Hospital criticised over DVT case

The woman was discharged from Dr Gray's Hospital

A patient with a fatal blood clot in her leg was forced to sit in a hospital chair for eight hours because of bed shortages, it has emerged.

The Scottish Public Services Ombudsman has upheld a series of complaints from the woman's daughter.

Ombudsman Alice Brown said doctors at Dr Gray's Hospital in Elgin had not diagnosed deep vein thrombosis (DVT).

The woman died just over a month later, in May 2003, after the condition worsened and gangrene set in.

The complaints upheld by the ombudsman included a failure to diagnose DVT, a failure to provide appropriate accommodation and a failure to deal with the complaint.

Even if they did have to 'turf' a very ill elderly woman out of her bed to sit on a chair for eight hours, why did they not provide her with a stool? Miss C's daughter

The complaints were made by the daughter of the woman, known as Miss C.

She was originally admitted to the hospital for gallstones but also complained of breathlessness, calf pain and swelling in her legs.

The ombudsman's report said doctors had failed to carry out a scan for a clot and discharged the woman as "well" eight days later.

In her letter of complaint, the woman's daughter said that when she arrived to pick up her mother she was sitting on a chair next to her bed.

"My mother told nurses that she was tired and her leg was sore and asked if she could lie on top of the bed but she was told she could not.

'Shortcomings' accepted

"Even if they did have to 'turf' a very ill elderly woman out of her bed to sit on a chair for eight hours, why did they not provide her with a stool?" she asked.

In her report, Ms Brown said she was "unclear" about whether there had been any improvements in how patients were looked after as they waited to go home.

A spokesman for NHS Grampian said: "We have always accepted there were shortcomings in the care provided to the complainant's late mother.

Once we have had an opportunity to study the report in detail, we will write to the complainant with a full update of the lessons learned and actions taken NHS Grampian

"We have previously apologised about these shortcomings and about the way the complaint was handled, and will do so again."

He said the complaint centred around the difficulty in diagnosing DVT.

"As a result of the ombudsman's report, the medical, surgical and orthopaedic teams in Dr Gray's Hospital will hold a multidisciplinary meeting to discuss the diagnosis of DVT, the various protocols and their use in clinical practice," added the spokesman.

"The induction handbook for junior doctors is also being re-written to include the diagnosis of DVT.

"Once we have had an opportunity to study the report in detail, we will write to the complainant with a full update of the lessons learned and actions taken."