13. Before we decide if we should formally investigate a complaint, we look at whether there are signs the organisation has done something wrong. We do this by comparing what should have happened with what did happen.. We have not found signs that anything went wrong in this case.
14. Ms A says the Trust stopped active treatment for Mr I and when her mother questioned the doctors about this, they were told the treatment was stopped because of a phone call with Ms A where she agreed to this plan.
15. Ms A says the family were confused and distressed because treatment had been stopped after a misunderstanding in a phone call.
16. Our adviser looked at Mr I’s medical notes. They said the term ‘active treatment’ does not have a set definition. but it includes treatment like antibiotics. Being given oxygen would also be seen as receiving active treatment, which Mr I had.
17. Our adviser told us the doctor’s decision to continue antibiotics until Mr I’s cannula stopped working but then not re-cannulate (put in a new one), was in line with the GMC standard, ‘Treatment and care towards the end of life: good practice in decision making’.
18. This says, ‘the benefits of a treatment that may prolong life, improve a patient’s condition or manage their symptoms must be weighed against the burdens and risks for that patient, before you can reach a view about whether it could be in their interests. For example, it may not be in a patient’s interests to provide potentially life prolonging but burdensome treatment in the last days of their life when the focus of care is changing from active treatment to managing the patient’s symptoms and keeping them comfortable’.
19. Our adviser said Mr I was coming to the end of his life and re-siting a cannula (putting a new one in) to continue antibiotics would be a difficult treatment. They said the plan to not re-cannulate when it stopped working was correct and in line with the guidance.
20. Our adviser looked at the notes from the phone call with Ms A and said the record of this conversation was clear and in line with GMC’s Good medical practice on ‘Recording your work clearly, accurately and legibly’.
21. The notes say Ms A was told that Mr I had deteriorated and his oxygen saturation levels had dropped, despite being on the highest amount of oxygen. It also states IV antibiotics would continue until the cannula stopped working, but they would not re-cannulate to avoid unnecessary distress to Mr I.
22. We do not know what was said for certain during this phone call, but the notes are clear. We think the decision not to re-cannulate and continue IV antibiotics was in line with relevant standards and guidelines and was also made in the best interests of Mr I. This decision was not made based only on the phone call with Ms A.
23. After speaking to our adviser, we cannot see anything wrong with the Trust’s actions.
24. Ms A says the family were distressed when Mr I was no longer receiving active treatment. She said the effect of stopping this treatment caused Mr I to die sooner and his family struggled to get to see him in time.
25. Mr I missed one dose of antibiotics between the time the cannula stopped working and when the family asked for it to be started again. Our adviser says that missing the antibiotic dose would not have made any difference to Mr I’s condition or the length of his life.
26. We hope our investigation gives Ms A and her family reassurance that the Trust acted in line with relevant standards and guidelines and in Mr I’s best interests. We also hope they can take some comfort in knowing that the short time when Mr I did not have antibiotics, did not have an impact on the end of his life.