Patient’s throat cancer was misdiagnosed 3 times

The Scottish Public Services Ombudsman strongly criticised the treatment received by the patient, referred to as “Mr C”, at Edinburgh Royal Infirmary.

In a report released yesterday, the watchdog said a “simple” examination to diagnose throat cancer was not conducted, leading to delays in treatment.

Mr C was first referred to the hospital’s ear, nose and throat (ENT) department on 23 September, 2010, after telling his doctor he had developed a cough which was producing phlegm with blood in it.

He was told his symptoms did not match those of throat cancer – fears which the patient raised during the hospital visit.

Concerned his dyslexia may have prevented him from fully expressing himself, Mr C wrote to the consultant responsible for his care, restating his symptoms.

However, he received a discharge letter telling him the examination had not shown anything out of the ordinary.

His symptoms continued and he was referred again to the ENT department on 7 February, 2011, where a locum consultant diagnosed congested nasal passages which had become inflamed and he was prescribed cortico-steroid nasal drops.

Mr C’s case was reviewed on 29 June, 2011, by another locum consultant who also diagnosed nasal congestion and ordered an endoscopy procedure, the results of which were described to Mr C as unremarkable.

The hospital’s ENT department was asked by a locum GP to consider Mr C once again, given that his tonsils had become visibly enlarged and more painful than before. On 26 August, Mr C’s GP, suspecting cancer after the patient’s neck became visibly swollen, made an urgent referral to the ENT department.

Mr C was seen on 5 September by a new consultant, who ordered biopsies and a throat examination, or panendoscopy.

Following the results, Mr C was diagnosed with throat cancer on 28 September – more than a year after he first suggested to an ENT doctor that he might have the condition. The patient complained to NHS  Lothian but was unhappy with the board’s response and raised the matter with the Scottish Public Services Ombudsman, Jim Martin, who launched an investigation.

Mr Martin, relying on the counsel of an independent adviser, found it was appropriate for Mr C to have been discharged after the first appointment.

But he said that, by the time of the second consultation, “there should have been increased suspicion of the symptoms and consideration given to examining the tonsils”.

He said: “I am concerned that had Mr C’s GP practice not been so persistent in pursuing his case, his cancer could have been left undiagnosed until the prognosis for him was significantly worse.”

The watchdog also ordered the board to carry out a serious clinical incident review.

Yesterday, Dr David Farquharson, medical director of NHS Lothian, said: “We have written to Mr C to apologise and I would like to take this opportunity to publicly repeat that apology.”

Margaret Watt, chairwoman of Scotland Patients’ Association, said: “This is not the first time I’ve heard of this sort of situation.”