Decision Report 201607444

Summary

Mrs C complained about the care and treatment that her late husband (Mr A) received at Ninewells Hospital after he attended with painless jaundice (a  condition with yellowing of the skin or whites of the eyes). Mr A was later diagnosed with pancreatic cancer. Mrs C considered that the board had not taken appropriate action in terms of treating his symptoms as a red flag for cancer, carrying out appropriate investigations, diagnosing the primary source of cancer, acting on problems with a stent that had been inserted to drain a bile duct blockage, decision-making around surgical treatment and prescription of a medication to help digestion.

We took independent advice from a consultant hepatologist and gastroenterologist (a specialist in the study of the esophagus, stomach, small and large intestines, pancreas, gallbladder, and liver). We found that the initial action taken to investigate Mr A was reasonable and that appropriate tests for his presentation had been carried out. We found that the primary source of cancer had been appropriately diagnosed within a reasonable timeframe and that the action taken in relation to Mr A's stent was appropriate.

We found that surgical decision-making was also reasonable as, although it was initially thought that an operation could be carried out to remove the cancer, subsequent scans showed this treatment would have caused significant harm to Mr A with no benefit. However, we found failings in the prescription of Creon (a  medication that replaces pancreatic enzymes which help digest food) and also prescription of appropriate medication to treat itching caused by bile duct blockage. We noted that Creon could and should have been prescribed earlier and that the types of medication prescribed to treat Mr A's itching are known not to generally improve itching associated with bile duct blockages. We found that Mr A could have been made more comfortable with a different approach. Overall, we considered that the care and treatment Mr A received was unreasonable and upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failure to prescribe Mr A with Creon, and more appropriate medication to treat the itching associated with bile blockage, earlier. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

What we said should change to put things right in future:

• Creon and appropriate medication to treat the itching associated with bile blockage should be prescribed when the symptoms are apparent.