displaced due to fluid buildup. She says she was admitted to hospital which meant she was separated from her eight-week-old exclusively breastfed baby and her nearly two-year-old daughter. She suffered significant disruption to her life and mental health and had to undergo therapy to manage anxiety triggered by the ordeal.

10. As an outcome of her complaint Miss L would like evidence of service improvements and a financial remedy.

Practice A

11. Miss L called Practice B on 7 January 2025 to request an appointment as she was struggling with back and shoulder pain, which she says started the day before. Practice B referred her to Practice A (an out of hours GP service) as it did not have any available appointments.

12. At this appointment Practice A took Miss L’s history. She informed them she woke up the day before with pain in the lower side of her back, shoulder and ribs. The pain worsened on inspiration (breathing or inhaling), twisting and bending.

13. Her pain score was stated as 6/10 on 6 January, and 1/10 on 7 January. The pain relieved when she too paracetamol. She did not have chest pain, leg pain/swelling, cough, shortness of breath or haemoptysis (coughing up blood). She had no fever, rashes, visible blood in urine, was not vomiting and her bowels normal.

14. On examination the GP found her oxygen saturation was 97%, her temperature 36.6, pulse rate 90 bpm (beats per minute) and respiration rate 16 breaths per minute. The GP found her to be breathing and swallowing normally, not acutely(severe) unwell with a clear chest.

15. The GP diagnosed her with muscular strain and advised she continue with over-the-counter pain medication. The GP discussed deep vein thrombosis (DVT) risk factors and advised her to her to revisit the clinic if she experienced shortness of breath, chest pain, fever, coughing up blood or felt unwell.

Practice B

16. Miss L states that as the pain got worse she subsequently returned to Practice B on 5 February 2025.

17. Miss L says she provided the Practice written information before the appointment, to form a history She says she told the Practice she first noticed back pain over a month ago and described the pain as intense. She informed the GP that at her appointment with Practice A she had been diagnosed with muscular strain. She had been advised to take paracetamol and ibuprofen, rest and lightly stretch to heal the muscles.

18. She stated she was using paracetamol and ibuprofen to deal with the pain. She also said simple exertion such as walking up the stairs leaves her breathless and struggling to catch her breath. She said her pain has not relieved since her last appointment and it incapacitated her, as it restricted her ability to function normally.

19. She stated the pain focused on her back and left shoulder, but it also extended around her chest and ribcage. She said was hard for her to catch her breath and she felt breathless sitting down, and it worsened when she walked around.

20. On examination the GP found her oxygen saturation was 95%, temperature 36.1, pulse rate 96 bpm (beats per minute). The GP listened to her chest and found her breathing to be normal. The GP also found her stomach and bowel sounds to be normal and noted her left back muscles hurt when she twists or stretches.

21. The GP diagnosed her with muscular strain of the left side of her back and muscle related chest pain around her sternum(breastbone) and ribs. The GP reassured her that her pain was muscle related, and to use analgesia when needed.

22. On 12 February 2025, Miss L stated she had her 6–8 week check-up for her baby. At that appointment she explained her symptoms to her doctor. The doctor took her blood pressure, checked her heart rate and oxygen levels. She said the doctor could not hear breath sounds on her left lung and told her to go immediately to A&E.

23. Miss L states on same day, following a visit to A&E, she was diagnosed with a pulmonary embolism, pneumonia and pleural effusion. The hospital admitted her from 12 February 2025 to 18 February 2025. During her stay, the hospital fitted her with a chest drain. The hospital also placed her on daily blood thinning injections which continued for six months after her discharge.

Practice A

27. Miss L complains Practice A misdiagnosed her with muscle strain when she had a pulmonary embolism (PE).

28. Pulmonary embolism (PE) is when a blood clot blocks a blood vessel in the lungs. It can be life threatening if not treated quickly. The symptoms of PE are:

• difficulty of breathing that comes on suddenly • chest pain that’s worse when you breathe in and • coughing up blood.

