Discharge
13. Mr A complains the Trust discharged him inappropriately from A&E on 9 and 16 March 2021. He says the Trust missed an opportunity to diagnose his heart failure.
14. In the Trust’s response dated 17 September, it said on Mr A’s first attendance he presented with abdominal pain and an inguinal hernia (a hernia in the groin). The surgical registrar felt the hernia was reducible (when the lump can be pushed back through the layers of the abdominal wall) and his condition was not considered an emergency.
15. On the second attendance, Mr A again presented with abdominal pain and difficulty opening his bladder and bowels due to the size of the hernia. The surgical registrar who reviewed him recommended outpatient follow-up.
16. We have reviewed the records for Mr A’s attendance on 9 March 2021.
17. The records show that Mr A attended the A&E department on 9 March at 4.03pm. He complained of left-sided groin pain. He said his hernia had become more painful, he had abdominal bloating and his abdomen was twice its normal size.
18. The records show an examination took place that included a relevant past medical history, current medication, listening to his chest, blood pressure reading, pulse reading, and assessment of his breathing rate and temperature.
19. A diagnosis was made of incarcerated inguinal hernia (a hernia that becomes stuck in the groin or scrotum and cannot be massaged back into the abdomen).
20. Mr A was referred to a surgical registrar who recommended an outpatient follow-up. Mr A was put on a waiting list for a hernia operation and discharged from the Trust.
21. GMC good medical practice guidance says:
‘Apply knowledge and experience to practice You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must: • adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient • promptly provide or arrange suitable advice, investigations or treatment where necessary • refer a patient to another practitioner when this serves the patient’s needs.’
22. The records show the Trust assessed Mr A’s history. The doctor completed suitable investigations to better understand Mr A’s condition. The doctor made a referral to a surgical registrar. These actions are in line with GMC guidance.
23. Our adviser explains the doctor used their judgement to make a diagnosis, in this case, as Mr A presented with abdominal pain and a hernia, a complication of his hernia. The A&E doctor’s primary objective is to identify and manage emergency problems, of which an irreducible or strangulated hernia is one.
24. Common symptoms of heart failure include shortness of breath with activity or when lying down, fatigue and weakness, swelling in the legs, ankles and feet, and rapid or irregular heartbeat. Mr A did not present with these symptoms at A&E, and his blood pressure, pulse reading and breathing rate were all taken and showed no signs for concern.
25. We accept this was a distressing time for Mr A, as he was concerned about the pain he was experiencing. We have seen the Trust acted in line with GMC guidance. The records and clinical advice given to Mr A persuade us that there is no evidence that the Trust missed an opportunity to diagnose Mr A with heart failure and admit him to the Trust. We see no sign of a failing.
26. We have reviewed the records for 16 March.
27. The records show that Mr A complained of pain in his left groin, including swelling over more than four weeks, on 16 March at 2.39pm. Mr A also had difficulty passing urine.
28. The records show an examination took place that included a relevant past medical history, current medication and a general physical examination. A referral was made and Mr A was seen by a surgical registrar. Mr A was to book a surgical operation appointment through his GP, as there was no immediate surgery repair needed for his hernia. Mr A was discharged.
29. We have seen the actions of the Trust on 16 March were in line with GMC guidance. The Trust assessed Mr A, arranged investigations and he was referred to another practitioner as this served his need.
30. Our adviser explains Mr A presented with abdominal pain and was diagnosed as having a possible incarcerated hernia. It was an understandable working diagnosis, given Mr A’s presentation, and appropriate to then refer him to the on-call surgical registrar.
31. One month later, Mr A attended the Trust and was diagnosed with a cardiac failure. This was a worrying time for Mr A and understandable that he would have questions about his previous contact with the Trust. We have seen that the actions of the Trust on both 9 March and 16 March are in line with GMC guidance. We see no signs of a failing.
Complaint handling
32. Mr A complains the Trust mishandled his complaint. Mr A was frustrated by the time it took the Trust to deal with his complaint.
33. We have reviewed the local resolution process between Mr A and the Trust.
34. On 16 May 2021, Mr A first complained to the Trust. On 16 June, the Trust spoke with Mr A’s partner. The Trust acknowledged his complaint for the first time.
35. We have reviewed the Trust’s Complaints and Concerns Policy:
‘Complaint is acknowledged via letter to the complainant by the PESO within three working days of receipt.’
36. We have not seen evidence that Mr A’s complaint was acknowledged within three working days of receipt.
37. On 16 June, the Trust provided a timescale to Mr A and said it would respond to the complaint in the week commencing 19 July.
38. Our principles of good complaint handling say customer-focused public bodies should do the following:
‘Acknowledge the complaint and tell the complainant how long they can expect to wait to receive a reply. Public bodies should keep the complainant regularly informed about progress and the reasons for any delays, and provide a point of contact throughout the course of the complaint.’
39. We can see the Trust’s actions are in line with our principles. The Trust provided Mr A with a timescale of when he could expect a response.
40. On 23 July, the Trust informed Mr A his complaint response would be delayed and provided a date of week commencing 23 August.
41. On 26 August, the Trust informed Mr A there was one question that remained outstanding. The Trust advised it hoped for a response to be available week commencing 6 September. The Trust provided a response to Mr A’s complaint on 17 September 2021.
42. The Trust’s policy states:
‘A “standard” complaint will usually require a 30 day working day investigation timescale.’
43. From the evidence we have seen, the Trust took four months to respond to Mr A’s complaint. This is not in keeping with the Trust’s policy. The Trust should have responded within 30 days. We recognise the Trust did keep Mr A updated. We have reviewed if the Trust took any action to put this injustice right.
44. We understand Mr A was frustrated by the time the Trust took to handle his complaint. We have seen evidence the Trust sincerely apologised for the delay in its letter dated 17 September. This is appropriate action and in line with our principles that mistakes should be accepted and apologies given where appropriate. We will therefore not take any further action on this complaint point.
45. We have continued to review the complaint-handling process.
46. On 18 October, Mr A requested a meeting with the Trust. On 20 October, the Trust acknowledged Mr A’s request and asked for more information. Mr A responded the same day. On 26 October, the Trust informed Mr A that it was checking availability of staff and would be in touch to confirm dates.
47. On 22 November, the Trust updated Mr A. It was still co-ordinating dates with staff and would be in touch to confirm a date. On 14 December, the Trust apologised for the delay and provided a further update.
48. The Trust’s policy on complaint handling does not state how long it should take to handle a complaint. In line with our principles, the Trust has kept Mr A up to date with how long he can expect to wait.
49. On 5 January 2022, the Trust contacted Mr A asking if he could attend a meeting online using Microsoft Teams. That same day, Mr A advised he wished to wait for a face-to-face meeting.
50. On 12 January, Mr A contacted the Trust and agreed to a Microsoft Teams meeting. On 26 January, the Trust confirmed a date of 1 February.
51. The Trust’s handling of Mr A’s complaint after his request for a meeting is in line with our principles. We can see Mr A was kept up to date and the Trust repeated its apology on 22 November.
52. In line with our principles, Mr A was regularly contacted with updates between 18 October and 1 February. We understand this was a frustrating period for Mr A, as he sought a resolution to his complaint. We have not seen any sign of a failing following the Trust’s apology on 17 September and will be taking no further action.
53. We thank Mr A for bringing his complaint to us.