Hospital apology for missing brain tumour
‘Unreasonable delay’meant extra treatment for child
NHS Forth Valley has apologised after a paediatrician failed to spot a child was suffering from a brain tumour over a period of months.
The then five-year-old child was originally referred by his GP in December 2013 to the paediatrician at Forth Valley Royal Hospital suffering from vomiting and headaches, with a first appointment in January 2014. He was then seen three times between then and July that year.
However, the brain tumour was only diagnosed after the child collapsed at home and was admitted to the hospital as an emergency in August that year.
Only then did a doctor in their fourth year of paediatric training make a correct diagnosis based on the same clinical information which had been available to the consultant three weeks earlier.
The boy was then transferred to the Royal Hospital for Sick Children in Glasgow and underwent “lengthy and difficult” surgery to remove the tumour, but it was impossible to remove completely and the child needed chemotherapy and was left with neurological defects including a squint and hand weakness.
At one point, instead of thinking about a potential brain mass, the paediatrician who is no longer working with NHS Forth Valley - had considered constipation and prescribed a laxative.
The child’s mother complained to the Scottish Public Services Ombudsman about her son’s care and treatment from the paediatrician at FVRH from January 2014 until August 2014, which was upheld in their report published this week.
The ombudsman concluded that the child should have been referred for a brain scan in the April at the latest and that the paediatrician’s failure to consider a brain tumour and arrange scans and referrals was “below an acceptable standard of care”.
They added: “These failures led to a significant personal injustice to the child in that it was likely an earlier diagnosis would have meant a smaller tumour and a shorter, less challenging operation.
“The unreasonable delay also meant an opportunity to completely remove the tumour was missed. The child required additional treatment (chemotherapy) with significant risks and was left with neurological effects.
“Given the evidence and information available to the paediatrician about the child’s condition, from January 2014 onwards, I am extremely concerned about their failure to properly assess and investigate his symptoms. Their failings in this case raises questions about the paediatrician’s competence.”
The ombudsman also accepted that despite clinical records prior to the child’s referral referring to headaches and a detailed diary kept by the child’s mother, the paediatrician’s record keeping was “poor” and they had failed to refer to the presence or otherwise of headaches.
The consultant paediatrician who had reviewed the notes said, had they reviewed the child and seen the diary information about his condition, they would have acted sooner, However, the ombudsman determined that “on balance” it was likely the boy’s mother did tell the paediatrician from the January onwards that the symptoms included headache.
The report added: “The boy’s mother remembered clearly reading out her diary extracts to the paediatrician and recalled specifically telling them the child had had headaches but that the paediatrician appeared uninterested. ”
A spokesperson for NHS Forth Valley said: “We recognise that aspects of the care we provided fell below our usual high standards and we have met with the family to offer them our sincere apologies. A number of actions have also been taken to address the issues highlighted in the report. This includes arranging additional training for paediatric staff to improve the diagnosis of children and young people with brain tumours.”