By Grant Smith

STAFF AT Liff Hospital, by Dundee, took too long to find out that a 90-year-old dementia patient had suffered a haemorrhage inside his skull, an official inquiry has found.

The Scottish public services ombudsman Professor Alice Brown also said another medical condition was not diagnosed quickly enough, and criticised a delay in transferring him to the accident and emergency department at Ninewells Hospital after a fall.

She was asked to look into the case by the man’s daughter.

The patient, known only as Mr A, suffered head injuries while in hospital. On the day he was admitted in March 2005 another patient pushed him into a doorframe, and he later had several falls. He suffered a hip fracture in the last fall and later died at Ninewells.

His daughter believed the injuries were not properly investigated or treated. In particular, a sub-dural haematoma—when blood from veins outside the brain collects within the skull— should have been diagnosed more quickly than it was.

The ombudsman’s medical adviser said that on several occasions doctors who saw Mr A did not record medical notes. That was worrying as it could explain the lack of reaction to his worsening physical and mental condition.

Had staff been alerted to the possibility of a sub-dural haematoma they could have ordered a brain scan, he said.

The inquiry report said, “There is no evidence that doctors were following the deterioration in Mr A’s condition, and its appears that Mr A’s mounting symptoms were overlooked.”

It was only when he was taken to Ninewells that the problem was investigated.

The ombudsman was satisfied there was a delay in diagnosing his condition.

An X-ray at Ninewells also found the patient was grossly constipated.

He suffered from this once before, but the doctor who treated him at Liff did not record this in the medical notes. However, hospital staff should have been aware the problem might recur, and they failed to diagnose it.

After his last fall on April 13, a restraining lap belt had to be used to stop Mr A falling out his chair. Mental Welfare Commission guidelines on restraints make it clear this procedure should have been discussed with his family, but it was not.

Later that day Mr A’s daughter was telephoned about 5pm and told her father was being taken to Ninewells as a precaution. However, the ambulance did not arrive for almost four hours and, after reaching Ninewells, Mr A was semi- conscious and very poorly.

The ombudsman’s medical adviser said the Liff doctor who ordered the transfer to Ninewells did the right thing in referring him for an X-ray.

However, the delay in the transfer was “very regrettable for an elderly confused patient in pain.”

The Scottish Ambulance Service said the call from Liff had put a two-hour timescale on the transfer, but a high level of emergency calls with higher priority that evening caused the delay.

Staff at Liff should have upgraded their request for an ambulance, asking for it to be made a higher priority.

She made several recommendations to NHS Tayside, the health authority responsible for Liff Hospital, all of which it has accepted and agreed to act on.

These include reminding staff to ensure entries in clinical records are appropriate and updated every time a patient is seen by a doctor. The issue of record-keeping should be raised at the next appraisals of the doctors who treated Mr A.

The board has also been told to look at its policy on restraints and communication with family members.

It has also been told to apologise to Mr A’s daughters for the failures identified by the inquiry.