Decision Report 201808293

Summary

Mr C complained that the care and treatment given to his late wife (Mrs A) by her GP practice were unreasonable.

Mrs A had a history of rheumatoid arthritis (an inflammatory disorder that mainly affects the flexible joints). Her health began to deteriorate further, but Mr C said that it took time to establish that Mrs A had heart problems for which she needed an operation. After surgery Mrs A was discharged home, but months later she required to be admitted to hospital again. Mrs A had developed a serious infection in her heart and died shortly afterwards. Mr C complained that it took too long to diagnose his wife's infection.

We took independent advice from a GP. We found that in the early stages of her illness, Mrs A had been investigated and treated appropriately and it had been very unusual for a patient to have developed such severe heart disease in a short space of time. After her operation and return home, Mrs A became increasingly unwell and was regularly seen by members of the GP practice who treated her for a urinary tract infection. However, we found that the severe heart infection (endocarditis) had not been considered as a possible diagnosis, as it should have been, particularly as it was known that Mrs A had an artificial heart valve and persistent signs of infection. Her pre-existing heart condition could have predisposed Mrs A to developing endocarditis, and it was unreasonable not to consider this. This led to a delay in diagnosis and a delay in admitting Mrs A to hospital. Therefore, we upheld the complaint.

During the course of our investigation, we also found the complaint handling to be unreasonable.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failure to properly consider Mrs A's presenting symptoms and for failing to consider and discount the possibility that she had endocarditis. As a consequence there was a delay in admitting her to hospital.
• Apologise to Mr C for the failure to deal with their complaint as required by NHS Scotland's Model Complaints Handling Procedure.

What we said should change to put things right in future:

• Patients' symptoms should be considered holistically.
• Clinicians should be aware of National Institute for Health and Care Excellence (NICE) guidance (s64) in relation to the symptoms that may indicate infective endocarditis.

In relation to complaints handling, we recommended:

• Complaints should be addressed and responded to in terms of the NHS Scotland's Model Complaints Handling Procedure.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.