Source · SPSO (Scottish Public Services Ombudsman)

A Medical Practice in the Lothian NHS Board area

SPSO (Scottish Public Services Ombudsman) Not Upheld Reference 201407287 Sector Health Category clinical treatment / diagnosis Decided 01 May 2016

Full decision

Summary

Mr C brought this complaint to us on behalf of his late wife (Mrs C), following a rapid deterioration in her health. He raised concerns that GPs should have identified her deteriorating condition over the course of three consultations she had with them prior to her admission to hospital. She was admitted to hospital suffering from shock within 24 hours of her last GP visit. The hospital doctors were unable to save her, as she did not respond to the treatment she was given, and she died a week after admission.

We took independent advice from a GP adviser. The adviser reviewed the consultations that Mrs C had with GPs, and was satisfied that the assessments had been reasonable and the treatments were appropriate. She noted that the main issue discussed had been back pain. There had been no mention of diarrhoea, though Mr C said that his wife had been suffering from this for several weeks. He reported that he mentioned it to the GP at the final consultation. However, it was not noted in the medical records, and the adviser was satisfied that the GPs had made reasonable decisions based on the information they were given. The adviser also noted that the GPs may have made different decisions if they had been told of Mrs C's persistent diarrhoea.

We noted the sequence of events that led to Mrs C's death, but concluded that GPs could not have predicted this, based on the information she gave them. We were satisfied that the GPs had assessed and treated Mrs C reasonably for the back problems she presented with, and noted that they were also reasonable not to ask about diarrhoea when she had not raised this as an issue. We were satisfied that the practice provided Mrs C with appropriate clinical treatment in view of the symptoms which she presented with.

Related reading

View Decision Report 201407287 as a PDF (11.43 KB) Updated: March 13, 2018

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