Decision Report 201305399

Summary

Mrs C complained to us on behalf of her husband (Mr C), following a consultation at the A&E department of the Royal Alexandra Hospital. Mr C went to A&E a few days after a fall, as he was suffering from back pain. He was examined by a consultant in emergency medicine, who concluded that the back pain was an exacerbation of a pre-existing problem. The consultant told Mr C to continue with pain relief and return if symptoms persisted or got worse. Mr C was eventually diagnosed with a fracture to one of his vertebrae.

We took independent advice from a consultant in emergency medicine, who considered the examination that Mr C had at his consultation to be reasonable, though he noted that it did not consider Mr C’s range of movement or any associated pain. Our adviser said that, when examining older people, doctors should have a low threshold for considering whether an x-ray is necessary, but that the decision should still be based on clinical judgement. However, he concluded that the decision not to x-ray Mr C had been reasonable in this case, given the findings of the consultant's examination.

The board apologised to Mr and Mrs C that an x-ray had not been requested, and said that they had raised this issue with staff, and reminded them of the need to particularly consider whether an x-ray is needed when an older person is examined.

On the basis of the advice we received, we considered that Mr C’s care and treatment had been reasonable. The board had already taken action, and there was nothing further we could achieve.