Fistula needle
19. Miss H says during her father’s routine dialysis appointment on 16 November 2020, the Trust left the fistula needle in for too long causing excessive blood loss and an infection to develop. Miss H says her father developed a renal infection four days after the incident with the fistula needle, and he was prescribed antibiotics by his GP. Miss H believes this incident led to her father’s deterioration and admission to the Trust on 23 December.
20. The Trust said excessive bleeding from a fistula needle is not unusual. The blood flow access points are internal, and the risk of infection is very low. During its local resolution meeting with the family it reassured them there were no signs of infection noted in the weeks prior to Mr A’s admission, which could have been caused by the fistula needle. It says given Mr A’s medical history of diabetes and kidney disease, there is an increased risk of developing an infection from any wound.
21. From Mr A’s dialysis records there are no records documenting any incidents occurring on 16 November 2020. The records state, ‘Mr A attended for dialysis, problem free cannulation. Observations are stable. Tolerated three hours problem free, no other issues, no bleeding post dialysis. Left the unit stable.’ We can see Mr A attended the Trust for dialysis again on the following dates 19, 21, 24, 26, 28 and 30 November. We cannot see any records documenting excessive bleeding from the fistula needle.
22. For completeness, we also checked Mr A’s dialysis records in December 2020 and note there were no documented incidents.
23. We next considered Mr A’s GP records to understand when he was prescribed antibiotics. Miss H says her father was prescribed antibiotics four days after his dialysis treatment on 16 November. Having considered the GP records we cannot find any documentation evidencing he was prescribed antibiotics due to an infection occurring from his dialysis treatment.
24. We note from earlier GP records, Mr A had a severe infection on his left ring finger with pus, which required surgical draining in theatre. He was an inpatient at the Trust for nine days between 17 October to 26 October. A follow up appointment in an outpatient clinic on 3 November documents his finger is healing well, and he was referred to a hand therapist for exercises. The GP records dated 3 December show Mr A was prescribed antibiotics as there was redness noted on the wound on his left hand.
25. There is no record of any issues with the use of a fistula needle. After each dialysis, the records say there has been no post dialysis bleeding, and the fistula site is clear of any significant issues.
26. We are unable to identify any incidents occurring during Mr A’s dialysis treatment and similarly, we cannot see his GP prescribed antibiotics during this time. We can see when he arrived at the Trust’s ED on 23 December, he was noted as having a ‘likely infection.’
27. The records show Mr A has had episodes of infection in the past and the source of his infection on 23 December was unknown. Our renal consultant adviser said patients with end stage kidney disease are already immunocompromised and prone to infection with an increase in severity. They are less responsive to medication in comparison to the general population. In addition, Mr A had type 1 diabetes with complications and heart disease which adds to his reduced immune status and increases proneness and severity of infection. They said fistula site bleeding post dialysis can occur but does not lead to infection by default.
28. We are sorry to hear about the family’s concerns and appreciate they are distressed their father’s condition declined following his dialysis treatment on 16 November.
29. From the evidence there is no indication a fistula needle caused excessive blood loss or infection during Mr A’s dialysis treatment on 16 November. There is no evidence Mr A was prescribed antibiotics by his GP because of his dialysis treatment on this date.
A&E assessment
30. Miss H complains the Trust did not assess her father for a stroke when he arrived at the Trust on 23 December, despite him presenting with a right sided facial droop. Miss H says she recalls a telephone consultation with an A&E doctor on 23 December, where they advised as Mr H has a right sided droop, he may have suffered a stroke.
31. The Trust set out Mr A’s reasons for admission on 23 December, staff initial consideration and treatment as set out in his records. It said acute confusion can be caused by a variety of acute medical illnesses including infection, high blood sugar and organ failure, and these contributed to Mr A’s condition. It says Mr A was not demonstrating signs of a stroke on his arrival to its ED.
32. From the Trust’s ED records we can see Mr A was brought in by ambulance. He was noted as ‘unwell for 3-4 days, shivering sweating episodes, nausea and vomiting, several episodes of diarrhoea. Likely infection. Indication: Sepsis – serious and unknown source. Hyperglycaemia likely secondary to infection.’ His C-reactive protein levels (CRP – a protein produced by the liver which rises where there’s an inflammation in the body) was noted as 394, whereas a normal CRP level is 5. We can see the Trust also administered intravenous (IV) antibiotics (tazocin).
