Nottingham University Hospitals NHS Trust

3. Mrs B complains about the care and treatment she received from the Trust during her admission from 27 to 30 June 2021, when her gastric band was too tight:

• the staff could not loosen her gastric band and did not move her to another hospital who could. She says she had no choice but to discharge herself while still unwell and to be treated at the private clinic where the band was fitted • she returned to the Trust after having her gastric band loosened at the private clinic, and the Trust told her was not a patient and she needed to go to the Emergency Department (ED).

4. Mrs B says she was left in pain as Trust staff could not deflate her band and this has affected her mental health. She feels traumatised by this and being away from her family left her feeling alone and vulnerable.

5. She feels she cannot trust staff at the Trust and she cannot return to the gastrointestinal (GI) ward (that deals with problems with the digestive system) in future.

6. Mrs B wants an apology, service improvements and financial compensation.

7. On 22 June 2021, Mrs B had her gastric band inflated at a private clinic. On 23 June she started vomiting blood. The earliest the private clinic could see her was 29 June.

8. On 27 June, Mrs B was taken to hospital by ambulance. She had non-diabetic hypoglycaemia, which is low blood sugar caused by being not able to eat and drink. She was admitted and given fluids intravenously (IV – through the veins) between 27 and 30 June.

9. The Trust could not deflate the band, and Mrs B was not well enough to be discharged because of her hypoglycaemia. On 29 June the Trust called a private surgeon to ask them to come to the Trust to deflate it. This was not possible.

10. An X-ray on 29 June showed the band had not slipped and needed deflating. The Trust’s GI surgeons could not do the procedure. The Trust made a plan to transfer Mrs B to another hospital), but the doctors said she was not medically fit to be moved.

11. On 29 June, a Trust GI specialist who had deflated a band before tried but could not deflate Mrs B’s band.

12. On 30 June, the Trust said Mrs B could leave and go to the private clinic. Mrs B became hypoglycaemic again, so the Trust would not discharge her. She discharged herself and went to the private clinic.

13. Mrs B went back to the Trust the same day and was told she had to go back to ED as she was no longer a patient. She says she went to ED, but it was busy and she felt unwell so she went home.

The Trust could not deflate the band, did not transfer Mrs B and refused to discharge her

17. Our adviser said there are no specific guidelines for Mrs B’s circumstances. The relevant guidance is general clinical care standards from the GMC guidelines ‘Good Medical Practice’.

18. The GMC guidelines say doctors should assess the patient and examine them where necessary. They should quickly give or arrange for advice, investigations and/or treatment. They should refer the patient to another practitioner where this is the best thing. It also says doctors should recognise and work within the limits of their competence.

19. We looked at what the Trust did to see if this was in line with the GMC guidance or if there was anything different it should have done.

20. The records show when Mrs B was admitted to the Trust she needed her gastric band deflating and the Trust could not do this. The doctors knew this was not something they could do competently. This is in line with the GMC guidance.

21. The records show it treated her hypoglycaemia with IV fluids, in line with the GMC guidance. It also thought about how to solve the problem with the gastric band.

22. When the private surgeon could not come to the Trust to deflate the band, the Trust made a plan to move Mrs B to another hospital, where the doctors were able to do this. It decided this was not safe because of her hypoglycaemia. Our adviser said it was the right thing to keep Mrs B at the Trust.

23. The Trust acted in line with the GMC guidance, because it saw that sending Mrs B to another doctor was needed to solve the problem with her gastric band. But, it was not safe to move her.

24. A Trust GI specialist at the Trust offered to try to deflate the band on 29 June. It was right for them to try to treat Mrs B, but this did not work.

25. This was a difficult situation for the Trust to manage. Mrs B’s vomiting and hypoglycaemia were because her gastric band was too tight. But, the Trust could not fix that and the hypoglycaemia meant she was not well enough to be safely moved to a hospital that could help.

26. We understand how distressing this was for Mrs B. We can see why she felt she had to discharge herself, and we thought about if the Trust could have done anything more. We do not think it could. It had to balance the risk of moving her somewhere else with getting the treatment she needed. We cannot see any signs the Trust did anything wrong.

Refusal to treat when Mrs B returned to ward

27. Our ‘Principles of Good Administration’ say an organisation should make sure any advice it gives is clear and accurate.

28. Mrs B went back to the ward after the private clinic deflated her band on 30 June. She says the private clinic told her to go back to look into why she could not eat and because she had ‘blacked out’. She says ward staff told her she was not a patient and she needed to go to the ED. She says she had been told she could return to the ward if she needed to. In her complaint letter to the Trust, she reported that a nurse said she could go to the ED if she felt unwell, but also said ‘don’t worry you can come straight here’.

29. Mrs B said she would not sign the papers to discharge herself because she did not want to go back to ED if she needed more treatment. She also did not have her cannula removed before she left.

30. The medical record entries on 30 June say staff repeatedly told Mrs B she would have to go to the ED to be readmitted.

31. We accept what Mrs B said about a nurse telling her she could return to the ward, but we cannot find evidence of what this. It is clear from the records that staff told Mrs B she would need to go back to the ED. Mrs B’s complaint to the Trust shows she understood this. It looks like she may have refused to sign the discharge paperwork so she did not have to go to the ED. Mrs B discharged herself, so the Trust was no longer treating her.

32. We know Mrs B wanted to be able to go back to the ward. In line with our Principles, the records show the Trust gave her clear and accurate information about what she would need to do. We can see no signs that the Trust did anything wrong when it told Mrs B she would need to go to the ED if she needed to return.

1. The Parliamentary and Health Service Ombudsman has carefully considered Mrs B’s complaint about Nottingham University Hospitals NHS Trust (the Trust). We are very sorry to hear about what happened and the effect this has had on Mrs B.

2. We can find no sign that anything went wrong with the care and treatment the Trust gave to Mrs B and we will not be investigating the complaint further.