Communication about Mr C’s condition and deteriorating health
15. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that something went seriously wrong in the Trust’s communication with Mrs C.
16. The GMC guidance says, ‘you must be considerate to those close to the patient and be sensitive and responsive in giving them information and support’.
17. Our adviser said the duty of doctors is to update the patient and they often rely on the patient to update family members. But they advised if something serious or unexpected happens, doctors should ideally speak to the patient’s next of kin (with consent from the patient).
18. We can see that Mr C was able to communicate with Mrs C directly by phone during his stay in hospital, and she was also able to come in and visit him for most of his stay.
19. Our adviser said the medical records also suggest there was regular communication from doctors with Mrs C. They said those caring for Mr C seem to have communicated with Mrs C regularly and at the correct times.
20. When Mr C deteriorated at first on 14 May, a doctor documented a discussion with Mrs C in the medical records. The doctor advised Mrs C that they were having to give Mr C maximum oxygen. The doctor advised at this time that Mr C may not survive. They also discussed a ‘do not attempt resuscitation’ order. Our adviser said from the notes this seemed to have been a very detailed, clear discussion.
21. The Trust then offered to update the family on 16 May, but Mr C said he would rather speak to his family member when they came to hospital. There were further documented updates on 19, 27 and 28 May - all when Mrs C was on the ward.
22. We recognise that Mrs C says the Trust did not tell her about some of her husband’s conditions, including that he had jaundice and fluid on his lungs.
23. In the medical records on 12 May, a doctor noted that they had ‘explained condition including pleural effusion’ and on 14 May a doctor noted ‘explained fluid on lungs’. It was also mentioned on 28 May when Mrs C was on the ward.
24. We cannot comment on the quality of these conversations. But it seems that attempts were made to tell Mrs C about her husband’s fluid overload at different stages in line with the GMC guidance.
25. We can see no specific reference in the medical records to doctors telling Mrs C that Mr C had jaundice. But we can see that Mr C had different issues during this admission. We do not think the lack of documentation around this suggests a failing.
26. At 1.15pm on 29 May, a doctor saw Mr C when Mrs C was there. The doctor documented that Mrs C understood Mr C was still very unwell and that they needed to take things one day at a time.
27. Later that day at 7pm, a doctor reviewed Mr C again and noted that he was in distress and agitated. They noted, ‘I think this man is dying’. They documented that they had spoken to Mrs C and made her aware that Mr C was terminally ill. They noted they would contact her again if Mr C deteriorated more.
28. On the morning of 30 May, there is a note to say a doctor reviewed Mr C who seemed more alert. They documented that Mrs C and Mr C’s sister were there and that they had no questions.
29. At the beginning of June, a doctor reviewed Mr C and again noted that they thought Mr C was dying. They noted that they discussed this with his sister, but they also noted that she was not his next of kin.
30. Ideally, the doctor should have contacted Mrs C at this time and had a discussion with her as well. We can see the Trust has accepted in its complaint response that it should have contacted Mrs C sooner and it apologised for this.
31. It seems that although the doctor had felt Mr C was dying, they did not withdraw treatment at this point. It does not seem they felt his death was imminent (or they likely would have contacted Mrs C and asked her to visit straight away).
32. The next morning, a doctor noted that Mr C was approaching the end stages of his life. They noted they had told Mrs C and she was going to visit that morning. This means there was a missed opportunity to update Mrs C the evening before but Mrs C was told the next morning. We do not feel this suggests a failing in communication.
33. Later that day (there is no time recorded next to this entry), a doctor noted the decision to withdraw treatment and focus on keeping Mr C comfortable. They documented that they had discussed this with Mrs C and Mr C’s two sisters who agreed with this approach.
34. We can see that, up to this time, the Trust was actively treating Mr C. We can see evidence of various conversations between doctors and Mrs C.
35. Although an opportunity was missed to update Mrs C at one time, there is evidence to show they told Mrs C about this the next morning when Mr C’s condition worsened. They also involved Mrs C in discussions around the decision to withdraw treatment.
36. Overall, we have found the communication was in line with the GMC guidance. We do understand that this was an extremely difficult and upsetting time for Mrs C.
COVID-19 diagnosis and ward move
37. Mrs C says the Trust did not tell her about her husband’s COVID-19 diagnosis and that he had been moved to a COVID-19 ward.
38. Mr C had a COVID-19 test on 12 May. But the first mention of him having COVID-19 in the medical records is on 14 May at 11.45am where a doctor noted ‘COVID?’.
39. At 5.20pm, a medical registrar reviewed Mr C and noted that he was transferred as he was COVID-19 positive and needed oxygen. The registrar also noted that the family needed updating but they needed to see another patient so would return.
40. At 8.10pm there is a note to say the same registrar returned. They noted they had tried to call Mrs C three times to update her on her husband’s deterioration but there had been no answer and they had left a message.
41. At 9pm there is a note to say the registrar spoke to Mrs C on her mobile and explained about his liver failure, fluid on his lungs, possible heart failure and his COVID-19 infection. From what Mrs C told us, by this time she already knew Mr C had COVID-19 and had been moved because she had received a phone call from her husband earlier in the day.
42. We do not think it was a failing that Mrs C heard this from her husband before the doctors had the chance to update her. This is because it is not uncommon for patients to update their family members themselves. It also seems the doctors were intending to update Mrs C and later did so, in line with GMC guidance.
43. Because there was not a big delay in Mrs C becoming aware of the COVID-19 diagnosis or the ward move, we cannot see that enough went wrong to amount to a failing in communication. Again, this does not take away from how distressing this diagnosis must have been to Mrs C at the time.