4. Mrs I complains the Practice did not appropriately assess her son Mr I on 21 October 2022.
5. Mr I died on 9 November 2022. Mrs I believes the way the Practice handled her son’s care, negatively affected his health and killed him.
6. Mrs I wants the Practice to acknowledge the failings and apologise. She also wants them to put in place significant service improvements. She also says financial compensation would be welcome as she can no longer work full time.
7. Mr I was a 23-year-old male with alcohol issues who died of acute pancreatitis. His mother Mrs I says he became very unwell on 19 October 2022. On 21 October 2022, she contacted his GP and requested an appointment for him relating to alcohol dependency and his sudden ill health. He went to the doctors and had a consultation with a clinical practitioner. Mr I came away from the consultation unsatisfied and still very concerned about his health and felt his physical symptoms were not the focus of the appointment and that the practitioner focused on his mental health. Mr I died 19 days later.
11. Before we decide if we should investigate 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, we have not found any indications that something has gone wrong.
Care
12. Mrs I complains the Practice did not appropriately assess her son Mr I on 21 October 2022. She says Mr I came away from the consultation unsatisfied and still very concerned about his health and felt his physical symptoms were not the focus of the appointment and that the practitioner focused on his mental health. The Practice maintain their approach was appropriate and followed the necessary treatment.
13. The clinical records show on 21 October 2022, Mr I was assessed by the Practice. The record shows there was a long history of anxiety symptoms and also notes that he started drinking at university to help him manage and was drinking about 500ml of vodka daily. It did note he does not always eat well but his weight was stable and whilst he did sometimes vomit there was no suggestion of blood in it. There was discussion about his overall life such as work and family position but notes the focus of Mr I’s concerns was long term damage to his health.
14. The clinical record also shows that a targeted physical examination, which included a thorough abdominal examination, took place. This assessment did not show any evidence of acute pancreatitis (such as pain or swelling of the abdomen) nor any other condition that would have necessitated same day hospital admission.
15. On examination, the records state “mild tenderness hypochondria, no mass and no organomegaly – liver edge not felt”.
16. Our understanding is that the GP was exploring if there were any signs of physical issue as a result of his drinking. The NICE guidelines say:
Suspect a diagnosis of acute pancreatitis in any person who presents with: • Acute sudden-onset upper or generalized abdominal pain, which may be associated with: • Nausea and/or vomiting • A history or clinical features of gallstones, alcohol misuse, or other risk factors.
17. We note there was no information understood by the Practice to suggest he had abdominal pain but we can see a suggestion of alcohol misuse and vomiting. As such it was reasonable to consider the possibility of acute pancreatis.
18. Our adviser explained acute pancreatitis is a sudden inflammation of the pancreas and the pain can be at any time. The abdominal pain is the most common symptom, and it is usually described as being in the left upper quadrant, epigastric area (below the ribs in your upper abdomen area) or around the umbilicus (commonly known as the belly button or tummy button), with radiation throughout the abdomen, or to the chest or back.
19. The guidelines says if the condition is caused by alcohol, the pain often develops six to 12 hours after drinking an excessive amount of alcohol.
20. Our adviser explained that acute pancreatitis is a temporary condition. It happens when your pancreas is attempting to recover from a minor, short-term injury. The abdomen may feel tender to the touch.
21. We can see the GP appears to have considered acute pancreatis as the records specifically refer to examining his abdomen which is suggested within the NICE guidelines for acute pancreatis and mentions no signs of swelling or fluid retention although it does reflect a slight tenderness. It also mentioned there are no signs of peritoneal irritation which can be a side effect of pancreatis. We can see they also specifically notes there were no enlarged organs or ability to feel the liver edge, which can happen where the liver is enlarged as a result of liver injury/pancreatis.
22. If the Practice had suspected acute pancreatitis, we would have expected them to have arranged treatment immediately through an emergency hospital admission. However, our adviser confirmed this was not necessary as he was not displaying signs of having acute pancreatis.
23. Instead, we can see blood tests were requested on the day. There are no medical tests that can diagnose mental or physical health disorders. But certain blood tests can show if a physical condition, such as thyroid disease or an electrolyte imbalance, is causing mental health symptoms. They can also help diagnose acute pancreatitis. However, our adviser noted these were not to diagnose with acute pancreatis.
24. A plan was initiated including blood tests and a written referral to the East Riding Partnership (ERP), which is a service equipped to help patients with alcohol and drug related problems and their mental health. At the end of the consultation Mr I was given safety netting advice of how and when to seek further urgent medical help, and we can see he was sent the details for the Crisis Team who can help is someone is having a mental health crisis. Accordingly, it appears reasonable in light of his condition at the time, that both physical and mental health aspects were explored and we have seen no indications of failings.
25. The records also indicate that the Practice prescribed Mr I medication in light of his presentation. Mr I was given Lansoprazole which is a medication which reduces stomach acid. It is a proton pump inhibitor (PPI), which means it blocks the enzyme that produces acid in the stomach. Lansoprazole is used to treat and prevent stomach and intestinal ulcers, erosive esophagitis, and other conditions involving excessive stomach acid. It may have been used in this case as the patient was intermittently vomiting and to protect the stomach lining from excess alcohol. He was also provided with Thiamine which is used to treat or prevent vitamin B1 deficiency. It is also a vital nutrient that helps the body convert food into energy and maintain nerve function. It is commonly given people consuming too much alcohol where they have poor nutritional intake which can lead to irreversible damage.
26. This assessment did not show any evidence of acute pancreatitis nor any other condition that would have necessitated same day hospital admission. Furthermore, whilst we appreciate concerns that physical health was ignored in favour of focus on mental health we can see appropriate examination and consideration of any symptoms was completed. In this was case based on how he was presenting at the time, it was appropriate to put in place support for his alcohol use and we cannot see any basis to suggest a failing to address physical health issues. We do fully appreciate the concerns in light of what happened next but we have seen no basis to suggest a failing in this interaction with the Practice on this occasion.
27. Based on the evidence we have seen; we can see that there are no clinical failings, our view is that we do not see indications of failings as the care and treatment appears to have been in line with the guidelines. In light of this, we can fully understand that you may find our decision disappointing and do not wish to cause you further distress which we apologise for.
1. We have carefully considered Mrs I’s complaint about a practice in the East Riding of Yorkshire area (the Practice). We were very sorry to hear about the sad loss of Mr I, and we appreciate how difficult this has been for Mrs I.
2. We were very sorry to hear Mrs I’s concerns and of the death of Mr I. We understand the huge ongoing impact the death of a loved one has on a family.
3. We have decided to take no further action on this complaint. This is because we have seen no indications of maladministration in the care and treatment. We go on to explain the reasons for our decision in this statement.