9. The law says we cannot investigate a complaint where a person has the option to take legal action, unless we consider this is unreasonable in the circumstances. We have discussed this with Mrs U to understand her circumstances and the outcomes she wants. We do not consider whether legal action would succeed, but whether it would be a reasonable option to look in to.
10. Mrs U says staff promised her mother a dignified death. She also says an end of life care plan was in place, but the Trust did not follow this.
11. Mrs U told us that Mrs R had episodes where she was gasping for breath and in a lot of pain. She said staff decided to fit a syringe driver (a small pump that is used to give medicine like pain relief gradually) to manage her pain better and to prevent these episodes.
12. Mrs U said the Trust held a meeting with the family in mid-October 2022 to discuss Mrs R’s end of life care. Mrs U said a doctor told the family that treating her mother was now ‘not in her best interest and prolonging the inevitable.’ The doctor said they would give Mrs R a bolus (where medication is given within a specific time, usually between every one and 30 minutes, to raise their concentration within the blood) of medication through the syringe driver, because the family did not want Mrs R to have more episodes of gasping for breath or pain.
13. Mrs U said a nurse removed Mrs R’s feeding tube at lunchtime. The nurse turned down the oxygen gradually and then removed Mrs R’s CPAP mask. After this, Mrs U said her mother was in great distress, struggling to breathe and writhing in pain. Mrs U said the doctor did not put the CPAP mask back on.
14. Mrs U said the nurses then tried to give morphine to ease Mrs R’s pain. She said this took a long time and Mrs R was in agony. She says nurses used three doses of morphine.
15. In the last stages of Mrs R’s life, Mrs U says her mother was grimacing in pain, gasping for air and in complete distress. She said this was a very traumatic experience for the whole family.
16. The Trust’s complaint response said, ‘[The matron] explains that due to the high amount of oxygen your mum was receiving the team caring for her anticipated that she would experience some level of breathlessness, and her breathing pattern would change once the oxygen therapy was reduced and stopped. The medical and palliative care team try their best to pre-empt this and the medications your mum was receiving were to try to achieve this. We apologise if this treatment wasn’t effective in reducing these symptoms. As a team we always try and ensure that when a patient is at the end of their life, medication level is appropriate to reduce symptoms as much as possible. The team confirm that nothing went wrong, and we are truly sorry that you felt your mum’s end of life care escalated into a disaster.’
17. Mrs U wants a financial payment and for the Trust to accept failings.
18. There is a clear legal route available which Mrs U could use to try to achieve her outcome of a financial payment. A court is best placed to consider this. A court cannot order the acceptance Mrs U wants that the Trust got things wrong, but this may be achieved as a secondary outcome of successful legal action.
19. We have explained to Mrs U that if solicitors do not accept her case or she has a successful claim but all her outcomes have not been considered, she can return to us. At that stage we would need to consider how far her legal claim had progressed and what, if any, outcomes she had achieved. We would also need to consider our time limit so we advise her to look into legal action without delay and come back to us as soon as possible if needed.
20. We cannot provide legal advice and so cannot say whether the claim will be successful. It is important Mrs U is aware there are time limits for legal claims. We would not want to disadvantage her by continuing to review her complaint when she has the option to take legal action.
21. We are very sorry to hear about the circumstances which led to Mrs U bringing her complaint to us. We understand how important this complaint is to her and how this continues to be a difficult time.