Decision report 201102732

Summary
Ms C was diagnosed for a second time with cancer in the left breast and a lumpectomy (operation to remove a lump) was carried out. Ms C complained that the board failed to carry out the consultant's agreed monitoring programme of six monthly clinic reviews and annual mammograms. She said that when attending her second six monthly clinic review she was advised by one of the doctors that her next clinic review would be in one year's time due to the volume of patients. Ms C was also dissatisfied that a mammogram appointment was supposed to have been arranged but that she had to raise it with the doctor and arrange it herself. She also complained that the board's response to her complaint contained inaccurate information, in that they said she had undergone a mastectomy (opertation to remove a breast) and reconstructive surgery, which was incorrect.

The board had advised Ms C that she was being reviewed in accordance with the agreed monitoring plan of two six monthly clinic reviews, followed by yearly reviews and yearly mammograms. The board also told her that the doctor had not said that the yearly clinic reviews were due to the volume of patients, but that they were based on patient need.

We did not uphold the complaint about the monitoring programme. Although we considered that the wording of the consultant's monitoring plan was open to interpretation, our medical adviser said that the frequency of clinic reviews was appropriate and in line with the Scottish Intercollegiate Guidelines Network for the management of breast cancer in women. We could find no objective evidence to support Ms C's concern that she had been told that her next clinic review would be in one year's time due to the volume of patients.

Our medical adviser also considered that it was not unusual or inappropriate for a mammogram appointment not to have been made prior to Ms C's last six monthly clinic review. This was because it is safer to book appointments from the clinical assessment than to have requests made many months prior to the mammogram due date.

During our investigation, the board acknowledged that a mistake had been made in their response to Ms C's complaint. The board explained that Ms C's medical records had recorded the surgical options of mastectomy and reconstruction, but that these procedures had not been carried out. We upheld this complaint, noting the importance of responses to complaints being clear and accurate to ensure confidence in the professionalism of the NHS.

Recommendation
We recommended that the board:
• apologise to Ms C for incorrectly stating in their complaint response that she had undergone a mastectomy and reconstructive surgery.