Decision report 201201697

Summary

Mrs C complained about the care given to her mother (Mrs A) by the practice GPs. Mrs A had rheumatoid arthritis (an inflammatory condition that mainly affects flexible joints) and osteoporosis (a condition that affects the bones, causing them to become fragile and more likely to break). She injured her ankle, which caused her severe pain, and she could not put weight on her foot. Mrs A's medical practice did not arrange for this to be x-rayed, and it was some time later that an out-of-hours doctor sent her for an x-ray, which identified a fractured tibia (shin bone) and fibula (bone on the outside of the lower leg). Mrs C complained that the practice unreasonably failed to arrange for Mrs A to be x-rayed.

Our investigation found that, over a two week period after the injury, the GPs twice visited Mrs A at home as well as having a phone consultation, yet did not arrange an x-ray. They instead diagnosed a flare up of arthritis and prescribed pain relief, with increased dosages when the pain did not subside (and indeed worsened). We found that the GPs should have arranged for an x-ray to be taken, particularly as Mrs A had osteoporosis and taking into account her age, frailty and the fact that she could not put weight on her foot. We also upheld the complaint that a phone consultation was inappropriate after the two home visits. We found that further action should have been taken at this time and that the decision to simply increase pain medication during a phone consultation was unreasonable.

Recommendations

We recommended that the practice:

• provide a formal written apology for the failure in service Mrs A experienced; and
• provide evidence to the Ombudsman that a significant event analysis has been carried out and of any service improvements that are identified following it.