The Royal Wolverhampton NHS Trust

7. Miss L complains about the care and treatment she and her son, Y, received from the Trust in August 2020. She complains:

· the doctor did not listen to her when she said her son was dehydrated, and

· the doctor did not physically examine her son.

8. In the days after, Y was taken to a children’s hospital as his condition worsened and was diagnosed with intussusception (where the bowel ‘telescopes’ in on itself) which required surgery. She says if the doctor had physically examined Y, then it could have been treated sooner, and if it had been left any longer, it would have been fatal. Miss L says that Y is doing well now but is behind on his milestones due to what has happened.

9. This time has been very distressing for Miss L, and she felt like she was not taken seriously or believed by the doctor. She has also had to deal with this on her own which is very stressful.

10. As an outcome to the complaint, Miss L would like an acknowledgement of failings and a financial remedy.

11. In the time since these events, the Trust took over the Urgent Care service this complaint is about. When we go on to explain our decision, we will refer to the Trust.

12. Miss L attended A&E with Y at the Trust in August 2020. The Trust referred Y to the Urgent Care service following a triage by A&E at approximately 7.48pm.

13. Miss L arrived at approximately 8.13pm and the doctor examined Y. The doctor advised Miss L to attend a follow-up appointment with her GP, and to call 111 if Y’s symptoms worsened.

14. In the early morning the following day, Miss L took Y back to A&E as his symptoms had worsened. A&E transferred Y to the local children’s hospital and tests were carried out. The children’s hospital discharged him two days later.

15. Later in the day, Miss L took Y back to A&E as Y was still experiencing the same problems. Y was transferred again to the children’s hospital where he was diagnosed with intussusception (where the bowel ‘telescopes’ in on itself).

Listening to hydration concerns

19. The doctor provided theirs account of the appointment in the response to Miss L’s complaint. In their observations of Y, the doctor says: ‘he was well hydrated, and all his observations were normal. Extra effort and time was taken to assess Y while being fed by Miss L, this was to obtain a better understanding of why he was refusing the bottle’.

20. They then said, ‘Ms L was then given advice on what to do if Y developed any worsening symptoms and, as I remember, was advised on the signs of dehydration to watch out for’. Miss L disagrees with the doctor’s account.

21. Overall, the Trust decided that the doctor’s examination was thorough, and the treatment and advice given was appropriate.

22. Section 31 of the GMC guidance says that ‘you must listen to patients, take account of their views, and respond honestly to their questions’.

23. The notes of appointment record Miss L’s presenting complaint in that Y was ‘still refusing bottle’ and included a history of Y: ‘started [nystatin] yesterday, started a week ago for oral thrush; still refusing bottle, white patches on tongue; x2 wet nappies since this morning’. This is in line with the GMC guidance as the notes reflect Miss L’s initial concerns.

24. Our adviser explained it is not possible for us to say whether the doctor listened to Miss L. The notes show that the doctor recorded the presenting complaint and Miss L’s concerns. However, we cannot tell how well the doctor listened from the notes. Our adviser has not raised any concerns about the actions taken by the GP based on the notes taken.

25. We have carefully considered the evidence. From speaking with Miss L, she strongly feels that the doctor did not listen to her concerns about her son’s hydration and did not take appropriate action. Considering the evidence available, there is no indication the GP needed to take further action, or any indication that they missed something relating to her son’s hydration.

26. We acknowledge Miss L’s account of events and we do not doubt her recollection. As an independent organisation, we rely on both her and the doctor’s account. In this situation, we are unable to give more weight to any of the sides.

27. As such, we do not think we could uncover anything more about what happened during this appointment.

Physical examination

28. In the doctor’s statement, they explain that: ‘a detailed examination of Y’s abdomen was carried out. His abdomen was not distended and there were no signs of acute abdomen’. They continue and say they wanted to ‘assure Ms L that there were no signs of intussusception present at the time of Y’s consultation’. Miss L disagrees that the doctor physically examined Y.

29. Section 15 of the GMC guidance says that doctors ‘must provide a good standard of practice and care. If you assess, diagnose, or treat patients, you must:

a. Adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social, and cultural factors), their views and values; where necessary, examine the patient

b. Promptly provide or arrange suitable advice, investigations, or treatment where necessary

c. Refer a patient to another practitioner when this serves the patient’s needs.

30. In the notes of the appointment, the doctor recorded that Y’s abdomen was ‘soft, non-tender, non-distended, no guarding, no rebound tenderness’. Our adviser explains it is not possible for the doctor to have made observations such as the abdomen being soft and having rebound without having physically examined and touched Y’s abdomen.

31. Undertaking a physical examination such as this would be in line with the GMC guidance.

32. As with Miss L’s concerns about her son’s hydration, there are differing accounts about what happened during the appointment. Miss L strongly maintains that the doctor did not physically examine her son, whereas the doctor’s recollection and medical notes say that they did.

33. It is clear Miss L had concerns about her son’s health as she had visited the Trust several times before with similar problems. We can also see Y underwent surgery and was diagnosed with intussusception not long after this appointment.

34. It is not possible for us to say which account is more accurate. Based on the available evidence, we can see no way of establishing which recollection of events is more accurate. To try and provide Miss L with some reassurance, we asked our adviser if the intussusception could have been prevented or recognised sooner.

35. Our adviser firstly explained that the symptoms for intussusception can come and go intermittently. For example, the bowel can ‘fix itself’ but then can ‘telescope’ back in on itself.

36. Based on the symptoms Y was showing at the time of the appointment, from the notes, our adviser says that it does not seem Y was showing symptoms of intussusception. However, we recognise that Miss L disputes that the doctor conducted a physical examination.

37. On balance, we unfortunately do not have enough evidence to be able to say what happened. Therefore, it is likely any further investigation would not be able to add anything more. We appreciate Miss L is likely to find this frustrating. We hope the reassurance we have offered about Y’s symptoms at the time of these events goes some way to mitigate this.

1. We have carefully considered Miss L’s complaint about The Royal Wolverhampton NHS Trust (the Trust). We were sorry to hear of the events complained about and the impact this had on her and her son, Y.

2. We are unable to say whether the doctor listened to Miss L, as the notes of the appointment suggest he recorded her concerns. However, we have seen no indication that the doctor did not take appropriate action regarding Miss L’s concerns about Y’s hydration.

3. Similarly, we are unable to say whether it is more likely than not the doctor physically examined Y. It is unlikely we could find out what happened at the appointment, so we are taking no further action.

4. Regarding Miss L’s concerns over whether she was listened to about her son’s hydration, the doctor followed the relevant guidance as they clearly documented the reasons for Miss L’s visit. Based on the notes, we are satisfied there was no indication the doctor needed to take further action.

5. The doctor’s statement and medical notes support that Y was physically examined during the same appointment. This is in line with the relevant standards. We acknowledge Miss L has a different recollection of what happened at the appointment in August 2020. We do not doubt Miss L’s version of events, but we cannot give more weight to either account due to the lack of independent evidence.

6. We appreciate our decision is not the outcome Miss L was looking for, as it was clear she felt very strongly that the doctor did not listen to her, or physically examine her son. We were sorry to hear of the lasting impact these events have had on Miss L and her son, and we want to reassure her that our decision does not minimise any impact Miss L and her son, Y, experienced.