iStockA health board has been ordered to reimburse a patient who was left with “no option” but to have surgery privately in England after being wrongly discharged.
The Scottish Public Services Ombudsman (SPSO) upheld the complaint against NHS Ayrshire and Arran, finding that the organisation failed to reasonably investigate or diagnose the cause of the patient’s symptoms.
The patient had experienced significant weight loss, intense abdominal pain, vomiting, altered bowel habit and nausea.
They also complained that they were discharged from the board’s gastroenterology service despite ongoing symptoms.
The patient said they had “no option” but to be treated privately in England, where they were diagnosed with mesenteric ischaemia caused by a restricted blood flow to the intestines.
They underwent surgery to correct this privately.
While this resulted in significant improvements in the patient’s health, they complained that this course of action should not have been necessary and that there were cost implications.
In response, NHS Ayrshire and Arran acknowledged and apologised for issues with delays in providing investigations and failings with respect to communication.
However, they considered the clinical decisions made in relation to the investigation and management of the patient’s case were appropriate.
The SPSO report found that the board should have considered a diagnosis of mesenteric ischaemia as a strong possibility based on the patient’s presenting symptoms.
Furthermore, when a CT scan was undertaken, there was said to be a failure to report the narrowing of the blood vessels supplying the gut.
The decision to discharge the patient from the gastroenterology service was deemed “unreasonable” given their ongoing persistent symptoms and, of particular concern, their ongoing weight loss.
The health board have been ordered to apologise to the patient for the failings identified in the decision and calculate and reimburse them in relation to their private treatment.
This includes the cost of travel to and from London for the patient after discharge from the gastroenterology service, provided receipts are produced.
The calculation should be based on what the treatment/surgery would have cost the NHS (rather than the full cost of the treatment) and what proportion of that the patient had to pay.
An SPSO statement read: “Care should be taken when discharging patients with ongoing and persistent symptoms and, in particular, who have ongoing weight loss when there is no clear explanation or diagnosis established.
“Where a patient presents with post-prandial abdominal pain and weight loss with no apparent cause despite extensive investigation, there should be a high index of suspicion of mesenteric ischaemia as a strong possibility being the diagnosis.
“There should be interdisciplinary working between a multi-disciplinary team (the investigating team and radiology) so as to reduce the risk of missing mesenteric ischaemia as a diagnosis, and there should be a specific review for evidence of any mesenteric blood vessel atheroma on CT scans carried out.
“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.”
Jennifer Wilson, executive nurse director at NHS Ayrshire and Arran, said: “We are sorry that the care experienced by patient C did not reflect the high standards of care we aim to deliver in NHS Ayrshire & Arran.
“The Board accepts in full the findings and recommendations of the Scottish Public Services Ombudsman (SPSO) and will be offering a formal apology to the patient.
“Work is already under way to address each of the recommendations, and we are committed to ensuring that the lessons from this report are shared across our organisation.”
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