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NHS Lothian has been ordered to apologise after the parent of a newborn baby complained to the Scottish Public Services Ombudsman (SPSO), a government watchdog that investigates complaints against public institutions in Scotland.
The parent of the child, who is referred to as ‘C’ in the ombudsman’s report, complained after their child’s dislocated hip was missed by staff at the Royal Hospital for Sick Children in Little France.
Despite a doctor’s ‘prior positive clinical assessment of hip instability’, the physio missed the child’s hip dysplasia and as a result it went undiagnosed for months.
Untreated hip dysplasia in newborn babies can require surgical intervention.
A report from the SPSO reads: “C complained about a failure to diagnose that their new born baby (A) had a dislocated hip from birth.
“A was reviewed by a physiotherapist at the Royal Hospital for Sick Children, and C raised concerns that their request for an ultrasound scan was refused despite the presence of a number of red flag risk factors for hip dysplasia (where the 'ball and socket' of the hip are not properly formed). A's condition was not diagnosed until some months later.
“The board noted that the physiotherapist found A's hips to be functioning normally.
“They accepted that initial screening will always have the opportunity for human error.
“They said that this is mitigated by regular teaching and peer review, and ensuring staff are competent in examination before reviewing patients.
“However, as a result of this complaint, they made changes to their hip screening procedures.
“We took independent advice from a paediatric physiotherapy specialist. We considered that the presence of a number of recognised risk factors of hip dysplasia, together with a doctor's prior positive clinical assessment of hip instability, should have led the physiotherapist to arrange an ultrasound.
“The decision not to carry out a scan of A's hips was unreasonable and resulted in a delayed diagnosis.”
Now, NHS Lothian must apologise to the family, and introduce an audit process to ‘ensure that improvements in teaching and peer review are followed through’.
Dr Tracey Gillies, medical director at NHS Lothian, said: “As well as issuing a written apology directly to C, I would also like to take the opportunity to apologise for the failings in this case and for the distress this has caused.
“We accept the ombudsman’s recommendations in full and are working through a plan to address these.
“Hip dysplasia, while common, can be difficult to diagnose.
“In response to this complaint we made changes to our hip screening processes, as well as enhancing the teaching, peer review and training that is available for staff."
Many babies are born with risk factors associated with hip dysplasia, but do not have or develop the condition.
Risk factors include a breech birth and previous associated family history.
A range of treatment options are available for hip dysplasia including the use of a specially designed harness. In some instances, surgery may be required.