In a case highlighted by the Scottish Public Services Ombudsman, NHS Lothian have apologised to a patient for failing to deliver the standard of care he could reasonably have expected to receive, following his presentation to the emergency department with acute hip and leg pain.

The patient, named only as "Mr C" by the Ombudsman, was initially assessed by an on-call orthopaedic surgeon. He underwent an X-ray and was then admitted to a ward for a total period of four days for observation. Mr C was subsequently discharged from the ward and sent home. It is not clear that any follow-up appointment was arranged.

A number of weeks later, Mr C remained in pain and returned to the emergency department at the Royal Infirmary. A second X-ray was performed at that time and further investigations were carried out. It was then identified that in addition to having suffered from a hip fracture, he had symptoms of advanced stage prostate cancer. He was ultimately diagnosed with Adenocarcinoma and also required hip replacement surgery.

Subsequent investigations have revealed that the medical records from the first admission have either been lost, or were never taken in the first place. The Public Services Ombudsman also made criticism of the failure to properly investigate the root cause of the hip pain on first admission, and ordered the health board to apologise to the patient for the significant issues identified.

Whilst NHS Lothian has expressed regret at the incident, and has assured the Ombudsman that lessons have been learned, many would expect that the specific consequences of negligent practice on health outcomes for patients should be investigated. In this particular case, it seems clear that an opportunity to diagnose the fracture and prostate cancer was missed. It is likely that if the diagnoses were made earlier, Mr C would have been able to begin appropriate treatment more swiftly than he ultimately did. Only expert medical opinion will be able to determine the impact that a delay is likely to have had on the progression of his condition, and questions will surely now be raised about the impact of those failures on the patient directly. 

Making a Claim for Delay in Diagnosis

To be successful in pursuing any claim for medical negligence, it is not enough to prove that a healthcare provider has acted negligently in the assessment and treatment of a patient. It must also be established that the negligence had a clear and measurable impact on his or her ultimate condition.  In cases involving a delay in diagnosis, expert witnesses must become involved in the case to consider the likely condition of the patient if treatment had been delivered at the first opportunity, as compared with after a period of delay.

If it can be established that an avoidable delay in treatment led to a poorer health outcome for the patient than would otherwise have been the case, an entitlement to make a claim for compensation arises. The potential value of that claim will be influenced by the severity and extent of the additional complications experienced by the patient as a result of that delay. In some cases, a delay in undergoing appropriate treatment will mean that life expectancy is significantly reduced. Where that occurs, the patient may be entitled to claim for a period of 'lost years', to reflect the difference between their current condition and what their position would have been if treatment had begun at the appropriate time, in the view of the experts appointed to the case.

Morton Fraser specialise in medical negligence cases involving delays in diagnosis and treatment. We are in a position to provide you and your family with specific, tailored advice based on your own unique circumstances. A successful claim may result in compensation being paid to reflect the losses you have suffered as a result of a delay in diagnosis. Crucially, it may also lead to a change in clinical practice with the potential to strengthen patient safety measures; minimising the risk of mistakes being repeated.