A medical practice has apologised to a widowed partner for an “unreasonable failure” after a patient’s death.
The Scottish Public Services Ombudsman (SPSO) asked an NHS Ayrshire and Arran GP surgery to apologise to a family after their loved one died following a botched diagnosis.
The deceased’s spouse, referred to as C in the SPSO report, complained about their care and treatment from the practice.
C had arranged an appointment for their partner, known as A, after they took ill over the weekend but A became too sick to attend.
C asked the practice for a house visit but a triage phone call took place instead, with A’s symptoms being noted and advice and medication prescribed.
But A’s condition deteriorated the next day, C said, and they asked if a doctor could come out. Arrangements were made but A became increasingly unwell.
The GP practice arranged an emergency ambulance to take A to hospital, where they died shortly after.
The primary cause of death was found to be diabetic ketoacidosis (a complication of diabetes mellitus) and respiratory tract infection.
SPSO took independent advice from a GP and found that “at the time of the triage phone call, there was an unreasonable failure to take an adequate history and further assess A” by visiting them or by hospital admission.
SPSO’s report said the practice provided “some evidence of reflection and learning” since the incident.
C also complained about how the GP surgery dealt with their complaint, but SPSO did not uphold this aspect of the complaint.
Vicki Campbell, NHS Ayrshire and Arran head of primary and urgent care services, said: “In addition to a formal apology to the family of A, I can advise that the practice concerned has fully accepted the recommendation in the SPSO report.
“The practice has addressed the issue highlighted and made the appropriate changes, ensuring clinical staff have received further training and guidance on the care of patients presenting with diabetic emergencies in primary care.
“In order to ensure learning across the organisation, the practice concerned completed an analysis of the incident which was shared with other clinical primary care colleagues.”