33. The British National Formulary describes tazocin as a broad-spectrum antibiotic used for various infections including sepsis.
34. We can find no details of the telephone conversation between the Trust’s A&E doctor and the family.
35. The records show Mr A was referred for a CT head scan on 23 December. The results of the scan state, ‘no acute intracranial haemorrhage or large vessel territory infarction, signs of cerebrovascular disease but no acute infarction seen.’
36. We asked our A&E consultant adviser if Mr A was displaying signs of a stroke when he arrived at the Trust’s ED. The records show the Trust took a history of Mr A’s condition and performed a neurological examination. Mr A had no speech or visual disturbance during the examination and there was no obvious facial droop or other neurological deficits. Our A&E consultant adviser said there was no indication of stroke in this examination.
37. The Trust’s assessment is in line with NICE guidance for Stroke and transient ischaemic attack in over 16s: diagnosis and initial management, which states, ‘1.1.3 For people who are admitted to the emergency department with a suspected stroke or TIA, establish the diagnosis rapidly using a validated tool.’
38. The records set out Mr A was confused but he had no headache, no neck stiffness or photophobia (meaning he was able to tolerate light). His reflexes were normal and symmetrical, and he had normal tone, power, and coordination in his limbs.
39. Our A&E consultant adviser said in this case, clinical signs like acute confusion and high temperature and blood tests results showing significantly raised inflammatory markers are indicative of sepsis. This is supported by Mr A’s high CRP level of 394, and the treatment of antibiotics was appropriate.
40. The National Library of Medicine: C Reactive Protein describes ‘a very high level of CRP, greater than 50 is associated with bacterial infections about 90% of the time.’ Additionally, The National Library of Medicine article titled, C-reactive protein levels correlate with mortality and organ failure in critically ill patients, explains, elevated levels of CRP on admission are correlated with an increased risk of organ failure and death.
41. Our A&E consultant adviser explained severe infection and metabolic disorders which Mr A suffered from including, renal failure, high blood sugar and high potassium levels are a well-known stroke mimic.
42. The National Library of Medicine defines a stroke mimic ‘as acute onset of neurological symptoms which are later diagnosed as not vascular or neurological in origin.’
43. We asked our cardiology consultant adviser if Mr A should have been referred to the Trust’s cardiology unit when he first arrived at its ED on 23 December.
44. Our cardiology consultant adviser said there is no evidence from Mr A’s initial presentation that an admission to the cardiac ward was necessary. This is because he was not displaying any signs of acute coronary syndromes (any condition resulting from the sudden reduction of blood flow to the heart which leads to shortness of breath and sudden chest pain), acute heart failure (a life-threatening condition where the heart is unable to pump enough blood to meet the body’s demands) or arrhythmias (irregular heartbeat).
45. This is in line with the European Heart Journal, which provides guidance on cardiac care units for the treatment of the above three conditions.
46. The family believed their father had suffered a stroke which was left untreated, we understand this caused distress and anxiety about the medical treatment he was receiving.
47. It is our view, Mr A’s examinations and clinical observations on 23 December did not indicate he had a stroke. He was assessed in line with NICE guidance for Stroke and transient ischaemic attack in over 16s to rule out a stroke. His symptoms correlated with a severe infection. With the source of the infection unknown when he first arrived at the Trust on 23 December, he was appropriately treated with a broad-spectrum antibiotic.
Communication and falls risk assessment
48. Miss H says when she would telephone the ward for updates on her father’s condition, she was told he was fine. However, after completing the local resolution process she has now become aware her father had a heart attack in the early hours of 25 December, he was deemed as no longer having mental capacity, had developed sepsis and was placed on one to one (1:1) care due to his critical condition.
49. Miss H says her father was deemed as at high risk of falls, but the Trust did not put up bed rails. She says, it was only during the complaints process when the family requested a copy of Mr A’s medical records they became aware he had an unwitnessed fall on 24 December. She says she asked the Trust about his fall in a local resolution meeting.
