Home > Publications > Selected Cases > Selected Investigations Completed AugustNovember 2002> Case no. E.1272/00-01
Complaint against a GP in the Hammersmith and Fulham Primary Care Trust Area
Summary of Case
Mrs B complained that Dr L failed to monitor her husband's blood pressure over long periods of time and instead just issued repeat prescriptions. She also complained that Dr L arrived late at night for home visits, or sent locums in his place, after Mr B's health deteriorated in June 1998. Most importantly, he failed to diagnose Mr B's last illness. Mr B had been a patient of Dr L's for some 25 years and had been treated by him for hypertension for most of that period. Dr L visited Mr B on 19 June 1998 and diagnosed depression. He saw him again three days later and prescribed a wide selection of medications to treat a variety of symptoms which Mr B reported; these included a fever, coughing, wheezing, abdominal pains and a headache. On 3 July the GP admitted Mr B to hospital with suspected pneumonia; Mr B was sent home the next day with a request that Dr L arrange a psychiatric opinion. On 5 July Mr B was readmitted to hospital after an emergency call from Mrs B; he remained there until his death two months later. At post mortem a diagnosis of Trousseau's Syndrome was made. This is the combination of a signet ring cell carcinoma (a cancer, probably of the stomach) associated with extensive thrombotic changes.
Findings The Ombudsman found that the issuing of repeat prescriptions to Mr B was not subject to sufficiently close scrutiny by Dr L, and that the GP's management of Mr B's hypertension was unsatisfactory against the generally accepted standards at that time. Although the clinical assessors did not criticise Dr L for employing locums, they did express concern at the GP's failure to record the outcome of home visits made both by the locums, and by himself, and to log home visit requests. They said that Dr L's home visiting system was chaotic and potentially dangerous. The Ombudsman concluded that Dr L's care and treatment of Mr B in the final weeks before his admission to hospital were inadequate. He failed to arrange follow-up after his visit on 19 June and failed to conduct a proper assessment of Mr B at his next visit three days later. The Ombudsman concluded, however, that more accurate monitoring of Mr B's condition by Dr L would have been unlikely to have made an earlier diagnosis more likely or to have made a difference to the eventual outcome. The Ombudsman upheld Mrs B's complaint.
Remedy The Primary Care Trust agreed to share the Ombudsman's report with the General Medical Council.
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