TB testing
13. Mr A complains he asked the Trust to test him for pulmonary TB, but it discharged him from hospital without completing the test. He said his GP advised this to be done. He said the hospital doctor sent samples to the lab which were rejected due to insufficient information on the form and the hospital doctor did not send a further sample.
14. Mr A said he was not referred to his GP and the community testing team for TB testing. The Trust said Mr A’s care was managed with the utmost diligence and in close collaboration with the infection control team. It said at the time of the discharge Mr A did not display any typical symptoms of TB.
15. The Trust said the decision to discharge him was based on a comprehensive evaluation by the infection control team, which included consideration of his clinical presentation and test results available.
16. We can see Mr A’s medical records show the Trust recorded on 9 September 2024, ‘TB test arranged to complete tomorrow…’ The records on 10 September 2024 show the plan was for the Trust to complete a TB test for Mr A. The records on 12 September 2024 said, ‘Still awaiting TB results…’
17. It said the plan was to send Mr A home that day and to contact the infectious disease team for the need to test for TB. The records further show a follow up discussion with the infectious disease team, ‘Not significant contact, can be discharged and for follow up with GP if he is worried (but not needed).’
18. Our adviser said the Trust requested a QuantiFERON (IGRA) blood test on 11 September 2024. This is a blood test to detect infection with mycobacterium tuberculosis, the bacteria responsible for TB. It identifies a person’s response to TB bacteria which diagnoses latent (person is not ill or infectious and asymptomatic) or active (potentially infectious) TB.
19. Our adviser said the test cannot distinguish between latent and active infection. It might take about six to eight weeks for the TB test to become positive after infection is acquired. They noted Mr A said his potential exposure to a close relative with TB was around 1 August 2024. They said however, the blood test was not processed as the blood tubes were overfilled so no results were received.
20. Our adviser reviewed Mr A’s records and confirmed he was admitted under the urology service with a kidney/ urinary tract infection. They said there were no clinical suspicions of active pulmonary TB, so it was not unreasonable to discharge him back to GP care who would be experienced to refer him to the community TB service for screening if the potential TB contact remained a concern.
21. They said, given the high incidence of TB in his local area, they said the GP would have sufficient experience to manage this situation and refer him appropriately. Our adviser referred to NG33 guideline, sections 1.2.1 and 1.6.1 which recommends contact tracing and screening for latent TB for close contacts of patients with active pulmonary TB.
22. We can see this guidance covers preventing, identifying and managing latent and active TB in children, young people and adults. Our adviser noted, from Mr A’s complaint to the Trust on 16 September 2024, his relative was started on TB treatment for latent TB. As mentioned in paragraph 17 above, this was not significant contact.
23. They said this would not pose any risk to the patient and therefore, TB screening was not indicated for Mr A in line with NG33 guideline. We understand Mr A said the doctors discharged him without the TB testing being completed because they were racist. We recognise it must have been frustrating for Mr A.
24. This was because he was eager for the Trust to test him for TB as he was worried it might spread to his family members if he had a positive result. From review of the available information, we have not seen any impartial evidence to confirm the poor conduct and attitude of the doctors during Mr A’s hospital admission.
25. We acknowledge attitude and conduct (including perception of racism) is subjective as individuals can perceive it differently. We are unable to reach a clear decision about this. We can see Mr A was asymptomatic and the Trust had not completed a TB test for him at the point of discharge. Our review of the available information supports it acted in line with the above NG33 guidelines.
26. This is because there were no indications for Mr A to have a TB test at the time. We consider the Trust acted appropriately to refer him to his GP if he had further concerns. Therefore, we have seen no indications of maladministration and shall not consider this issue further. We are pleased Mr A did not confirm he or his family went onto develop a TB diagnosis. We wish them all the best in their health going forwards.