Decision Report 201501178

Summary

Mr C saw a podiatrist because of the deteriorating condition of his foot due to an ulcer. He then had several admissions to Ninewells Hospital as well as being seen as an out-patient. He underwent an artery bypass (a procedure to improve blood flow) from just below the knee to the foot with amputation of several toes and a skin graft. The bypass and the skin graft failed and Mr C may need further surgery in the future.

We took independent advice from a podiatrist and a vascular surgeon. In relation to the podiatry treatment provided, we found that there were clear indications that Mr C had progressive foot disease when he saw the podiatrist on three occasions which the podiatrist failed to act on including referring Mr C to secondary care within a reasonable time. Clinical notes of Mr C's assessments were also inadequate. We found that the relevant guidelines (Scottish Intercollegiate Guidelines Network, SIGN) were not followed. We upheld this aspect of Mr C's complaint. With regard to the surgical care that Mr C received during his two admissions to hospital, we found that on the whole the board provided a reasonable standard of care and treatment but that there was an unreasonable delay in treating the foot initially when clinicians became aware that it was infected. We upheld this aspect of Mr C's complaint. In relation to Mr C's out-patient appointments following discharge from hospital, we were satisfied that there was evidence showing that assessment for each out-patient appointment was reasonable as was communication in relation to the management plan. We did not uphold this aspect of Mr C's complaint.

Recommendations

We recommended that the board:

• review the podiatry service to ensure complex foot problems are appropriately managed in the community in line with relevant SIGN guidelines including access to multi-disciplinary teams;
• bring our decision including the medical advisers' comments to the attention of the podiatrist and ensure it is reflected upon and addressed at their annual appraisal;
• address the shortcomings in record-keeping with the podiatrist;
• bring our decision including the medical advisers' comments to the attention of the relevant vascular healthcare professionals and ensure it is reflected upon and addressed at their annual appraisal; and
• apologise for the failings identified.