HOSPITAL staff decided a man found at the bottom of a flight of stairs with a suspected head injury was probably drunk and failed to carry out a scan – but he was later found to have suffered a brain haemorrhage and needed emergency surgery.
An ombudsman’s report said an ambulance had been called to attend to the man, known only as Mr A, after he had attended a wine-tasting event.
He was said to have been “combative and uncooperative” with the ambulance crew but although he had been drinking during the afternoon a friend told them he was not drunk before the fall.
Mr A was taken to A&E at Edinburgh Royal Infirmary and kept in overnight. The ombudsman’s report said: “He was assessed as having a reduced level of consciousness but this was attributed to intoxication. It was therefore decided that he would be observed in A&E overnight to ensure his symptoms improved.”
When his mother went to collect him from the hospital she found him “confused and disorientated” but staff assured her he was medically fit to leave.
However, she remained concerned about his condition and went with him to A&E at Wishaw General Hospital, where a CT scan was carried out. This showed Mr A had suffered a brain haemorrhage, and he was transferred to the Southern General Hospital for emergency surgery.
Mr A’s sister, referred to as Mrs C, complained the ERI had failed to give him appropriate treatment for his head injury.
The ombudsman said Mr A should have received a CT scan on admission to the ERI, based on his recorded symptoms, and that it was “not reasonable” to attribute those symptoms to intoxication in the circumstances.
The ombudsman said NHS Lothian should apologise for the failings, review their procedure for management of patients with a head injury, carry out an audit of a sample of recent cases to ensure they are being dealt with appropriately; and identify why the medical and nursing staff on duty did not follow the systems in place.
Dr David Farquharson, medical director, NHS Lothian, said: “I would like to take this opportunity to publicly apologise to Mr A and Mrs C for the failings in this case and for the distress this has caused them.
“We accept the Ombudsman recommendations in full and have a thorough action plan in place to address all of the issues highlighted.
“As part of our action plan our teams are in the process of revising our clinical protocols and are updating our staff training.
“NHS Lothian takes all complaints very seriously and has learned lessons from the findings in this report.”