A WOMAN who died from ovarian cancer was let down by delays in diagnosing her condition, a watchdog has found.
NHS Greater Glasgow and Clyde have been ordered to apologise to the family of the patient, known only as Miss A, over failings in her care which included a two-week delay in flagging up cancer detected by a biopsy.
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The Scottish Public Services Ombudsman (SPSO) said there "may have been a lost opportunity to halt the progression of the cancer" as a result of this delay.
A report into the case said Miss A had been urgently referred to the gynaecology service at Glasgow Royal Infirmary (GRI) after developing an abdominal swelling.
Tests showed she had an ovarian cyst and she subsequently underwent surgery to have it removed.
However, the SPSO said there was evidence to indicate that the cyst had burst during the operation but "the records did not contain clear information about this having occurred".
There was also a "failure to accurately report the pathology specimens after the cyst was removed".
The report added: "We considered that, had these been reported in a timely manner, this would have altered Miss A's clinical management and she would not have been discharged from the gynaecology service with no follow-up."
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In addition, there was no record that any questions had been asked - in line with national guidance - to determine Miss A's family history of ovarian or breast cancer.
During the year following her surgery, Miss A visited her GP with various symptoms and eventually ended up in the emergency department at the GRI.
After several attendances at hospital, tests identified that she had advanced cancer. She died a short time later.
However, the SPSO said that biopsies taken during an examination of her rectum and lower colon showed evidence of cancer, but that there had been a two week delay in this being recognised by the clinical team and Miss A being informed of the results.
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The report said: "We concluded that there may have been a lost opportunity to halt the progression of the cancer."
A spokeswoman for NHSGGC said: "We have received the Ombudsman’s report and his recommendations.
"We have already written to the family to reiterate our sincere condolences and to apologise for the clear failings in this patient’s care.
"The recommendations will now be discussed by a multi-disciplinary team to identify how these can be quickly implemented and ensure that lessons learned in this case are shared with appropriate staff."
Meanwhile, a separate investigation into the case of a pupil who suffered memory loss as a result of a playground head injury said the school should liaise with NHS 24 to make sure that staff know what to do and that their guidance on accidents is clear.
The child, who has not been named, hit their hit during playtime at an Edinburgh primary school. The injury left them "confused, distressed, and suffering from loss of memory".
The SPSO said staff should have called for an ambulance immediately, but instead contacted the child's parents which resulted in a "delay of around 45 minutes before they could collect their child and seek medical attention".
The SPSO added that Edinburgh City Council's handling of the parents' complaint had been "unreasonable".
The report said: "A reasonable investigation should have highlighted that the school's failure to arrange direct transport to hospital was in clear contravention of the Accidents to Pupils procedure."
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