Poor care exacerbated family's distress after mother's death

What happened

Mrs B was referred to hospital in spring 2012 to investigate a range of symptoms she had had for about two months. She was initially diagnosed with atypical polymyalgia rheumatica; a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips. Trust staff ordered more tests and a CT scan, and these suggested diverticular disease.

Mrs B's symptoms continued and her health deteriorated. Two months later, she went into hospital. Staff diagnosed Mrs B with a stroke caused by a blocked artery in her neck, and a tumour in her bowel. Although doctors arranged for bowel surgery, they postponed this until they could identify if surgery to unblock Mrs B's artery was needed. By the time clinicians carried out bowel surgery in the middle of the year, the cancer had spread extensively and was incurable by surgery. Mrs B died in autumn 2012.

Mrs L, Mrs B's daughter, complained to the Trust that staff had misdiagnosed her mother in the early stages of her illness, and she had therefore had steroid medication that was inappropriate. She complained that Trust staff had not diagnosed cancer earlier. Mrs L also raised a number of other concerns about Mrs B's care, about poor communication and about the attitude of the staff involved.

What we found

We partly upheld this complaint. Polymyalgia rheumatica was a reasonable initial diagnosis on the basis of Mrs B's initial symptoms. Therefore we could not conclude she had been misdiagnosed. However, clinicians should not have excluded cancer as a possible diagnosis after the first CT scan. This was compounded when staff did not arrange urgent follow up after the scan.

There were delays in diagnosing Mrs B's cancer, but, given the information available to us, we were unable to say whether or not her death could have been prevented if the diagnosis had been made earlier. There were failings in how staff communicated with Mrs B and her family, and this made their distress worse. Poorly completed records also left the Family without reassurance that the nursing care given to Mrs B was appropriate, and this added to their anxiety.

Putting it right

The Trust wrote to Mrs L to acknowledge the failings and to apologise for the distress caused.

It also paid her £1,000 to recognise the distress caused by the loss of opportunity to diagnose Mrs B's cancer earlier and to know if an earlier diagnosis could have led to curative rather than palliative bowel surgery.

The Trust developed an action plan which addressed the failings we found and to identify the reasons for them, and described the learning and actions it would take as a result.