By Craig Smith

HEALTH CHIEFS have pledged to improve the training of accident and emergency staff at a Fife hospital after the tragic death of a young woman almost two-and-a-half years ago.

Following a complaint by her father, a report by the Scottish Public Services Ombudsman (SPSO) has concluded the out-of-hours service and A&E at Victoria Hospital, Kirkcaldy, did not properly diagnose and treat the illness that led to the 21-year-old’s death on August 9, 2005.

The woman, referred to as Ms A in the report, had attended A&E on July 22 and the out-of- hours service based at A&E on July 23 complaining of severe pain in her head and neck and blurring in her right eye.

Medical staff diagnosed a migraine on both occasions after tests and X-rays were done and she was given painkillers and a sedative to help her sleep.

However, on August 7 Ms A —who had continued to suffer discomfort in her head and neck and had also attended her GP practice three times since her hospital visit—suddenly became severely unwell and was taken to A&E by ambulance.

A CT scan showed Ms A had suffered a large brain haemorrhage and she was transferred to intensive care where her condition deteriorated and she died.

Although the SPSO noted that A&E and intensive care staff dealt with the woman and her family in a “reasonable” manner, the report found failings with aspects of her treatment and upheld the family’s complaint.

“This was, and for the family still is, a tragic case,” the ombudsman said.

“It is clear the history and examination of Ms A in A&E on July 22 was not adequate and missed the differential diagnosis of subarachnoid haemorrhage.

“It is also clear the history and examination, and record-keeping, by the out-of-hours service on July 23 was also not adequate and missed the differential diagnosis of subarachnoid haemorrhage.”

The SPSO initially received a complaint from the woman’s uncle, but the matter was later pursued by her father —referred to as Mr C in the report—who claimed that out-of-hours and A&E staff did not properly diagnose and care for his daughter’s illness.

In its report, the SPSO recommends that Fife NHS Board apologise to the woman’s father for the failure of medical staff to diagnose the condition and ensure that out-of-hours records are in line with relevant record-keeping standards—for example as laid down by the General Medical Council.

The board has also been asked to review its locally-agreed process for the admission, observation and investigation of patients with acute headache in A&E, including ensuring the teaching and guidance given to A&E junior doctors is based on current research.

An NHS Fife spokesperson said the authority accepted all the recommendations made and had carried out procedural changes to address them.

“We take the recommendations very seriously and have taken steps to improve the in-service training of A&E staff and the documentation of the out-of-hours staff,” the spokesperson said.

The report also revealed that after the two hospital visits on July 22 and 23, Ms A visited her GP practice on July 25 where a GP diagnosed a tension headache and prescribed alternative painkillers.

She returned to the practice, not identified in the report, with her father on July 26 and another GP diagnosed a muscle tension headache and prescribed betablockers and diazepam.

The same GP asked her to return as a follow-up, which she did on August 2, when the GP noted her symptoms had appeared to improve so he stopped the betablockers and diazepam and changed her painkillers.

Five days later, the woman collapsed and went into a fit at her fiance’s home. She was taken to the intensive unit and was pronounced dead on August 9.

Although a similar complaint against the GP practice involved was not upheld by the SPSO, the watchdog recommended that the practice should review its threshold for considering whether or not a patient might have a brain haemorrhage and whether or not early scans would be beneficial.

It also suggested the practice should consider recording patients’ actual blood pressure when a check is made.