50. We can see from the complaints correspondence the Trust accepts its communication with the family could have been better and it apologises for this.
51. From the records we can see Mr A’s mother telephoned the Trust’s ED on 23 December, ‘Mr A's mum rang - upset she hadn't been given the right information, updated her that he would need admission for at least a couple of days, currently delirious due to infection and high blood sugars.’
52. We understand from the complaint’s responses, the Trust says it tried to contact the family to provide an update on 24 December. We can see a nursing entry on the records dated 24 December at 9.32 am stating, ‘attempted to update NOK however unable to contact with number provided.’ The family dispute this and say they did not receive any calls or indeed missed calls from the Trust.
53. We can identify documented conversations with the family from 25 December onwards.
54. We can see from the first conversation on 25 December at 3.59pm, the family were informed Mr A is unwell and a working diagnosis of endocarditis (inflammation of the inner lining of the hearts chambers and valves caused by an infection) and acute coronary syndrome. It set out its treatment plan with the family with a view to transferring him to its cardiac unit. Further telephone conversations took place on the same date at 7pm and 10.30pm when Mr A’s condition started to deteriorate. End of life conversations started to take place on 26 December at 3.43am and 6.53am. We cannot see the Trust informed the family Mr A was also being treated for sepsis.
55. A falls assessment outcome documents Mr A as at a ‘high’ risk of falls on 23 December and he is noted to be unsteady on his feet. The intervention to manage his risk is documented as lying and standing blood pressure recordings. From the records we can see Mr A had a fall on 24 December where he was found ‘on the floor.’ A post fall review took place where no medical cause of concern was identified, and Mr A was noted as ‘stable.’ We cannot see any records evidencing the family were informed of this incident.
56. There is documented evidence of discussions with the family when Mr A became rapidly unwell from 25 December. However, there is no documentation evidencing the Trust supported and kept the family informed of his treatment and progress prior to 25 December. Our nursing adviser said when Mr A arrived at the Trust on 23 December, he was clinically unwell and required close monitoring and observation. On this basis, the medical and nursing staff should have kept the family updated and informed much earlier than 25 December. As this did not happen the family had little time to process and understand the clinical status of their father.
57. This is not in line the Nursing and Midwifery Code of Conduct, which states at paragraph 5.5 to ‘share with people, their families and their carers, as far as the law allows, the information they want or need to know about their health, care and ongoing treatment sensitively and in a way they can understand.’
58. Similarly, NICE guidance for Patient experience in adult NHS services: improving the experience of care for people using adult NHS services, recommends, ‘1.3.10 Clarify with the patient at the first point of contact whether and how they would like their partner, family members and/or carers to be involved in key decisions about the management of their condition (or conditions). Review this regularly. If the patient agrees, share information with their partner, family members and/or carers.
1.3.11 If the patient cannot indicate their agreement to share information, ensure that family members and/or carers are kept involved and appropriately informed, but be mindful of any potentially sensitive issues and the duty of confidentiality.’
59. With regards to a falls risk assessment, the records do not evidence the documenting of frequent multifactorial assessments and interventions to show a thorough assessment of high risk of falls had taken place.
60. This is not in line with NICE guidance, Falls in older people: assessing risk and prevention, which recommends for Multifactorial falls risk assessments and Interventions:
‘1.1.2.1 Older people who present for medical attention because of a fall, or report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance should be offered a multifactorial falls risk assessment. This assessment should be performed by a healthcare professional with appropriate skills and experience, normally in the setting of a specialist falls service. This assessment should be part of an individualised, multifactorial intervention.’
61. Our nursing adviser says the Trust should have informed the family of the fall as soon as it occurred and advised on any injuries sustained. It should have completed a duty of candour document clearly outlining discussions held with family and it should have reported the incident.
62. We are sorry to hear the family’s concerns the Trust did not keep them updated on Mr A’s condition.
63. The Trust should have kept the family updated with Mr A’s condition from the date of his admission at the Trust. Mr A arrived at the Trust on 23 December acutely unwell and the Trust could have done more to communicate this to the family, so they had time to process what was happening. This is not in line with the Nursing and Midwifery Code of Conduct and NICE guidance for patient experience in adult services.
