Summary
Mr C complained to us that the board had failed to provide his wife (Ms C) with appropriate clinical treatment following a GP referral to Perth Royal Infirmary for a suspected brain aneurysm. Ms C had been referred to the hospital by a GP after becoming unwell. In the referral letter, the GP referred to, amongst other things, a suspected subarachnoid haemorrhage (an uncommon type of stroke caused by bleeding on the surface of the brain). Ms C had reported sudden onset of pain in her head and neck with some visual disturbance. She was admitted directly to the acute medical unit in the hospital where she was medically assessed by a specialist trainee doctor. She was then reviewed by a consultant physician. She was subsequently discharged home with the problem felt to be musculoskeletal.
Ms C attended her GP on several occasions over the next few weeks. She then collapsed at home and was taken to the intensive care unit with signs of acute subdural haematoma (a serious condition where blood collects between the skull and the surface of the brain). Further treatment was not deemed appropriate and Ms C died in the hospital two days later.
We took independent advice on Mr C's complaint from a consultant physician. The adviser noted that there were sufficient features to suggest that Ms C had a thunderclap headache and that a CT scan should have been performed at that time. If this was negative, a lumbar puncture (a medical procedure where a needle is inserted into the lower part of the spine to test for conditions affecting the brain, spinal cord or other parts of the nervous system) should have then been performed and, if positive for subarachnoid haemorrhage, a neurological opinion would have been essential at that point.
We found that it was unreasonable that Ms C had been diagnosed with musculoskeletal neck pain. The adviser said that a patient with no previous significant headache history who presents with sudden severe neck and occipital pain (pain at the back of the head) should be investigated as a thunderclap headache. We also found that Ms C had not been monitored appropriately in the acute medical unit.
In view of the fact that Ms C's headache was not reasonably investigated, we upheld Mr C's complaint that the board failed to provide Ms C with appropriate clinical treatment on 7 January 2016. Whilst we cannot say that Ms C's life would definitely have been saved if these tests had been carried out, the adviser has stated that it was probable that Ms C's condition was treatable.
Mr C also complained that the board had failed to address his complaint in a timely and professional manner. We found that the board's response had not addressed all of the points Mr C had raised and that they should have provided a more detailed response to him in relation to his questions about the failure to take action in line with the relevant medical guidance. The board also delayed in issuing the minutes to Mr C after meeting him to discuss the matter. In view of these failings, we also upheld this aspect of Mr C's complaint.
Redress and Recommendations
The Ombudsman recommends that the Board:
- issue a written apology to Mr C for the failure to provide reasonable treatment to Ms C when she attended the Hospital on 7 January 2016;
- provide evidence that steps have been taken in the Hospital to ensure that adult patients presenting with headache are investigated in line with SIGN 107 (the Scottish Intercollegiate Guidelines Network guidance on the Diagnosis and Management of Headache in Adults);
- provide evidence that steps have been taken in the Hospital to ensure that patients are monitored appropriately;
- provide evidence that steps have been taken in the Hospital to ensure that, in appropriate cases, patients are issued with a discharge note in line with SIGN 128 (the SIGN discharge document);
- confirm that this report will be discussed at the Consultant's next appraisal; and
- issue a written apology to Mr C for the failure to provide a satisfactory response to his complaints.