The visit to the accident and emergency department by the woman, known as Mrs A, is recounted by the Scottish Public Services Ombudsman which investigated and has now upheld complaints over the care she received. In a report published last week, the watchdog recalls how Mrs A, after falling at home, was admitted to A&E where it was discovered she had fractured a bone in her arm.

Although discharged home the same day, she returned to the hospital “in significant pain” just 24 hours later.

“Further tests showed she had fractured her kneecap and had bone cancer,” states the SPSO.

“We took independent medical advice from a consultant in emergency medicine who considered Mrs A did not receive a reasonable standard of treatment when she initially attended A & E.

“There was insufficient evidence to show the emergency doctor had carried out a thorough examination of her joints below the arm fracture or her lower limbs, despite ambulance staff having documented bruising to her right knee.

“We also took independent medical advice from an orthopaedic consultant who considered the one-day delay in indentifying the fractured kneecap was unlikely to have impacted on Mrs A’s overall outcome.

“However, we also found that her significant pain level was not reassessed prior to her being sent home. Had it remained high, she may have required intravenous morphine and admission to hospital.

“There was also no evidence to show any assessment had been carried out of how she might manage at home and who was able to care for her, if required.” The SPSO also investigated a complaint about an eight-week delay in Mrs A being referred to the orthopaedic clinic and for physiotherapy.

“Given that she was to be reviewed within three weeks, we found the delay in this case to be unreasonable,” says the watchdog.

“We upheld all the complaints although we noted that the board [NHS Borders] had apologised to Mrs A that the pain relief they gave her was inadequate and acknowledged that a mistake had been made in her not being referred to the orthopaedic clinic and physiotherapy for further review.

“They [the health board] also arranged for the hospital’s discharge procedure to be reviewed, with a view to making improvements in order the prevent the matter re-occuring.” Notwithstanding these actions, the watchdog has recommended that NHS Borders ensures the emergency doctor who dealt with Mrs A “reflects on the failings and confirms when this has been done.” A spokesperson for NHS Borders told the Border Telegraph: “NHS Borders accepts and has completed the recommendations in the SPSO report and the patient has been given a full apology.

“We have reassured the Ombudsman’s office that we fully recognise and regret the aspects of the patient’s treatment which did not meet expected standards and will take what has been learned from this experience to improve our service in the future.”