Summary of Case No. E.2211/97-98
Jump to
Health Service Ombudsman for England
Investigations of complaints about clinical failings
Summary of Selected Cases
Case No. E.2211/97-98
Treatment by a doctor from a deputising service; complaint handling by the deputising service; insufficient assessment and monitoring by nursing and medical staff, and inadequate care
Matters considered:
Whether a doctor from a deputising service when reaching his diagnosis took proper account of a boy's symptoms and recent visit to a malarial area; whether he gave advice to the boy's family about what to do if his condition deteriorated; the handling by the deputising service of the boy's father's complaint.
Complaint against: West Midlands Medical Duty Services.
Summary of case
On 28 June 1996 a boy was prescribed an antibiotic by a GP because he had been ill with a high temperature. On 3 July the boy was no better, and the doctor from the deputising service was called to see him. The boy's sister told the doctor that the boy might have malaria because he had been to Pakistan and had not taken any prophylaxis. The doctor said that the boy did not show any symptoms of the disease, and concluded that he had had an adverse reaction to the antibiotic prescribed earlier. The doctor gave no advice about what to do if the boy's condition deteriorated. The following day the boy's GP referred him to hospital, where he was diagnosed as having malaria.
Findings
The doctor had practised in Africa, and had suffered himself from malaria. He said that 99% of strains of malaria found in Pakistan were not life-threatening and he could not send to hospital all patients with a high temperature who had recently returned from Pakistan. However, guidance issued by the Department of Health points out that a life-threatening strain of malaria can be found in Pakistan, and that the consequences of the main strain of malaria found there, while not life-threatening, can be very serious. The Ombudsman obtained a report on the clinical aspects of the case from two independent professional assessors. They said that patients with suspected malaria should be referred for diagnostic blood tests which will show whether a patient has malaria and, if so, which strain of malaria is present. The Ombudsman found that the doctor was under an obligation to follow the Department of Health guidance, and that he should have referred the boy for a blood test that night. He also found that the doctor had given an inappropriate diagnosis of adverse reaction to the antibiotic because it appeared to ignore the boy's reported symptoms and past medical history. The doctor did not seem to have entertained the possibility that his diagnosis might be wrong: to that extent the Ombudsman upheld the complaint that he did not advise the family what to do if the boy's condition deteriorated. The Ombudsman was concerned that the medical director of the deputising service thought that the doctor's actions had been correct. The handling of the complaint by the deputising service was hampered by the fact that the medical director believed that he did not have a current address at which to contact the doctor, who had left the deputising service, for a substantive response. The Ombudsman's investigation revealed that there was a forwarding address in their files.
Remedy
The deputising service apologised to the boy's family and agreed to ensure that they always kept a forwarding address for any doctors who left their employment.
