Decision Report 201403058

Summary

Mr C fractured his ankle which was put in a plaster cast for six weeks. He was told not to bear weight on the foot and was prescribed medication to prevent blood clots forming during this period.

When Mr C's cast was removed, the medication was stopped. He was referred for physiotherapy which took place one week later when he was provided with a sandal-type shoe to wear and given exercises to complete. A follow-up physiotherapy appointment was arranged for three weeks ahead.

Mr C died of a pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs) and deep vein thrombosis (DVT - a blood clot in a vein) a week before the follow-up physiotherapy appointment.

Mr C's wife (Mrs C) complained to us, and said that a failure to provide Mr C with appropriate and timely treatment following the removal of his plaster cast had allowed a blood clot to form. This caused him to suffer the pulmonary embolism and DVT which caused his death.

We took independent medical advice from a consultant orthopaedic surgeon who said there was no evidence that Mr C's medication should have been continued after the removal of the plaster cast. Our adviser also considered there was no difference between providing a patient with footwear and leaving the ankle completely free after the removal of the plaster cast. Furthermore, the adviser said that starting early physiotherapy treatment was not known to have any impact on the risk of developing a pulmonary embolism and a DVT.

Our adviser also said DVTs are difficult to diagnose. It was uncertain when Mr C's DVT had started, and fatal pulmonary embolism is a rare but an ever-present risk with surgery even if full prevention measures have been taken. On the basis of the advice we received, we found that the treatment Mr C received was reasonable.