Decision report 201003592

Summary
Mrs C made a number of complaints about the care and treatment that her late husband (Mr C) received from his medical practice before his death from cancer. She complained that the practice failed to diagnose her husband's illness and order appropriate tests within a reasonable time, or to chase up the result of the tests. We took advice from our medical adviser, and found that it was in fact appropriate for the practice to refer Mr C to a specialist in order that the specialist could carry out further tests. The practice made an urgent referral, which was sent the day after Mr C attended the practice. In addition, there was no evidence that the practice were subsequently asked to chase up the results.

Mrs C also complained that the practice failed to refer her husband to hospital when he was severely dehydrated. We found that the practice had failed to carry out a reasonable clinical assessment. They had also failed to assess Mr C for hydration. We upheld the complaint as, based on the inadequate assessment, it was not possible to say whether Mr C was dehydrated or whether he should have been admitted to hospital.

In addition, we found that the practice should not have told Mrs C that she would be able to accompany her husband in the transport that they booked for him to attend hospital to get his results. The practice could not guarantee this, as space is limited when patients are being transported. We upheld the complaint, as the practice should have told Mrs C this, although we noted that they had already apologised to her for their failure to make her aware of this.

Mrs C also complained that the practice failed to provide palliative care to her husband or to offer any information about palliative care nursing. We found that the deterioration in Mr C's condition was extremely rapid, and that it would have been difficult to foresee this. We were satisfied that the practice's attempts to provide palliative care and to offer information during the short period from confirmation of his terminal diagnosis to his admission to hospital were reasonable. We also noted that the practice had taken steps to improve their delivery of palliative care.

Finally, Mrs C complained that the practice failed to show an appropriate degree of compassion throughout Mr C's illness by making inappropriate and insensitive comments. In response to her complaint about this, the practice said that part of their role in such situations is to be open, honest and realistic. Although we understood why Mr and Mrs C might have found the comments distressing, we did not find them inappropriate.

Recommendations
We recommended that the practice:
• make relevant staff aware of the need to undertake proper clinical assessment where appropriate; and
• draft a protocol for patient transport.