29. At this appointment, Practice A took details of Miss B’s condition and symptoms, such as her pain levels, the location of her pain, whether she had difficulty breathing, or chest pain and or, if she was coughing up blood. The records demonstrate, Miss B said she had no symptoms of chest pain, no shortness of breath and was not coughing up blood.

30. Based on the information available to it, Practice A diagnosed Miss L with muscular strain, advised her to take pain medication, discussed the risk factors of DVT and advised her to return if she experienced shortness of breath, chest pain, fever or was coughing up blood.

31. GMC Good Medical Practice states that in providing clinical care a doctor must adequately assess a patient’s condition, taking account of their history, including symptoms, relevant psychological, spiritual, social, economic, and cultural factors and the patient’s views, needs, and values.

32. The records show Practice A adequately assessed and examined Miss L’s condition in line with GMC GMP. Practice A noted her recent childbirth and considered the possibility she of a PE, by running through the symptoms of PE with her. However, the examination revealed she did not have the symptoms consistent with a PE. The GP also provided Miss L appropriate safety netting advice, to return if she developed any new or worsening symptoms. Our adviser confirmed our view.

33. Based on the information we have seen so far, we consider Practice A acted in line with GMC guidelines when providing care and treatment to Miss L as it assessed her condition, discussed her symptoms and history with her and offered her appropriate follow up advice. For this reason, we will not consider this complaint further.

Practice B

34. Section 4 of the HSCA 1993 says we cannot look into complaints when a legal route is available, unless we consider it would be unreasonable for you to pursue it.

35. Miss L says Practice B misdiagnosed her pulmonary embolism as a muscular strain due to childbirth. She says this led to her suffering a pulmonary embolism ad a large pleural effusion. She says this caused her heart to be displaced due to fluid buildup and she had to undergo a painful procedure to drain the fluid. She also says it significantly disrupted her life and mental health.

36. It appears there is a clinical negligence action open to Miss L. Negligence in law is an act or failure to act (omission), that does not meet the level of appropriate care expected, which results in injury or loss. If a doctor or health professional is negligent when giving you medical treatment, this is called 'clinical negligence’. This can be addressed through the courts.

37. As a legal remedy appears to be open to Miss L, we then need to consider whether it is reasonable for her to pursue the matter in that way. In doing this we have considered the outcomes sought. Though a clinical negligence claim would not address her desired outcome of service improvements, it could address the financial remedy she seeks, which is the main outcome Miss L seeks.

38. We recently spoke with Miss L, and she informed us that she has instructed a solicitor to take on her case. As she has found a solicitor to pick up her case, we consider it reasonable for her to pursue the legal route.

39. Considering the available information, the availability of a legal remedy, and the level of financial remedy that Miss L is seeking, we consider legal action should be explored in this case.

40. We hope that our decision explains why it is better to explore taking legal action as the best way to achieve the outcomes she wants. If, however, she is unsuccessful he can return to us, and we can consider the complaint further.

1. We have carefully considered Miss L’s complaint about two Practices in the York area (Practice A and Practice B). We were sorry to hear how Miss L has been affected. It is clear she had a difficult and upsetting experience, and understandably, Miss L wants to ensure this does not happen again.

Practice A

2. There are elements of Miss L’s complaint where we have not seen any indications that things went wrong. This means that from the evidence we have considered, it appears that Practice A provided appropriate care and treatment to Miss L.

Practice B

3. We have decided not to take further action at this time because we consider it is reasonable for Miss L to explore legal action on the issues she has bought to us.

4. We will explain our reasons for our decision in this decision statement. Complaints give us valuable insight into the organisations we investigate, so we would like to thank Miss L for sharing her experience with us. It is also important to acknowledge that finding no indications of service failure in relation to some aspects of this complaint does not detract from Miss L’s experience, or the upset and frustration these events caused.