NHS Lanarkshire has been ordered to apologise to the family of a cancer patient who died three weeks after being diagnosed.
The Scottish Public Services Ombudsman (SPSO) found there were “missed opportunities” to carry out vital tests at University Hospital Monklands in Airdrie.
The patient had been ill for around five months, with multiple hospital attendances and admissions, as his loved ones battled for answers.
But doctors failed to test fluid around their lungs until eight weeks later, an investigation has found.
When the results came back as inconclusive, staff should have carried out a biopsy, however this was not done.
A scan of their abdomen revealed more fluid, which also should have been tested, but this test was also not carried out.
A keyhole biopsy into their pleural space - chest cavity - was eventually performed 14 weeks later with the results showing the patient had a rare form of cancer.
NHS Lanarkshire have been told to apologise to the person’s family and to adhere to national guidelines on managing pleural disease.
The SPSO said: “We found that A's case was complex and unusual and that it was reasonable to consider other diagnoses more likely than cancer, and to treat these accordingly while investigations continued.
“However, we found that reasonable action was not taken to manage the pleural effusions (fluid around the lung) that A initially presented with.
“Guidelines indicate that a fluid aspiration (removal of a small amount of fluid for testing) should have been arranged to rule out infection in the pleural space (cavity between lungs and chest wall).
“This was not arranged until almost eight weeks later. When this was done and the result was inconclusive, guidelines recommended that a biopsy be carried out and this wasn't done either.
“In addition, an ultrasound scan the following day reported ascites (fluid within the abdomen), and again a fluid aspiration was indicated but wasn't carried out.
“A biopsy via thoracoscopy (keyhole camera into the pleural space) was not carried out until a further 14 weeks later. A's cancer was diagnosed thereafter.
“We found that there were earlier indications for a thoracoscopy and missed opportunities to diagnose A's cancer from the time of their initial presentation.
“While we acknowledged that an earlier diagnosis was unlikely to have altered A's prognosis, we noted it would have enabled palliative care to commence and allowed the family time to prepare and make the most of the time they had left together.
“We upheld this complaint.”
NHS Lanarkshire have been contacted for comment.
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