Doctors had no record of urgent scan results
Date published: 31 July 2014
DOCTORS at the Royal Oldham Hospital missed the opportunity to consider treatment for an Oldham woman who later died because staff did not follow protocol, an inquest heard.
Ann Taylor (53), who had severe learning difficulties and a number of long-term health problems, had a CT scan at the hospital on February 7 after being admitted six days earlier with respiratory problems.
The findings of that scan were sent to Dr Joshi, a specialist radiologist at North Manchester General Hospital, who ruled that a large blood clot may have been blocking two arteries, Heywood Coroner’s Court was told yesterday.
Dr Joshi faxed over the results to the Royal Oldham and advised an urgent clinical evaluation.
However, staff at Oldham had no record of receiving the information and Dr Joshi did not speak to anyone at the hospital directly — against Pennine Acute Trust protocol.
Miss Taylor was discharged on February 11 without anyone at the Royal Oldham Hospital seeing the scan results — even though they were marked “urgent”.
Only five days after returning to Treetops nursing home on Carthage Street, Oldham, Miss Taylor was rushed back to the Royal Oldham Hospital after being found unresponsive by nursing home staff and later died.
A post-mortem conducted by pathologist Dr Alan Padwell revealed Miss Taylor had died from a large blood clot which completely blocked one of two arteries with the other being completely clear — contradicting the scan.
Doctors at the Royal Oldham only found the scan results when Miss Taylor was admitted on the 15th but said they would not have treated her any differently had they known earlier.
Following Miss Taylor’s death, an internal investigation was carried out by the Royal Oldham Hospital.
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