Issue 1: Assessment
16. Before we decide whether we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any signs something has gone wrong. This is because we consider Mrs O was assessed in line with the relevant guidelines, as explained below.
17. Mr O complains the Trust did not assess Mrs O properly. The GMC Guidelines say doctors must provide a good standard of practice and care. If they assess, diagnose or treat patients, they must:
• adequately assess the patient’s condition, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors) and their views and values and, where necessary, examine the patient • promptly provide or arrange suitable advice, investigations or treatment where necessary • refer a patient to another practitioner when this serves the patient’s needs.
18. On attendance at the ED, Mrs O complained of deteriorating back pain that had started three days earlier when she was pulling her stockings up. Our adviser reviewed the assessment that took place. Mrs O’s relevant medical history was taken, and it was noted she had had back pain in the past, but otherwise she was well at that time.
19. The physical examinations carried out did not reveal any red flags (signs of a more serious cause for the pain). Her observations and blood tests were also within a normal range.
20. Mrs O was diagnosed with mechanical back pain, which is an overarching diagnosis for people who have pain caused by a strain, spasm or inflammation in the back. This diagnosis is used as it is usually clinically impossible to tell which ligament, muscle or joint has been stretched or strained, and the treatment provided is the same.
21. Mrs O was also assessed by physiotherapists on both days of her admission. The conclusion from the second assessment was she was back at baseline (her condition had returned to normal for her). This shows she was fit for discharge. Our adviser said a rapid return to normal would not normally occur in a serious condition such as cancer or infection of the spine. Mrs O was also given paracetamol and antibiotics for a possible urine infection, and no further actions were required from an ED perspective.
22. Taking all that into account, our view is that Mrs O was assessed in accordance with the GMC Guidelines. This is because the evidence from the medical records shows her symptoms were taken into account and she was examined in line with the guidelines. There is no sign anything was missed. We understand this was a worrying time for Mr O, and we hope this reassures him about the care Mrs O received.
23. For these reasons, we will not be considering this part of the complaint further.
Issue 2: Scan
24. Mr O says the Trust failed to scan Mrs O’s back. The NICE Guidance explains that doctors should only consider imaging (different techniques used to view the body to diagnose and monitor conditions) in specialist settings of care for people with low back pain if the result is likely to change the required management.
25. In line with this guidance, medical imaging, such as a computerised tomography scan (CT scan, which uses a series of X-rays and a computer to create detailed images of the inside of the body) or a magnetic resonance imaging scan (MRI scan, which uses magnetic fields and radio waves to produce detailed images of the inside of the body), is not routinely carried out for the type of back pain Mrs O was experiencing, as it will not change what is done for the patient.
26. Our adviser explained an emergency MRI scan is only carried out in an ED setting if a patient has symptoms suggesting the nerves at the bottom of the spinal cord are squashed, such as a loss of feeling around the bottom, incontinence or severe pain radiating down both legs. There is no evidence Mrs O was experiencing these symptoms at the time of her attendance.
27. An emergency MRI scan may also be carried out if there is a suspicion of a spread of cancer to the spine, such as a history of previous cancer, weight loss or other symptoms suggesting possible cancer elsewhere in the body. The medical records show Mrs O did not present with any symptoms or signs of cancer.
28. X-rays are not routinely carried out unless there is a history of recent injury to the back. There is no evidence in the medical records suggesting this was the case for Mrs O.
29. Taking all that into account, there is no evidence Mrs O presented with any symptoms or signs that would have suggested imaging was required. The decision not to carry out a scan was in line with the NICE Guidance.
30. For these reasons, we will not be considering this part of the complaint further.
Summary
31. We are sorry to hear of the impact of Mrs O’s death, and we recognise how difficult this has been and the sadness it has caused for Mr O.
32. Having reviewed Mrs O’s care, we see no sign anything went wrong, and her treatment was in line with the relevant guidelines. We are not taking further action on the complaint.