A hospital which outsourced the review of an elderly patient’s CT scan has agreed to award him a five-figure damages settlement after his tumour was missed for almost eight months due to errors and delays.
The patient, who had a history of cancer in his kidney, pancreas and lung, had undergone tests at Leicester Royal Infirmary after finding a pea-sized lump over his eye.
Despite his urgent referral a number of delays in scans being carried out, combined with the failure to spot the cancer, meant it was eight months before an operation was performed to remove it.
During this time the Trust sent CT scans to a self-employed radiologist, rather than review it internally. In his report back to the Trust he suggested the lump to be a harmless cyst, a mistake which meant it only became apparent it could be cancerous during a procedure to drain it.
Further investigations were then carried out and the patient was eventually diagnosed with cancer and referred to a different hospital for a major operation to remove it, by which time it had dissolved part of his skull.
This led to the man needing a much more serious operation which has left him with a very noticeable indentation in his forehead, a visible and raised operational scar across the top of his skull from ear to ear, and a watering eye.
The patient has now been awarded £20,000 damages after bringing a medical negligence claim against the Trust through Hudgell Solicitors.
Treatment to drain cyst was eight months after ‘urgent’ referral
The failure to spot the tumour – firstly by an internal radiologist and then the outsourced expert – combined with delays in waiting for other scans and reviews, meant it was eight months after being urgently referred before an operation to drain the cyst was carried out.
It was alleged as part of the legal case that the patient faced an unacceptable catalogue of delays following his initial urgent MRI scan, which was carried out on August 9, 2013. This was not reported on until September 6 and the patient was then referred for a CT scan.
That was performed on September 18 and scans were sent to the private radiologist for review. Again there was a wait of almost a month for the results to return to Leicester Royal Infirmary on October 13, which suggested it was not a tumour.
He was then referred for another MRI and bone scan, which was booked for November 28, but after he complained it was brought forward to October 31. The recommendation to drain the ‘cyst’ was made after that x-ray.
The procedure was not carried out until April 2014 and notes and his consent form were missing on that date.
The operation to remove the cancer was performed at the Royal Hallamshire Hospital in Sheffield, and involved the surgeon shaving his hair and peeling back his scalp.
Patient disappointed that scans were outsourced for review
The patient, an 84-year-old great-grandfather, had previously had cancer three times, leading to him having a kidney removed, pancreas removed, and lesions in his left lung removed. He says he cannot now face further corrective surgery to reduce the dentation in his forehead, as it would include having a titanium plate fitted.
“It’s all been very disappointing, I now have a scar from ear to ear,” he said.
“I recently saw the photographs of myself after the operation, and with the scar and all my hair shaved off, it was quite an eye opener to see, it’s a good job there weren’t children around to see me like that.
“The surgeon at the Royal Hallamshire Hospital was talking about fitting a plate to cover up the concave part of my skull but after discussions with my family I said ‘no’. I’m not going to go through all that again as it’s another major operation.
“Sometimes I am aware somebody gives me a quick glance and looks away again. One time I was shopping and I was wiping my eye as it does water now, and I heard a little girl ask her mummy ‘why is that man crying’ but you just have to live with that.
“I feel very disappointed in the hospital and I am surprised that scans are sent out to others for review. I wasn’t aware that this happened.
“I suppose if it has been properly explained to the patient where it is being sent and why it’s necessary, then that’s alright. But not to explain to the patient and not to give any reason why it is being outsourced is wrong.”
Solicitor concerned over outsourcing of scans and accountability when errors made
Gary Warriner, a senior solicitor at Hudgell Solicitors, said the delays in treatment, incorrect reporting of the MRI scan and subsequent surgery had caused ‘significant personal trauma’ for the elderly patient.
And he said that, having considered the legal issues as the case progressed, he was concerned about the possible wider ramifications linked with the practice of hospitals out-sourcing scans to a third party.
“Not only did this patient suffer significantly due to continued delays, failure to correctly diagnose the cancer and the eventual major operation to remove it, but this case has thrown up serious concerns regarding an NHS practice which many patients may well be completely unaware of,” he said.
“Here we had a case where our patient had been badly let down and initially our task was to establish who was legally responsible given the circumstances of the scan being passed from one organisation to another.
“If the NHS happily delegates to a third party, who is responsible when something goes wrong?
“In this case the defendant Trust denied all allegations and initially sought to deflect responsibility for one of the scans which had been outsourced. It was only when we asked for the terms of the outsourcing arrangement, including copies of the referral contract, that we received sensible damages offers.
“We were never presented with any documentation detailing the outsourcing agreement.
“I suspect this is going to be a growing issue given the pressures on hospitals, and if it is the case, there must be clear documentation as to where responsibility lies. Patients should also be fully informed as to who is reviewing their scans and where they are being sent.
“In this case there were delays in the reporting back from the radiologist, and the standard of service was questionable. Again, who is responsible for that when it is of an insufficient standard?
“I think patients will be concerned to learn that this goes on. Where is the quality control? The patient thinks all aspects of their treatment and reviews are carried out by the NHS, but they are not.”
The allegations of negligence made against Leicester Royal Infirmary as part of the case centred around the delay in, and the quality of the radiology reports, particularly given the patient’s history of cancer.
It was also alleged delays in treatment caused him to have to undergo a more serious operation than he would otherwise have done, which would have left him with much reduced scarring.
The Trust offered the £20,000 damages settlement despite not making any admissions.