NHS Fife apologises after delay in diagnosing infection on the brain

The patient complained to the Scottish Public Services Ombudsman (SPSO) over the failure to diagnose and treat their infection earlier and the complaint was upheld.

Following the dental procedure the patient was reviewed in hospital on several occasions, including out-patient reviews by oral and maxillofacial surgeons (OMF) – specialists in treating diseases and injuries of the mouth and face – and an in-patient admission to Kirkcaldy’s Victoria Hospital.

The patient questioned how the infection was missed on so many different occasions by so many different people.

In the findings of the case, published last month, the SPSO said NHS Fife indicated in their response that there was no clinical signs which led them to suspect bacterial infection, and jaw joint problems were being considered as the cause of the patient’s symptoms.

Medical staff then suspected the patient, described in the report as C, to have viral encephalitis (inflammation of the brain) while an in-patient. A plan to carry out an MRI wasn’t pursued due to noted improvement int he patient’s condition.

The responsible consultant reflected that an MRI should have been performed during the admission and that not doing so may have delayed the identification and treatment of the infection in the brain.

The SPSO took independent medical advice from a consultant oral and maxillofacial surgeon and a consultant physician.

Its findings report said: “While it was noted that C’s infection presented atypically and was difficult to diagnose, their C-reactive protein was raised when they initially presented and this wasn’t acted upon.

"A CT scan also showed subtle signs of infection but this wasn’t picked up at the time.

"An urgent out-patient MRI was requested to look for joint problems and not to exclude infection, otherwise it may have been carried out sooner.”

The report went on to say that the review found the in-patient assessment “didn’t give due care and attention to C’s recent wisdom tooth extraction and hospital attendances”.

Adding: “It was agreed that the failure to pursue an in-patient MRI contributed to the failure to correctly diagnose and appropriately treat C’s infection.

"We considered that the decision to discharge C with a persistent headache was unreasonable.”

The SPSO recommended NHS Fife apologise to the patient for the failure to diagnose and treat their infection earlier.

The case should also have joint Mortality and Morbidity review with the findings of the investigation being presented to ensure relevant learning for staff from the OMF service, radiology and medicine.

Janette Owens, director of nursing for NHS Fife, said: “We strive to provide all of our patients with the highest standard of care. However, in this instance it is clear that we have fallen short of our standards.

“We accept the findings of the Ombudsman and this individual will be provided with a sincere, formal apology. We are also reassessing the relevant processes and procedures to ensure similar outcomes are avoided in future.”