Older woman took steroids for too long after delay in follow up

What happened

An out–of–hours doctor diagnosed that Mrs Y had temporal arteritis, a condition in which inflammation of an artery causes soreness around the temples and problems with sight. She went to A&E at the Trust, where a locum doctor ordered blood tests and gave her steroid medication to take home. The locum doctor told her that she would get a letter about a neurology appointment within two days.

Mrs Y did not receive a follow–up appointment as quickly as she had expected. Her GP found that the hospital could not find any record of a referral from the locum doctor. Mrs Y then got a follow–up appointment for three weeks later. When she went to the hospital, staff realised that she had been referred to the wrong department. They referred her to rheumatology, which was the correct department. In the meantime, Mrs Y's GP had referred her to a consultant rheumatologist, who found that she did not have temporal arteritis. Mrs Y's GP helped her gradually stop her unnecessary steroid medication.

Although Mrs Y was taking a low dose of steroids by the time she saw the consultant rheumatologist, she experienced a number of unpleasant side effects of the steroids, including depression, weight gain and hair loss.

What we found

We partly upheld this complaint. Mrs Y received appropriate treatment in A&E. Given the risk of blindness, it was reasonable for the Trust to prescribe high–dose steroids. However, there was no clear pathway in place for an A&E doctor to get a patient seen quickly by a specialist in an appropriate follow–up clinic. This led to delays and confusion, and meant that staff did not carry out the correct diagnostic tests at the right time. When Mrs Y was referred to the rheumatology department, the Trust did not give her an urgent appointment, as it should have done.

If Mrs Y's follow–up care had happened as quickly as it should have, the dosage of steroids would have been reduced sooner and the side effects would have cleared more quickly. Communication was also poor.

The Trust's complaint handling was generally good. It put a robust pathway in place to avoid similar problems happening in future.

Putting it right

The Trust apologised to Mrs Y for its failings and paid her £350 to recognise the discomfort and distress she experienced.