University Hospitals Birmingham NHS Foundation Trust

3. Mrs H complains on behalf of Miss C saying the Trust did not do the right tests and investigations on 3 November 2021 after a referral for a suspected blood clot in her right leg.

4. Mrs H says that because of this, Miss C had her lower right leg amputated which affected her independence and she now uses a wheelchair. Mrs H says these events caused Miss C trauma and also had a negative impact on her emotional and psychological wellbeing. Mrs H explains Miss C has been self-harming, misusing alcohol and her self-esteem has got worse. Mrs H says Miss C needs new accommodation which has wheelchair access and has an adapted kitchen and bathroom. Mrs H says Miss C’s care needs have also changed and it has been difficult to find support. This has affected her mental health.

5. Miss C would like an acknowledgement of failings, an apology, service improvements and a financial payment.

6. On 2 November 2021, the GP referred Miss C to the Trust with a suspected blood clot in her right foot.

7. Miss C went to the Trust on 3 November and the Trust did an ultrasound scan which did not show any blood clots. The Trust referred Miss C back to her GP.

8. On 29 November, Miss C returned to her GP because she was experiencing pain in her foot and she was struggling to walk. The GP could not find a pulse in Miss C’s foot and made an urgent referral to the vascular department at the Trust.

9. Miss C went to the Trust on 30 November and the Trust found four blood clots in her right leg. The Trust fitted a stent on 3 December, which was unsuccessful, and it did a lower limb amputation of her right leg on 6 December.

10. Miss C complained to the Trust on 19 January 2022 with support from her community nursing team.

14. Mrs H says the Trust neglected Miss C’s health needs on the 3 November as it did not complete the necessary tests. Mrs H says if the tests that were completed on 30 November, had been done before, the blood clots may have been found earlier. And Miss C may not have had to endure life-changing surgery by having her lower limb amputated.

15. The Trust said Miss C was seen in its clinic on 3 November 2021 and it did a scan and confirmed there were no blood clots found.

16. The Trust said the blood clots that were later discovered on 30 November 2021 were arterial (formed in the artery). It said it did not check the arteries before as the clinic she attended was for assessing leg veins, specifically blood clots in the thigh. The Trust said the blood clots in the arteries would not have been visible on the scan as it only picks up blood clots in the veins.

17. NICE guidance says if deep vein thrombosis (DVT is when a blood clot is found in the vein) is suspected to offer a Doppler ultrasound scan (a test to measure blood flow through the blood vessels), and if negative, tell the patient it is unlikely they have DVT.

18. We can see in the GP appointment notes on 2 November, it was written that Miss C had a three-week history of right leg pain, swelling, with a blotchy red appearance and the foot was cold to touch. It was noted that Miss C was walking with a limp as it was painful to weight bear on her right foot. The GP noted Miss C needed a DVT scan.

19. In the medical records we can see that on 3 November the Trust wrote Miss C reported her right foot and toes were numb, cold, and painful. The Trust wrote that Miss C’s right lower leg was normal in colour and Miss C reported it changes colours and can become purplish.

20. The Trust wrote it had completed a Doppler ultrasound. The Trust noted it checked the common femoral vein, femoral vein and the popliteal vein (all veins in the lower limb) and there was no evidence of DVT. The Trust advised Miss C to return to the GP for further investigation of her symptoms.

21. We asked the Trust and Miss C’s GP practice to provide a copy of the referral from the 2 November, to investigate if the correct team saw Miss C. Unfortunately, both organisations were unable to provide this information. We think it is likely that the referral was made by phone. On 2 November the GP noted a SPA team had contacted Miss C to arrange a DVT scan. We think this is referring to a ‘single point of access’, which would be a phone referral.

22. The Trust said the requested investigation was for the veins and not the arteries, where the clots were later found. The Trust said the referral it received was specifically for the DVT clinic.

23. We think it is likely the GP referred Miss C to the Trust’s DVT department.

24. Our adviser said the Trust did the tests for a suspected DVT in line with the NICE guidance and the result was normal, showing no blood clots in the veins. Our adviser said if DVT is not found, the patient is returned to the care of the GP to continue to investigate the symptoms.

25. From the evidence we have seen, we find the Trust acted in line with NICE guidance. We can see the Trust did the ultrasound, as stated in the guidance, and after a negative result advised Miss C to return to her GP for further investigation.

26. Our adviser explained Miss C was diagnosed with arterial blood clots after her appointment at the Trust on 30 November. Our adviser said DVT is a clot that is an entirely different and unrelated condition, and an arterial clot would not be identified by DVT tests. Our adviser compared this to requesting a chest X-ray to check for a broken leg. Our adviser confirmed the Trust did tests in line with NICE guidance for DVT and arterial clots would not be found in this clinic.

27. We understand our decision is going to be very upsetting for Miss C. We hope by reassuring Miss C that the Trust did the correct tests, it will give her some comfort.

28. Based on the evidence, we have found no failings in the tests and investigations done by the Trust. We are not upholding this complaint.

1. We have carefully considered Mrs H’s complaint on behalf of Miss C, about University Hospitals Birmingham NHS Foundation Trust (the Trust). We have found the Trust did tests and investigations for a suspected blood clot in line with guidance.

2. We understand our decision is not the outcome Mrs H and Miss C was hoping for and we understand Miss C has been through a painful and distressing experience. We apologise for any further distress our decision causes Miss C.