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Investigation Report 201302080 201402758

  • Report no:
    201302080 201402758
  • Date:
    August 2014
  • Body:
    Lothian NHS Board and Borders NHS Board
  • Sector:
    Health

Overview
The complainant (Mr C) complained on behalf of his wife, Mrs C.  He said that although Mrs C had an operation to her spine in June 2012, it was not until February 2013 that it was discovered that the operation had been undertaken in the wrong place.  Mr C said that, as a consequence, his wife suffered unnecessary pain and discomfort which impacted significantly upon her life, particularly as Mrs C was recovering from radiotherapy treatment in respect of breast cancer.

Specific complaint and conclusion
The complaint which has been investigated is that the care and treatment provided in connection with surgery on Mrs C's spine was unreasonable (upheld).

Redress and recommendations
The Ombudsman recommends that Lothian NHS Board:

  • ensure that the Consultant Neurosurgeon revisit her procedures for determining the level of surgery and consider doing two x-rays, one before incision and one with the wound open.  Alternatively, do only one x-ray but with the wound open and the spinal elements clearly visible.

The Ombudsman recommends that Borders NHS Board:

  • ensure that Hospital 2 review their procedures concerning the timely dispatch of radiology reports.

Updated: December 11, 2018