In a complaint to the Scottish Public Services Ombudsman (SPSO), C claimed that the NHS board had “failed to reasonably investigate and/or diagnose” their symptoms, and instead sent them home.
The board’s gastroenterology service, which dealt with C’s case, is primarily located at University Hospital Crosshouse in Kilmarnock.
The patient had to travel to London for care.
Following this, C was “left with no option” but to travel to London, more than 400 miles away, to obtain private care.
There, they were diagnosed with mesenteric ischaemia (restricted blood flow to the intestines), which can be deadly if not treated quickly.
C underwent private surgery to correct the ischaemia. While this improved the patient’s health, it also had cost implications.
After C raised a complaint, NHS Arran and Ayrshire apologised for communication failings.
However, they contended that all clinical decisions made were “appropriate”.
However, the SPSO has now ruled that the discharge was “unreasonable” and ordered the board to pay for the cost of C’s surgery.
A report published in late November explains: “We took independent advice from a consultant gastroenterologist and a consultant radiologist.
“We found that the board should have considered a diagnosis of mesenteric ischaemia as a strong possibility based on C’s presenting symptoms. Furthermore, when a CT scan was undertaken there was a failure to report the narrowing of the blood vessels supplying the gut.
“We found that the decision to discharge C from the gastroenterology service was unreasonable given their ongoing persistent symptoms and, of particular concern, their ongoing weight loss. Therefore, we upheld C’s complaints.”
The board has been ordered to apologise to the patient, and to reimburse them for the cost of their private treatment, including travel to and from London.
The SPSO report added: “Care should be taken when discharging patients with ongoing and persistent symptoms and, in particular, who have ongoing weight loss when there is no clear explanation or diagnosis established.
“Where a patient presents with postprandial abdominal pain and weight loss with no apparent cause despite extensive investigation, there should be a high index of suspicion of mesenteric ischaemia as a strong possibility being the diagnosis.
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“There should be interdisciplinary working between a multi-disciplinary team (the investigating team and radiology) so as to reduce the risk of missing mesenteric ischaemia as a diagnosis and there should be a specific review for evidence of any mesenteric blood vessel atherome on CT scans carried out.”
In a statement, Jennifer Wilson, the board’s executive nurse director, said: “We are sorry that the care experienced by patient C did not reflect the high standards of care we aim to deliver in NHS Ayrshire & Arran.
“The Board accepts in full the findings and recommendations of the Scottish Public Services Ombudsman (SPSO) and will be offering a formal apology to the patient.
“Work is already underway to address each of the recommendations, and we are committed to ensuring that the lessons from this report are shared across our organisation.”