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Eye-removal operation was avoidable, Ombudsman finds

A man lost his eye due to NHS failures in treating an eye infection, causing him significant distress and leaving him unable to work or drive, an investigation by the Parliamentary and Health Service Ombudsman has found. Failure to diagnose and treat Eric Stevenson’s eye infection meant that it became untreatable and, as a result, he had to have one eye surgically removed.

His wife, Mrs Stevenson from Cumbria, brought a complaint about North Cumbria University Hospital Trust to the Ombudsman in September 2018 after she felt that the Trust’s own investigation failed to recognise several mistakes in her husband’s care.

Eric Stevenson, who was 66 and a software engineer, went to his GP in September 2016 with problems with his vision in his left eye. He was referred to the Trust’s ophthalmology clinic where tests showed that his vision in his left eye was impaired. It was also inflamed and he was given eye drops to treat the inflammation. Four days later, the Trust tested his vision in his eye again and although it had got worse, the Trust told him to continue using the eye drops.

Mr Stevenson went back to the Trust in October and was given steroid medication, but at an appointment three weeks later tests showed his vision had got even worse. The Trust decided not to send Mr Stevenson for surgery to diagnose the problem, and told him in December to continue using the steroid medication.

In January 2017, Mr Stevenson asked to be referred to another Trust which found that his eye was so severely infected, the only option was to remove it.

Even though Mr Stevenson’s medical records showed he had recently been treated for a blood infection and he had clear signs of an eye infection, the first Trust failed to diagnose and treat it properly. Instead, he was given steroid medication which was ineffective and can make infections worse.

The Ombudsman found that if the Trust had correctly diagnosed his eye infection, it could have treated it sooner and saved his eye. Knowing that this could have been avoided caused Mrs Stevenson considerable distress.

Rob Behrens, Parliamentary and Health Service Ombudsman, said:

Doctors and nurses do a vital job caring for hundreds of thousands of patients under enormous pressure. But as this case shows, it is essential that the NHS learns from mistakes to prevent the same things from happening to others.

‘Losing an eye was understandably very traumatic for Mr Stevenson. The fact that this happened because of failings in NHS care, is inexcusable.

‘The Trust has now acknowledged that it was at fault and made changes to ensure that this does not happen again.’

Mrs Stevenson said:

‘Losing his eye had a huge impact on Eric and the last few months we had together before he died. The whole experience wore him down as he wasn’t able to work or drive and he was reluctant to go on day trips we had planned together.

‘The change I saw in him before and after the operation was huge and very upsetting for our daughters.

‘This must not happen to anyone else. I hope that lessons have been learnt and that other trusts realise they must take patient’s complaints seriously.’

Stephen Eames, Chief Executive at North Cumbria University Hospitals NHS Trust said:

‘I wrote to Mrs Stevenson in January offering her our unreserved apologies and I would like to reiterate our apologies again.

‘The care provided to Mrs Stevenson’s late husband fell below acceptable standards and we have carried out a full investigation where learning was identified and shared with the team.

‘I would also like to offer assurance that we are acting on all of the Ombudsman’s recommendations.’

Following the Ombudsman’s investigation the Trust wrote to Mrs Stevenson to acknowledge and apologise for the failings in her husband’s care. It outlined improvements that have been made, including changes to referral processes and making sure patient history records are available at appointments. At the Ombudsman’s recommendation, the Trust also made a payment to Mrs Stevenson in recognition of the injustice she suffered as a result of its failings.

Eric Stevenson passed away in September 2017 for reasons unrelated to his eye infection and operation.

 

-ENDS-

 

Notes to Editors:

  1. The Parliamentary and Health Service Ombudsman provides an independent and impartial complaint handling service for complaints that have not been resolved by the NHS in England and UK government departments. We look into complaints where someone believes there has been injustice or hardship because an organisation has not acted properly or has given a poor service and not put things right. We share findings from our casework to help Parliament scrutinise public service providers and to help drive improvements in public services and complaint handling.
  2. Part of the new corporate strategy for 2018-21 is to increase transparency and the impact of our casework. This case summary forms part of an interim measure to move towards publishing the majority of our casework on our website over the next three years. Sharing insight and learning from our casework will help to improve public services.

 

PHSO press office

Kate Minton, E: Kate.Minton@ombudsman.org.uk, T: 0300 061 4129

Out of office hours – E: press@ombudsman.org.uk , T: 0300 061 4444