Decision report 201202327

Summary

Mr C hurt his foot while gardening. He complained that the board did not diagnose that it was fractured despite two visits to a hospital accident and emergency department (A&E). When he first attended A&E, Mr C was recorded as limping but able to bear weight on his injured foot. The records showed that his foot was sore but with a good range of movement. A bad sprain was diagnosed and Mr C was given advice on how to care for his foot.

Mr C then went on holiday for two weeks. His foot had not improved so on the way home he went to another A&E. Again the foot was recorded as having a good range of movement and Mr C was able to put weight on it. A rash was also recorded but was put down to a sweat rash, and it was noted that Mr C told staff that he had done a lot of walking on his holiday. Again a bad sprain was diagnosed. Mr C's foot was not x-rayed during either visit to hospital.

Mr C then went to see his GP as he was still having trouble with his foot and now felt it was mis-shapen. The GP arranged an x-ray which revealed that Mr C's foot was fractured. He was referred to an orthopaedic specialist (a specialist in medicine of the musculoskeletal system) who diagnosed that four of the five bones in Mr C's foot had been displaced. Mr C now has to wear orthotic footwear (special footwear available on NHS prescription) to accommodate his mis-shapen foot. Mr C was also unhappy that the board would only provide two pairs of footwear and would not provide specialist footwear such as Wellington boots; gardening boots; or sandals.

Our investigation, which included taking advice from an independent adviser specialising in emergency medicine, concluded that it was reasonable that

x-rays were not taken and that the fracture went un-diagnosed. The adviser pointed out that there should always be clear clinical indications of the need for examination by x-ray. In Mr C's case no such clear indications were present - he was able to bear weight and although his foot was painful and swollen, it had a good range of movement. The adviser commented that this type of dislocation is a relatively rare injury and so, in the circumstances, it was not unreasonable that it was not diagnosed at the time. On the matter of the orthotic footwear, we found that the board’s guidance reflects national guidance issued by the NHS in Scotland, and that it was reasonable for them not to provide more than two pairs.