Failure to diagnose lung cancer while in hospital

What happened

Mr M was in his seventies and went to the A&E department at the Trust's hospital because he had fallen out of bed and was feeling generally unwell. Doctors examined him and arranged blood tests and a chest X–ray. He was admitted and treated for pneumonia with antibiotics and fluids. Staff discharged him home after a week.

Approximately four months later, Mr M returned to A&E. He had fallen, and had pain and swelling in his knee. He was admitted, but investigations of his knee did not reveal any obvious fracture. The plan was to fit a splint, send him home and see him again in two weeks. However, before Mr M could be discharged, he developed symptoms that doctors put down to a chest infection or possibly pneumonia. They planned to treat him with antibiotics and fluids.

Mr M then had a chest X–ray, and this showed he might have lung cancer. A later scan confirmed this and further investigations showed that Mr M's cancer was advanced and had spread to his liver. Mr M stayed in hospital for approximately three weeks before being discharged so that he could go home to die, in line with his and his family's wishes. He died the day after returning home.

What we found

We partly upheld this complaint. Doctors assessed Mr M and treated him for pneumonia during his first admission to hospital, but they did not consider the alternative diagnosis of lung cancer.

Although a chest X–ray taken at the time showed a suspicious lesion, doctors did not arrange the further investigations and treatment that Mr M's condition warranted, as the General Medical Council's Good Medical Practice states they should have done.

This meant that doctors' decisions about Mr M's further care and treatment were not based on all relevant considerations. The doctors' care and treatment of Mr M fell so far below what they should have been that they amounted to service failure.

There were shortcomings in some aspects of the care and treatment the Trust provided for Mr M during his second admission. As the Trust had already acknowledged, communication with Mr M and his family did not meet the family's needs. The family did not get important information they needed in a way they could understand at what must have been a very difficult time. Mr M was discharged without getting the medication he should have had.

However, taken as a whole, the care and treatment Mr M received during his second admission did not fall so far below what they should have been that they amounted to service failure.

We could not imagine the shock and distress Mrs M and her family suffered as a result of her husband's sudden deterioration and death, but we could not conclude that the outcome for Mr M would have been different. It was likely that he would not have survived even if everything that should have been done, had been done.

We recognised, however, that if Mr M's cancer had been diagnosed sooner, Mr M and his family would have had the opportunity to be involved in deciding how his cancer would be managed and they would have had the opportunity in those last few months to prepare themselves for the end of Mr M's life. The fact that Mr M and his family did not get these opportunities was an injustice to them.

Putting it right

The Trust acknowledged and apologised for its failings. It also paid Mrs M £1,500 as a tangible acknowledgement of the injustice her husband and her family had suffered. The Trust created an action plan that showed learning from its mistakes so that they would not happen again.