The Newcastle Upon Tyne Hospitals NHS Foundation Trust

3. Mr U complains staff at the Trust misdiagnosed his wife’s cancer as liver disease during her admission between 26 August and 16 September 2022.

4. He explains the misdiagnosis meant doctors gave his wife painful and inappropriate treatment and she died sooner than she would have done if the cancer was diagnosed sooner.

5. He says this added to the distress of losing his wife. He has told us he now struggles with dayto-day life despite grief counselling.

6. As an outcome to his complaint, Mr U would like the Trust to acknowledge it got things wrong and pay financial compensation.

7. Mrs U attended an outpatient clinic at the Trust on 26 August 2022 to follow-up her latestage liver disease (liver cirrhosis). This is when the liver becomes scarred and stops working properly. She had shortness of breath and fluid in her chest (a pleural effusion), so the doctor Xrayed her chest and admitted her to the hospital.

8. A liver specialist met Mrs U the following day. They suspected Mrs U’s problems were possibly related to her liver cirrhosis. They arranged scans to investigate further.

9. The scans led doctors to believe the fluid around Mrs U’s lung was likely due to her cirrhosis. They suggested ongoing management with tablets that would help reduce the fluid build-up around her lungs. On 13 September doctors removed one litre of fluid from Mrs U’s chest which was sent for tests (a cytology). Mrs U then returned home.

10. On 23 September Mrs U went back to hospital by ambulance. A consultant explained the cytology found cells in the fluid that indicated cancer and arranged a CT scan to investigate further.

11. The CT scan happened on 26 September and the results returned the following day. It showed a stage 4 gynaecological cancer that had spread to other parts of her body. She died on 1 October. Mrs U’s cause of death was recorded as cancer with underlying liver cirrhosis.

Diagnosis 15. Before we decide if 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 indications something has gone wrong.

16. Mr U told us staff at the Trust did not account for all the symptoms his wife displayed when they tried to diagnose her illness. He feels they did not do the right tests to diagnose her condition. Specifically, he says Mrs U’s pleural effusion was an indicator her problems were not caused by the liver, as doctors believed.

17. The consultant who saw Mrs U at the outpatient appointment on 27 August X-rayed her chest. This showed a moderate pleural effusion on Mrs U’s right-side. They did a blood test and admitted her to hospital.

18. A consultant liver doctor visited Mrs U the day after. They suspected her problems were related to her pre-existing liver cirrhosis. There was a reduced amount of oxygen in her blood stream, so the consultant gave Mrs U another blood test to investigate and an oxygen mask to help her breathlessness.

19. On 30 August a consultant ordered several tests including a CT scan of Mrs U’s chest and a scan of her heart to assess how well it was working. They also considered asking the respiratory team to take a sample of fluid from Mrs U’s lung once the CT scan was complete.

20. The CT scan showed fluid around Mrs U’s right lung and that her left lung appeared infected. The scan showed her liver was damaged, but staff considered there was no indication of cancer that could not be explained by the cirrhosis at that point.

21. After the CT scan the consultant started Mrs U on some tablets to reduce the amount of water in her body and continued giving her oxygen. They also spoke to Mrs U about draining some fluid from her lung. Initially Mrs U was happy to continue with just the tablets and oxygen. On 13 September Mrs U agreed to have some of the fluid removed.

22. Mrs U was discharged home and the fluid was sent for tests. The test results were available on 22 September and showed the fluid contained cells which should not have been there. This indicated Mrs U had cancer.

23. Mrs U returned to a different hospital at the same Trust by ambulance on 23 September. A consultant explained the findings of the cytology to Mrs U and arranged a CT scan to investigate the results. The scan happened on 26 September and was returned the following day. It confirmed the late-stage cancer starting in her reproductive organs.

24. The Trust explained Mrs U’s symptoms indicated her liver cirrhosis was causing the pleural effusion. This meant the tests they performed focused on her liver and lungs, and not the site of the cancer lower down in her body. The Trust added full test results indicating her cancer were only available when Mrs U visited hospital for the second time.

25. Mrs U’s symptoms and chest X-ray indicated a pleural effusion. This meant the doctors should have investigated in line with NICE CKS ‘Breathlessness’. Specifically, the section on diagnosis and investigations. It explains appropriate investigations include an X-ray, a scan of the patient’s heart and blood tests.

26. Guidelines on the management of ascites in cirrhosis were also relevant, and provide information on investigating and managing someone’s symptoms. Ascites is a condition where fluid collects in spaces within someone’s abdomen. These guidelines recommend a CT scan of the abdomen to confirm the presence of this fluid.

27. The adviser explained liver cirrhosis can cause ‘hepatic hydrothorax’. This is when fluid moves from someone’s abdomen into the space around their lungs. They told us Mrs U’s medical history and symptoms at the time meant it was reasonable for doctors to consider this was the problem she was experiencing when she visited hospital.

28. In line with the two pieces of guidance referred to above, the Trust then carried out the appropriate tests to investigate this. It also took a sample of fluid, which sadly later showed Mrs U had cancer.

29. We consider doctors appropriately considered Mrs U’s condition was initially due to a hepatic hydrothorax given her symptoms. Although doctors did not identify Mrs U’s cancer during her first admission, they investigated her symptoms in line with the relevant guidance.

30. We understand how upsetting this heartbreaking loss has been for Mr U. We hope our decision provides some closure on these sad events.

1. We have carefully considered Mr U’s complaint about The Newcastle Upon Tyne Hospitals NHS Foundation Trust (the Trust). We have seen no indication anything went wrong with how doctors diagnosed his wife, Mrs U.

2. We acknowledge the devastating upset Mr U has experienced following the death of Mrs U. We understand just how heart-breaking this has been for him and how it affects his day-to-day life.