Decision Report 202001199

Summary

C complained on behalf of their child (A). A attended their GP practice and A&E at University Hospital Hairmyres on a number of occasions before examination by a physiotherapist led to a referral back to hospital, further x-ray and diagnosis of slipped upper femoral epiphysis of the hip (SUFE, where the growing part of the bone in the hip joint moves). C complained that A was advised to continue walking unaided despite being in severe pain. C believes failings in care contributed to A’s condition worsening to the point where significant surgery was required. C was dissatisfied with the board’s response to their complaint and asked this office to investigate.

In their response to our enquiry, the board confirmed that A’s case had been discussed at a Morbidity and Mortality review, with learning identified. They said that the initial referral letter from the GP to orthopaedics (specialists in the treatment of diseases and injuries of the musculoskeletal system) prompted no red flags from the orthopaedic team and they suggested musculoskeletal physiotherapy in the first instance. A was given an appointment but they attended A&E in the interim.

We took independent clinical advice from a consultant in emergency medicine and a consultant orthopaedic surgeon. We found that SUFE was a difficult condition to diagnose and we did not consider the delay in diagnosis to be unreasonable. We were, however, critical of the decision to discharge A without further investigation, when they were unable to weight-bear. We noted that the board had identified learning but considered they also ought to develop a multidisciplinary pathway for the limping child. We also found that the referral from the GP was assessed appropriately in view of the information it contained. On balance, we did not uphold this complaint but provided the board with feedback in relation to the issues mentioned above.