North Middlesex University Hospital NHS Trust

3. Ms L complains about the Trust’s care and treatment from August 2017 to 2019.

4. Ms L complains the Trust’s rheumatologist misdiagnosed her with systemic lupus erythematosus (SLE). SLE is an autoimmune disease that means the immune system attacks healthy tissue. It causes joint pain, skin rashes and tiredness. There is no cure but symptoms can improve if treatment starts early.

5. Ms L says the Trust’s misdiagnosis led to it prescribing unnecessary dangerous treatments.

6. Ms L says the treatment the Trust prescribed caused these side effects: • rapid weight gain • diarrhoea (loose stools) • nausea and vomiting • hand tremors • difficulties with sleeping • bleeding gums • mental fogginess.

7. Ms L wants a financial payment of over £10,000.

8. On 10 December 2012, Ms L had an appointment with a Trust rheumatologist. She says the Trust rheumatologist found she was suffering from pain in multiple joints.

9. On 18 December 2013, Ms L had another appointment and she says a Trust rheumatologist told her lupus tests from 2011 and 2012 were negative.

10. On 24 December 2016, Ms L’s children took her to an emergency department (ED) after she had episodes of unconsciousness. Ms L reports ED staff completed tests and diagnosed sepsis, pneumonia, respiratory failure, tachycardia (rapid heart rate), severe hypoxia (oxygen deficiency) and diminished oxygen levels causing insufficient blood supply to the brain and heart.

11. She reports a clinician noted her blood gas tests showed evidence of lactic acidosis, which is when tissue shows signs of oxygen deprivation. She reports they also noted her lungs were unable to supply oxygen to her body.

12. Ms L explained that unknown to her, she had been inhaling carbon monoxide for ten months, a fact she only discovered on April 6 2017 during a routine boiler and gas annual check.

13. On 29 June 2017, Ms L got the results of blood tests for autoimmune disorders. Ms L reports all of these were negative meaning she did not have an autoimmune disorder.

14. On 21 August the Trust rheumatologist did a series of blood tests. Ms L says the main lupus related tests were negative.

15. The Trust complaint response from 2017 says Ms L was found to be strongly positive for ANA and ENA antibodies. The immune system makes antibodies to fight infection. Positive ANA and ENA antibodies are a sign of a possible autoimmune disease.

16. The Trust complaint response from 2018 says the rheumatologist made a suspected diagnosis of SLE, which they treated with prednisolone, azathioprine and mycophenolate mofetil. Prednisolone is a steroid used to treat a wide range of health problems including autoimmune conditions. Azathioprine and mycophenolate mofetil are immunosuppressants, which help to control the body's immune system.

17. Ms L reports attending an appointment on 19 February 2018 with the rheumatologist and they told her she did not meet the criteria for SLE. But, she says the rheumatologist did not change her diagnosis and continued to prescribe medication for SLE.

18. The Trust complaint response accepts Ms L did not meet the full diagnostic criteria. It stated there are well recognised spectrums of lupus-like disorders and the treatment depends on signs and symptoms, which may be identical to that of classic SLE. It explained in this situation it was correct to treat Ms L in the same way they would treat a patient with classic SLE.

Diagnosis

21. The law says we cannot investigate a complaint where a person has the option to take legal action, unless we consider this is unreasonable in the circumstances. We have discussed this with Ms L to understand her circumstances and the outcomes she wants. We do not consider whether legal action would succeed but whether it would be a reasonable option to look in to.

22. Ms L believes the Trust provided her with very poor treatment that put her life at risk and caused her lasting harm. She complains it did not diagnose her correctly and as a result prescribed medication which has had a long-term impact on her health. She says this has significantly impacted her quality of life.

23. Ms L has an alternative legal route available to her by making a clinical negligence claim. She wants a payment to make up for the reduction in her quality of life. This outcome can be achieved by a successful claim.

24. Legal proceedings are not the only way for Ms L to achieve a financial payment. If we upheld her complaint, we may suggest a financial payment.

25. We explained our severity of injustice scale to Ms L. The scale has six different levels of injustice that a complaint could fall into, which increase in severity. Each level is then linked to a range of financial payment we would usually recommend in those circumstances. This allows us to make sure the recommendations we make are consistent and transparent for everyone who uses our service.

26. On reviewing the scale, Ms L felt her complaint fitted with the highest level on our scale, level six. This means she wants a payment of more than £10,000.

27. Ms L did not highlight any issues that would prevent her getting legal help. She did tell us she believes her details have been shared somehow to tell solicitors she is fraudulent.

28. Ms L told us she has already taken legal advice for a personal injury claim for the carbon monoxide poisoning. She has also taken advice from two solicitors about the misdiagnosis. Ms L gave us the responses she had from the solicitors.

29. The first solicitor said it was unable to take her case due to capacity issues and advised her to get advice from another firm. The second solicitor stated it did not think she had a high enough chance of success for it to take her case on a ‘no win no fee’ basis. It advised her she could continue investigating whether she has a claim by getting another solicitor.

30. Although Ms L has taken some legal advice it is clear from the responses she has had that she has not exhausted her legal options. This is because different solicitors may have different opinions on the likely success of a case.

31. Ms L told us she would be unable to afford to pay for a solicitor because she cannot work due to her disability. Ms L also said that since being told she does not have lupus, she has approached many solicitors and been told no. She says she does not have the energy to speak to more solicitors only to be told no.

32. Ms L has not been able to provide evidence of speaking to these other solicitors.

33. Ms L told us she has bought a solicitors manual so she could represent herself in a personal injury claim. We note that representing yourself in court could be difficult and we would not normally expect someone to do this.

34. Ms L told us she has personal contacts who are solicitors and they told her once she is ready to proceed, they can go ahead. Ms L told us she told them she would not need to because the complaint is with us and if she does not have to deal with the Trust, it is one less thing for her to take to court.

35. Whether to explore legal action or ask us to investigate is not a choice a complainant can make. This is because the law says we cannot investigate a complaint where a person has the option to take legal action, unless we can see that this would be unreasonable.

36. We appreciate preparing to represent herself in court must be time consuming and stressful. But, if Ms L were able to get legal advice on her complaint about the Trust, this would be handled by a legal team. As Ms L has already taken legal advice, we can see no reason why she could not attempt to do so again.

37. We are sorry to hear Ms L feels solicitors may be unwilling to help her. We will write separately to her with a list of organisations that are able to offer support and guidance about the legal process.

38. Considering the seriousness of the claimed failing, the legal route available and the amount of payment she wants, it is important for her to look into her legal options fully. We do not want to disadvantage her by keeping her case open. This is because there are time limits for making a legal claim.

39. We have explained to Ms L that should solicitors not accept her case, she is able to return to us. At that stage we would need to consider how far her legal claim had progressed and what outcomes she had achieved. We would also need to consider our time limit, so we advise her to take legal advice quickly. We can only set aside our one-year time limit if there are strong reasons to.

40. We are very sorry to hear about the circumstances which led to Ms L bringing her complaint to us. We know how important this complaint is to her and understand this continues to be a difficult time.

1. We have carefully considered Ms L’s complaint about North Middlesex University Hospital NHS Trust (the Trust). We are very sorry to hear about the difficulties she has experienced with diagnosis and the ongoing impact she says this is having on her health.

2. We have decided to take no further action on Ms L’s complaint. This is because we think Ms L could take legal action on the matters she has brought to us.