• Case ref:
    201003054
  • Date:
    June 2011
  • Body:
    Highland NHS Board
  • Sector(s):
    Health
  • Subject:
    clinical treatment; diagnosis; back injury
  • Outcome:
    Not upheld, no recommendations

Summary
Ms A injured her back in 2007 and went to the Accident and Emergency Department at Raigmore Hospital. They diagnosed a soft tissue injury in her lower back. They told her GP that she was able to move about and they had allowed her home with some advice about how to deal with the injury. In 2010, Ms A had an x-ray and a scan that showed she had three fractures in her back. This caused her concern that she might have been mis-diagnosed in 2007. An MSP complained on Ms A’s behalf that the hospital failed to carry out a comprehensive and appropriate assessment of her injury.

After taking and accepting advice from one of the Ombudsman’s professional medical advisers we found that that the hospital’s assessment of Ms A had in fact been entirely reasonable, and of a good standard. Our adviser said that medical records showed that the doctor made a good assessment of the possible presence of neurological damage. The symptoms recorded at the time would not normally support a diagnosis of a fracture, but would support a muscular or arthritic cause for the pain. He said that there was a possibility that a fracture first occurred then but, given the assessment that was made, it was unlikely that it had. As the hospital had diagnosed a muscular injury, it was reasonable and in accordance with relevant guidelines for them not to have
x-rayed Ms A’s spine. He pointed out that the guidelines generally advise against
x-rays in such circumstances. The board had also pointed out that x-rays of the lumbar region involve large doses of radiation.

Our adviser also said that the fractures seen on the x-ray in 2010 could have happened before or after Ms A attended the hospital in 2007, and that the x-ray could not be used to establish when they occurred. He had reviewed the films with an experienced consultant radiologist who agreed with this conclusion. Ms A also now had other underlying medical conditions that may have had a bearing on the discovery of the fractures in 2010.

We recognised that Ms A had experienced considerable health difficulties over the last few years, but found that the care and treatment she received in 2007 was entirely reasonable in the circumstances at the time.