A woman who had previously had cancer died after medics misdiagnosed a recurrence as a common bowel condition.
The patient, who was from the Highlands, had been successfully treated for breast cancer.
When she began suffering abdominal pain, recurrent vomiting and diarrhoea her symptoms "were considered to be related to irritable bowel syndrome", a condition of the digestive system that can cause stomach cramps, bloating, diarrhoea and constipation.
Her symptoms persisted and she was admitted to hospital on numerous occasions but "unusual" bone lesions were not investigated.
A scan later showed a tumour attached to her kidney and she died months later.
A sibling of the patient lodged a complaint with Scottish Public Services Ombudsman, Rosemary Agnew that despite multiple hospital admissions and concerns that the cancer had returned, NHS Highland failed to reasonably respond to her worsening condition and delayed appropriate investigations.
The Ombudsman took independent advice from a consultant colorectal and general surgeon adviser and upheld the complaint.
She said: "We found that, overall, there was a failure to adequately investigate symptoms, take into account patient history, and appropriately manage A's care, including acting on findings of sclerotic bone lesions (an unusual hardening or thickening of your bone) and a failure to consider an overarching diagnosis.
"Whilst the board did carry out a Significant Adverse Event Review (SAER) in relation to A's care and treatment, this failed to identify all of the failings highlighted above."
NHS Highland has been ordered to apologise to the family and ensure that "appropriate and timely investigations" are considered for patients presenting with unexplained abdominal pain, recurrent vomiting and diarrhoea and sclerotic bone lesion should be investigated appropriately.
The inquiry was told that NHS Highland carried out a Significant Adverse Event Review (SAER) following the patient's death but this failed to identify all the failings in her care.
A spokesperson for NHS Highland said: "We fully accept the recommendations made by the SPSO and we have written to the family to express our apologies"
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