To complain to hospital or when to complain

[Luckymummy22]

Basically my 5 year old has just had surgery because they missed an elbow dislocation when she broke her arm.

It was only picked up after 4 weeks when her cast came off.

Because it was missed the surgery was more complex that it needed to be and there is a chance she will not get full use of her elbow back (hopefully that will not be the case). She may also be more at risk of dislocating her elbow now.

We have subsequently been told that the dislocation was visible on her 1st X-ray.

We are going to complain just wondering when best to do it and in what way should we approach it?

Go in all guns blazing, or make inquiries initially as to how this hs happened?

Obviously our main aim is to ensure that the hospital are aware of this failure and put steps in place to reduce the chance of it happening to another child.

Should we wait until all her treatment is completed before complaining? We don't want to negatively impact how she is treated from now on (although could it get worse?)

We are now actually under the care of another consultant within the hospital as he was her surgeon and specialises in upper limbs.

Her initial consultant was the one we saw when the dislocation was discovered although we had only seen Drs under him previously.

I work in A&E as an Emergency Nurse Practitioner, so seeing adults and children when they first come in with injuries like this. We judge who needs an X-ray and then review it deciding on further treatment.

We r/v maybe 20 X-rays a shift and even after years of working like this, we still miss the very occasional fracture on X-ray. There is a safety net of a senior Radiologist or reporting radiographer R/V all the x-rays daily and report back if we have missed anything. Step one for you would be to find out why this safety net (even if you saw a Dr first) didn't work for you.

If your child was in a cast for 4 weeks they should have been see in a fracture clinic after the initial cast was put on. In the Fracture clinic they should have looked at the original x-ray/maybe done another and changed the cast from a plaster of paris cast to a fibreglass one. If you didn't get a fracture clinic apt for 4 weeks that is ridiculous.

I presume they missed that the fracture was dislocated, ie. it was worse than they thought. At your next apt. I would ask

1. Why was the fracture missed and who r/v'd the x-ray initially?
2. Why did no senior radiologist r/v the x-ray within 48hrs?
3. What it says on the initial x-ray report? i.e. was it the radiologist that missed it. - If this is the case then it was very probably extremely difficult to see.
4. Ask if an IR1 form has been done for the error (this is a form within the NHS that allows a root cause analysis to take place by a senior team so they can find out what went wrong.) - You as a patient/mum can do one as well legally you just need access to their computer systems.

If it were me I would talk it all through with the new consultant and see if you are happy with his explanation as he maybe able to explain the point at which things went wrong. Not all practitioners/Drs/Radiologists are perfect all the time but the system should be as such that errors get picked up.

If you are still unhappy go to PALs at the hospital and they can help you make a complaint.

I hope yr DD makes a full recovery. Sorry this happened!

Thanks for this. She was xrayed the day it happened. It was difficult for them to get the X-rays but they eventually managed it.
We didn't see a Dr in A&E. we saw a nurse practitioner and then the plaster nurse who put a temporary cast on.
We were then sent to the Fracture clinic the next day.
It was xrayed again in the cast. We saw a Dr who said there was no displacement. I'm not sure if he was referring to the ulna bone which had been fractured or the radial head.

A hardcast was put on.
She then went back 2 weeks later and was xrayed again. Was told everything was healing well by a different Dr.
Returned 2 weeks later and saw the consultant who said she may need an operation as elbow looked as if it was dislocated. He said it had moved in the last 2 weeks and was only now visible.
Returned on the Monday and saw a different Dr who said it was visible on the 1st X-ray.
Surgeon also said it had been missed and that they didn't miss many.

We are back this week so will ask further questions.

Can we ask for the notes and copies of X-rays?

Generally speaking with complaints, the thing to thing about is what you want.

If you go in all guns blazing wanting blood you are likely to find the whole thing highly disappointing.

If you go it wanting to know what happened and asking for things to be reviewed and processes put in place so this can't happen to someone else, it can be a much more rewarding process as may get to see a change happen that will benefit others.

Someone made a complaint about my department once - it was about something I'd been banging on about for years. The complaint got me senior management interest and finally got some money spent on the problem when my funding requests had been turned down repeatedly before. That complaint was the best thing that happened to us as I'd never have got the change I wanted without it.

However the complainent approached it in a 'wanting this not to happen to other people way' - if it had entirely been about just their complaint, the change wouldn't have happened.

With the best will,in the world some fractures and dislocations will,be missed. It's a known complication and whilst unfortunate it happened to your child, itbreally is just bad luck. Complain via PALS but there is no system on earth that completely negates human error. It's made worse when because they are a child wriggling and scared, they move around and make it hard to get the X-ray.
What good would 'all guns blazing' do anyone?

You can ask for your notes but you have to apply for them through the secretaries, there is no point having the x-rays as you can just get the reports. You don't need notes or x-rays to make a complaint. You have seen a lot of professionals and are having the necessary treatment. If you are going for a medical negligence claim then I'm not sure you have a case as if you saw 3 professionals who all thought it wasn't dislocated before you saw an expert who saw something the others didn't (thats what the consultants are therefore) and it also sounds like there will be no harm in the long run.

there for*

The type of fall she had (falling from beam with hand outstretched), her age, breaking the ulna bone (clean through) all mean that it was important to check the radial head had not dislocated. It was a Monteggia fracture which can be easily missed.
My main gripe is that they should have been checking more thoroughly for this type of fracture because whilst uncommon it is common for the radial head to dislocated with the force needed to break the ulna.

I know there are tolerances and she may have been on the edge of those tolerances but perhaps xraying her good arm would have highlighted that it was displaced or even getting a consultant to sign it off (I don't know if this happened).

We will make a complaint and see where we get. Even saving 1 child from having months in cast unnecessarily is worth it