Decision Report 201402754

Summary

Mr C has a history of back problems. He complained that he was only given an x-ray for his back pain and had to arrange for a magnetic resonance imaging (MRI) scan privately because a clinician at Dumfries and Galloway Royal Infirmary refused him one. Unlike an ordinary x-ray, MRI shows the soft structures in the spine such as disc, nerves, ligaments and muscles.

In response to the complaint, the board said that Mr C had an increase in back pain with no new symptoms and there was no indication that an MRI scan would be needed in accordance with national guidance on the early management of persistent non-specific low back pain.

We took independent advice from our medical adviser who said that Mr C's presentation was not straightforward and did not properly fit with the diagnosis of non-specific low back pain or any existing spinal guideline. The medical advice we received was that Mr C should have been assessed for the possibility of spinal cord compression and either have had an MRI scan or his case discussed with a spine specialist given he had a pre-existing deformity of his spine and had several red flags (symptoms that are likely to indicate a particular serious illness). We only found records to show that an orthopaedic specialist had interpreted the x-ray but no evidence to show that the specialist was aware of the red flags and the pre-existing deformity.

Recommendations

We recommended that the board:

• apologise for the failings identified;
• review their local guidance with a view to including information on spinal presentations, such as spinal deformity and myelopathy pathologies;
• ensure the clinician reflects on the shortcomings in their next appraisal; and
• consider reimbursing Mr C for the cost of the private MRI scan on provision of appropriate receipts.