Poor clinical assessment by A&E locum doctor

What happened

Following three previous inpatient admissions for gall bladder infections, Mr B said he had been clinically advised that if he was in severe pain he should attend the A&E department. He was already on a waiting list for surgery for gall bladder removal.

As he was experiencing pain, Mr B went to A&E and was seen by the triage nurse late at night. He said he had abdominal pain, which had worsened since the previous day. He mentioned his history of gall bladder problems and having taken Gaviscon.

The records show that he was offered pain relief medication by nursing staff but declined this. Nursing staff also took blood for testing and the results, which arrived back after Mr B's discharge, were negative for infection. The observations done by nursing staff were all normal.

Mr B was seen two hours later by a locum doctor, examined and assessed as likely to have acute viral gastritis, and discharged. Mr B said that the doctor told him to find a nurse to remove the cannula from the back of his hand, and that he did this, although he thought it was inappropriate.

Following his return home in the early hours of the morning, Mr B said he could not sleep because of pain and went to his GP. The GP diagnosed a gall bladder infection and prescribed a seven day course of Cefadroxil which relieved the pain within the following 36 hours.

Mr B had surgery for his gall bladder in January 2014.

What we found

The actions taken by the nursing staff were in line with what would be expected. However the actions taken by the locum doctor did not reflect established good practice. There was however, no indication from the observations recorded, (including those recorded by nursing staff), that Mr B should have been admitted, and the failings identified had no impact on his treatment or outcome.

There were failings in the way in which the Trust dealt with the performance of the locum doctor. We did not consider that the Trust took appropriate steps to reassure themselves that the agency which supplied the locum doctor was taking action to address serious concerns about him.

We partly upheld this complaint.

Putting it right

The Trust apologised to Mr B for the failings identified in his medical assessment and the resulting lack of confidence in his care and treatment.

The Trust prepared an action plan to show that it had learnt lessons from the failings identified with its process for dealing with the performance of locum doctors, in order to avoid a recurrence of this in the future.