Home > Publications > Selected Cases > Selected Investigations Completed December 2002March 2003 > Case no. E.529/01-02
Complaint against the Royal Free Hampstead NHS Trust
Summary of Case
Ms R was referred by her GP, with swelling on the side of her neck, to a consultant surgeon. The referral specifically drew attention to her lymph nodes. A senior clinical research fellow working with the consultant saw Ms R. He arranged a scan and thyroid tests, and reviewed Ms R two weeks later, when he commenced thyroid treatment. After seeing Ms R again, the research fellow concluded that Ms R was suffering from Hashimoto’s thyroiditis (reduced thyroxine production due to antibodies which scar the thyroid gland). He decided to review Ms R in a month and placed her on a waiting list for surgical removal of the thyroid. Ms R’s GP practice wrote again to the consultant asking for a review of the case. After reviewing her records the consultant agreed that Ms R was suffering from Hashimoto’s thyroiditis but that surgery would be unnecessary. Ms R was taken off the waiting-list. A second opinion was sought by the GP practice and Ms R was diagnosed, at another hospital, with lymphoma (cancer in the lymph glands) for which she then began treatment. Ms R died nine months after her initial referral. Her sister complained to the Trust and an independent review was held. However, Ms R’s sister remained dissatisfied and the Ombudsman considered whether the Trust’s medical staff failed to make a reasonable assessment of Ms R’s condition in light of information available to them.
Findings
The Ombudsman found that, although the diagnosis of Hashimoto’s thyroiditis had been correct, Ms R also had a lymphoma that went undetected. The Ombudsman concluded that insufficient consideration had been given to the possibility that Ms R had co-existing conditions and that there were opportunities missed by the research fellow and the consultant to investigate Ms R’s condition further, which would possibly have led to an earlier diagnosis of her lymphoma. The Ombudsman also identified failings in record-keeping, the organisation of out-patient clinics and delays in reporting Ms R’s ultrasound report. In addition it was found that the research fellow, who had been introduced to the Trust by a senior doctor as qualified to consultant level, was not appropriately qualified to deal with Ms R’s condition. The Ombudsman upheld the complaint.
Remedy
The Trust apologised and agreed to review its procedures for reporting abnormal test results; that they should arrange for consultant cover for clinics when the consultant was unable to attend; and that a system should be introduced to facilitate multi-disciplinary meetings for patients with multiple problems. The Ombudsman also recommended that the Trust take steps to ensure that research fellows are only involved in clinics for which they have appropriate training and expertise.
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