Background
A woman who was suffering with heart palpitations was initially diagnosed as having long QT syndrome by a Consultant Cardiologist in Letterkenny General Hospital in June 2007. (Long QT syndrome is a genetic abnormality where the risks are of sudden death from vigorous exercise. The actual diagnosis of the syndrome is considered to be difficult. The most definitive diagnosis is through genetic screening). The woman was told by the Consultant that she should not exercise. She was placed on beta-blockers (medication) and was warned not to stop taking them. The medication caused her to feel tired and dizzy and to notice more chest palpitations. She was very distressed by the diagnosis.
Following further tests in Letterkenny General Hospital in February 2008 the Consultant told her that she did not have the condition. Much to her relief, she was allowed to come off the medication, was told to lose weight and to exercise. A check up was arranged for her with the Consultant in a year’s time. In June 2008 the woman was referred to a Consultant Clinical Geneticist in Dublin for genetic screening which was also recommended for her sister and brother. The results of the genetic screening suggested that she did not have familial long QT syndrome.
However, when the Consultant Cardiologist in Letterkenny received the genetic test results, he wrote to the Consultant Clinical Geneticist, indicating that the woman did have long QT syndrome. He said he was unsure as to whether it was familial or not and recommended that she be left on beta-blockers. This completely contradicted what the Consultant had told the woman previously. When the woman discovered this she was totally confused, upset and fearful that she might die or that her child might have the condition. She wrote to Letterkenny General Hospital in September 2009 seeking an urgent referral for a second medical opinion to another cardiologist in a different hospital.
Rather than arranging the second medical referral, the Patient Liaison Officer simply forwarded the request to the same Cardiologist who had treated the woman. She asked him if he could arrange an appointment with the woman to discuss her diagnosis. The Consultant responded directly to the Patient Liaison Officer, advising her that the woman had long QT syndrome and said that her care had been appropriate. The General Manager of the hospital then wrote to the woman in November 2009, two months after her request for a second opinion, to tell her that the Consultant had confirmed the diagnosis and would meet with her if she wished. The onus was placed on the woman to contact the hospital and her request for a referral to another cardiologist for a second medical opinion was ignored. The General Manager did, however, apologise for any unintentional upset caused to her.
In March 2010, the woman wrote to my Office as she was unhappy with the way her complaint had been handled. She said that she had no option but to arrange a second medical opinion privately (February 2010) which had cost almost €1,000. The results from this second consultation indicated that she did not have the condition. Although she was very relieved, the woman was annoyed that the hospital had not arranged the second opinion for her, given the very serious diagnosis which she had received.
Examination
I pursued this complaint with the HSE in Letterkenny and asked why the woman’s request for a second medical opinion had not been acted upon. I raised my concerns at the way her complaint had been handled and enquired about the delays she experienced in having her complaint dealt with. I also asked the HSE to consider reimbursing the woman for the costs she incurred in securing a second medical opinion. In its response, the HSE said that the Consultant had offered to meet the woman to discuss her diagnosis but that she had not taken up this offer. It apologised that the time frame for replying fell short of HSE stated policy, that is, within 30 days. Following further discussions between my staff and the HSE, arrangements were made for the woman to meet with the hospital’s Clinical Director to discuss the treatment she had received and her concerns.
Outcome
Arising from this meeting, the Clinical Director arranged for the woman to be seen by a Specialist Cardio Electro Physiologist for a further definitive medical review. The cost of this medical review was covered by the HSE. The outcome was that the woman did not have long QT syndrome. At my request, the HSE also agreed to reimburse the woman for the costs of the second medical opinion.
This complaint highlights the need for public bodies to have a complaints system in place which engages with, and is responsive to, complainants and which deals with complaints in a fair and timely manner. The seeking of second medical opinions is an issue which has arisen in other hospital complaints dealt with by my Office in 2012. According to the HSE’s Patient Safety First document ‘You and Your Health Service’, patients can seek a second opinion at any time during their care. Guidelines for such referrals are also laid down by the Irish Medical Council in its “Guide to Professional Conduct and Ethics for Registered Medical Practitioners”.