Trust refused to arrange second opinion for cancer patient

What happened

Following investigations at the Trust, staff gave Mr R a diagnosis of cancer and told him that it was inoperable. He was offered palliative chemotherapy. Mr R asked for a second opinion, but the Trust refused this. He says Trust staff told him it was pointless. Mr R managed to arrange a second opinion from a private hospital. After further tests, he was told that his condition was operable. Mr R returned to the Trust to request an operation, but the Trust asked for an additional test before agreeing to perform surgery. Mr R was unhappy with this and managed to arrange surgery at a different NHS hospital. The surgery was successful.

Mr R complained that the Trust incorrectly diagnosed his cancer as terminal and that it refused to arrange a second opinion. He also complained that the Trust refused to take the advice of the private hospital and declined to operate. He said that the Trust's actions caused him expense and inconvenience, and the thought of what would have happened if he had accepted the Trust's diagnosis and treatment plan has caused him considerable distress.

The Trust said that Mr R's presentation was unusual and concluded that its actions, based on the clinical findings at that stage, were appropriate. It also concluded that the further tests it requested before surgery was carried out were reasonable. The Trust agreed, however, to refund the £12,000 Mr R had paid for the second opinion at the private hospital. It declined to pay an additional £7,500 that Mr R asked for in recognition of the distress caused to him.

What we found

During our investigation, we took clinical advice from a specialist.

Based on Mr R's clinical presentation, the Trust's initial diagnosis and treatment plan were reasonable. We agreed with the Trust that Mr R's clinical presentation was very unusual and it would not be expected that his cancer would be operable. It was also appropriate for the Trust to request a further test before proceeding with surgery, because a scan showed that the cancer might still be in nodes that could have made surgery impossible.

Fortunately for Mr R, his cancer was operable and his surgery was a success. However, the Trust's refusal to arrange a second opinion when Mr R asked for this was unreasonable. Additionally, the Trust did not adequately address this issue in its complaint response and we were not reassured that the Trust had adequate procedures in place for when patients requested a second opinion.

Putting it right

The Trust acknowledged the failings we identified and apologised to Mr R. It also paid Mr R a further £500 in recognition of the inconvenience and distress caused by the failings. In addition, it formulated an action plan to address the failings identified and make sure that appropriate procedures are in place for dealing with requests for a second opinion.