3. Mrs E complains between 10 April and 29 August 2022 the Trust did not recognise her father, Mr C, had an abdominal aortic aneurysm (AAA) and did not adequately investigate his abdominal pain.
4. Mrs E says her father’s AAA was left untreated and this caused his death. She says the concerns about Mr C’s death had an emotional impact on the whole family and made it harder to grieve. She wants the Trust to apologise, make improvements to its service, and pay a financial remedy.
5. Mr C attended the Trust’s ambulatory emergency care unit (AECU) on 10 April 2022 with a history of worsening shortness of breath that was impacting his daily activities. The Trust assessed him and saw his symptoms were due to previously undiagnosed heart problems. He was seen in the AECU again on 11 April and a plan for follow up care was made.
6. Following this, until August 2022, Mr C went on to receive care from the cardiology team (heart specialists) as an outpatient and in hospital. He had two admissions to the Trust during this time, from 30 April to 15 May and from 12 to 23 June.
7. Mr C had tests on his heart and was diagnosed with ischaemic cardiomyopathy, which is damage to the heart muscle caused by a lack of blood flow. It was the result of a previous heart attack. This was treated with specialist heart surgery at another NHS trust.
8. Mr C attended the Trust’s emergency department on 29 August. He had severe abdominal pain and an urgent scan showed he had a large AAA. This is a swelling in the aorta, the main blood vessel that carries blood from the heart to the abdomen.
9. The scan showed the AAA was at risk of rupture and needed urgent treatment. Mr C was transferred to a hospital with the facilities to carry out this specialist treatment, but he sadly died there.
13. 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 that something has gone wrong.
14. Mrs E is concerned that when her father had abdominal pain the Trust did not properly investigate it or recognise he had an AAA. In its complaint response the Trust said Mr C only reported abdominal pain on one occasion (on 10 April) and abdominal examinations after this were normal. It said there were no signs of an AAA before 29 August.
15. AAA’s often have no symptoms and are usually only diagnosed during a screening test, or abdominal scan for another condition. However, if an AAA becomes larger it can cause people to experience abdominal or back pain, or a pulsing feeling in the abdomen.
16. We carefully examined Mr C’s medical records and saw no indication abdominal pain was present on any date other than 10 April. During his admissions to hospital his abdomen was examined, and no pain or abnormality was noted. The records also show Mr C did not report abdominal pain to staff during his interactions with them as an outpatient. The only pain reported was in his chest, which was due to his heart problems.
17. We have therefore focussed on the occasion where abdominal pain was noted.
18. On 10 April a doctor who saw Mr C in the AECU documented that his abdomen was soft and there was no enlargement of his organs. They also noted that Mr C reported ‘mild epigastric tenderness’ when examined. This refers to tenderness in the upper central area of the abdomen, under the breastbone.
19. Then, on 11 April Mr C returned to the AECU. Another doctor examined his abdomen and noted this time it was still soft, and no pain was present. They said he may have a hernia in his epigastric area. A hernia is where fatty tissue pushes through a weakened area in the tummy muscles.
20. The GMC guidelines say doctors must examine patients and arrange suitable investigations where necessary. The hernia guidelines say they can be diagnosed by examination alone, and do not routinely need to be scanned. If someone may have a hernia but has no symptoms, a ‘watchful waiting’ approach is appropriate.
21. Our adviser explained based on Mr C’s presentation there was no indication further investigations such as abdominal scans were required, and there was no reason to suspect AAA at this time.
22. His pain on 10 April was mild and only prompted through examination. Mr C otherwise had no pain day to day, as reported to staff. Then on 11 April the pain was not present. The doctor queried whether it could be due to an epigastric hernia, but further investigations to confirm or rule this out were not as Mr C was asymptomatic and the focus of his care was his serious undiagnosed heart problem.
23. We therefore consider the Trust acted in line with the GMC and hernia guidelines when it took no further action. As there were no signs of an AAA, there was no reason to suspect it.
24. We note the discharge summary to the GP mentions the examination findings and the hernia query. This meant the GP could be aware of the situation and take further action if the problem recurred or got worse.
25. We also note Mr C then did not report any other episodes of abdominal pain to the Trust (either when examined or asked about his health) until 29 August. Therefore, during this time there would have been no reason for the Trust to carry out further abdominal investigations.
26. We understand why Mrs E is concerned the AAA could have been picked up sooner. We hope the explanations provided in this statement offer her some reassurance about this.
1. We have carefully considered Mrs E’s complaint. We were sorry to hear her concerns about her father’s unexpected death and the ongoing impact this has had.
2. We have seen no indications anything went seriously wrong in the matters Mrs E complains about. We have seen abdominal pain was only present on 10 April and the Trust dealt with this appropriately. There was no reason for it to suspect an AAA. We will therefore not consider the complaint further.