SPSO Individual Decisions

In late 2005, tests revealed that Mr C had elevated liver function tests and he was advised to reduce his alcohol consumption. Mr C's liver function tests became significantly elevated in 2007 and his GP believed that these were consistent with his alcohol history, a view supported by hospital specialists. In 2010, following tests, a hospital specialist diagnosed hepatitis C. Mr C complained that his GP did not look beyond alcohol misuse as the cause of the abnormal results and that he should have been screened for hepatitis C much earlier. He said that as a result of the failure to do so, he began treatment at an advanced stage of the disease which had impacted adversely on his chances of surviving. We found that the GP failed to fully investigate Mr C's liver functions abnormalities, particularly in 2007. Although it was impossible to say definitively whether Mr C would have tested positive for hepatitis C earlier than 2010, we found that it was possible he might have and, therefore, an opportunity to make an earlier diagnosis was missed and treatment was potentially delayed.

Mrs C complained on behalf of her husband (Mr C) about the care and treatment he received from his medical practice in relation to abdominal pain. Mr C had been suffering from constipation for several months. A GP visited Mr C at home as he was unable to attend the practice because of the pain. Mrs C called the practice several times shortly after the home visit, telling two GPs that Mr C's condition was not improving despite intervention from the district nurse and treatment for constipation. The practice did not, however, arrange a further home visit during the telephone calls. Mrs C telephoned NHS 24 and an out-of-hours GP examined Mr C and arranged an emergency admission to hospital. Mr C had an operation on the day of his admission given the seriousness of his condition. He had peritonitis and a large inflammatory mass related to the large bowel. His recovery was traumatic and he continues to experience significant health problems and chronic pain. Mrs C said that if the practice had properly followed up their initial home visit, Mr C would have been admitted to hospital earlier and might not have been so severely ill. She felt that his continuing significant health problems and chronic pain could also have been avoided. We found that the information available to the GPs from the telephone calls and the district nurse should have prompted them to reassess Mr C in person and examine him. Having said that, our medical adviser said that it was not certain that the deterioration in Mr C's condition would have been picked up by clinical examination or whether it would have made any difference to the outcome. A home visit could, however, have improved the chances of a better outcome for Mr C. The practice have already recognised that there were failings and have taken some action to address these.

Mrs C attended her GP in January 2010 complaining of abdominal pain. She complained that from then until November 2010 when she was diagnosed as having intra-abdominal cancer, her GP practice failed to either act upon her symptoms or treat them appropriately. Our clinical adviser found that Mrs C had significant, persistent symptoms which appeared to become worse despite a number of medications related to the gastrointestinal tract. In the adviser's view, this should have prompted a review of the diagnosis especially in the presence of a normal upper abdominal ultrasound and normal endoscopy and sigmoidoscopy (a procedure used to see inside the sigmoid colon and rectum). The adviser added that Mrs C's communications with the practice were clear and concise and that her requests for assistance were specific. Accordingly, the adviser concluded that the management of Mrs C was deficient and we upheld the complaint.

Ms C complained about the care and treatment she received after she registered with a new medical practice. She said that a GP did not carry out a general check of her health and that the action taken by the practice in relation to her symptoms of depression was inconsistent. When Ms C had registered with the practice, they had checked her height, weight and blood pressure, in line with normal practice. They were not required to carry out a full physical examination. We found that the practice had initially treated Ms C for depression in light of the symptoms she displayed. When it became clearer that there were some doubts about whether she had depression, we found that the practice had acted reasonably in changing the way Ms C was treated. Ms C also complained about the treatment she received for the abdominal symptoms she presented with. We found that the treatment provided was appropriate. The practice had performed a pregnancy test. When this proved negative, they made referred her for an ultrasound scan. They also examined her abdomen on a number of occasions and documented the findings. We also found that the practice had acted reasonably in relation to a gallstone identified by the ultrasound scan. Related reading View Decision Report 201100261 as a PDF (14.12 KB) Updated: March 13, 2018