Decision report 201004740

Summary
Ms C broke a bone in her foot and attended Accident and Emergency at hospital on 9 May 2010. A backslab plaster cast was fitted that day and she was asked to return on 10 May when a below the knee cast was applied. Replacement casts were fitted on 24 and 25 May but she had to return on 26 May because the cast had become loose and uncomfortable. The cast was removed by a nurse. Ms C alleged that she did this without proper consultation and that its removal was contrary to all the advice Ms C had been given previously. Ms C said that although she told the nurse this, she removed the cast regardless. Later, when Ms C complained about the circumstances, she says the nurse failed to provide a truthful account of what happened.

Our investigation showed that Ms C had an unusual fracture which needed to be held in a cast for up to eight weeks. After taking advice from one of our professional medical advisers, we found that the cast was removed too early and that there were deficiencies in the record-keeping. We also confirmed that Ms C's complaints about this were not properly investigated and that there was delay in responding to her. We did not uphold the complaint about the nurse’s account of events as, although there was some doubt about it, there was no evidence that it was untruthful.

Recommendations
We recommend that Highland NHS Board:
• apologise to Ms C for any pain and inconvenience she suffered as a consequence of her cast being removed on 26 May 2010;
• remind staff of the importance of listening to their patients and to be alert to the fact that their initial assumptions of a situation may not be correct;
• emphasise to staff the necessity and importance of maintaining a full and correct clinical record of patients' care and treatment; and
• apologise to Ms C for their failure to investigate her complaint properly.