Home > Publications > Selected Cases > Selected Investigations Completed December 2002March 2003 > Case no. E.1265/01-02
Complaint against St George's Healthcare NHS Trust
Summary of Case
Mr D, who had underlying cardiovascular problems, was admitted for surgery for cancer of the oesophagus. Doctors did not consider that Mr D's heart condition was sufficiently serious to warrant deferring the operation. He had a successful operation to remove the lower end of the oesophagus. Two days later he began to develop a heart irregularity and his oxygen requirement rose; he was bleeding from a chest drain and required a blood transfusion. A further operation revealed no problem at the site of the surgery. However, Mr D's condition began to deteriorate further and he developed multi-organ failure. He developed MRSA (a bacterium which is resistant to most antibiotics) and died three days later. Mrs D complained that her husband had been recovering well from surgery until he had contracted MRSA, which was potentially avoidable. The Ombudsman did not uphold the complaint. She found that Mr D's death could well have been a response to several surgical procedures in quick succession, as well as his heart problems. Although the presence of an infection such as MRSA could potentially increase the chances of suffering complications, there was no particular evidence that that had happened here and, in any event, Mr D had already been receiving an appropriate antibiotic when MRSA was first identified. The Trust agreed to give a high priority to ensuring that staff correctly followed infection control procedures.
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