64. The Trust did not conduct a robust falls risk assessment for Mr A, which is not in line with NICE guidance, Falls in older people. Further, when Mr A sustained a fall on 24 December, during the post fall review, a plan should have been made to inform the family by way of a duty of candour. We also cannot see the incident was reported on its internal systems.
65. We next considered the impact of these indicated failings on the family. The lack of communication and updates from the Trust is likely to have compounded their anxiety when they were already in distress and worried for Mr A’s health. Being informed Mr A sustained a fall after his death is likely to have come as a shock to the family, impacting their distress and grief at what was already a difficult time.
66. We understand the Trust admits its communication was poor and has apologised. An apology goes some way to put things right. An apology is in line with the NHS Complaints Standard Framework, which provides guidance on how organisations delivering NHS services in England should handle complaints. It states, an effective complaint handling system should include the following four standards of promoting a learning and improvements culture, positively seeks feedback, is thorough and fair and finally, gives a fair and accountable decision. It specifically states, organisations should ensure the apologies and explanations they give are meaningful and sincere.
67. At this time, we do not think an apology alone fully puts right what went wrong and we make recommendations at the end of the report.
Delay to transfer to cardiac ward
68. Miss H says her father had a heart attack on 25 December. The family believe had Mr H been transferred to the Trust’s cardiac unit upon his arrival at the Trust on 23 December, he may not have had the heart attack on 25 December.
69. The family believe the Trust made its clinical decisions based on inaccurate information. It transpired during the complaints process the Trust believed Mr A was immobile, and he did not leave the house. Miss H says this information is inaccurate, and the family say had the Trust documented the correct information and involved the family in its decisions, it would have made different medical decisions and her father may have had the chance to survive this period.
70. From its responses, the Trust has admitted its communication with the family could have been better. It also says its clinical decisions were appropriate.
71. We have already addressed above our view that Mr A did not have signs of a stroke nor was he displaying any signs of acute coronary syndromes when he first arrived at the Trust on 23 December. On this basis, there was no indication for a referral to the cardiac unit at that point.
72. From the records we can see on 23 December, Mr A was transferred from the Trust’s ED to a medical ward, H3 around 6.30pm. On 25 December at 4.24am, Mr A’s condition appeared to deteriorate in that the Trust, ‘contacted oncall SHO to come and review the patient urgently as he is looking very unwell. ECG done as per request.’
73. Mr A’s deteriorating condition was discussed between two clinicians on 25 December at 15.29pm, which states, ‘Case discussed with Dr – differential diagnosis of infective endocarditis or myopericarditis. Plan for monitored bed on heart case unit, to remain under the care of renal. Requires a CT-TAP with contrast to find source of infection.’
74. The family were informed of the Trust’s decision to transfer Mr A to its cardiac unit during a telephone conversation on 25 December at 3.59pm. He was transferred to the Trust’s cardiac unit around 8pm and was under the review of heart specialists and the critical care team.
75. We asked our cardiology consultant adviser if the Trust should have considered referring Mr A to its cardiac unit sooner and if there was a delay.
76. Our cardiology consultant adviser said Mr A’s initial cause of deterioration was sepsis. Given he required dialysis and treatment for sepsis, he was initially on the appropriate unit under the care of renal specialists. When he failed to respond to ward based treatment his care was appropriately escalated to cardiac and then to high dependency wards.
77. This is in line with the GMC Good Medical Practice, domain 15 Apply Knowledge and Experience to Practice, which states, ‘You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must: promptly provide or arrange suitable advice, investigations or treatment where necessary. Refer a patient to another practitioner when this serves the patient’s needs.’
78. Our cardiology consultant adviser explained, Mr A had a chronic cardiac condition which increased his risk of cardiac arrest, but the dominant cause of deterioration was not cardiac related. Therefore his heart attack on 25 December could not have been prevented.
79. We are sorry to hear about Miss H’s concerns her father may not have received appropriate treatment for his condition and when the Trust decided to transfer him to its cardiac unit, it was too late to save him. We recognise this caused the family anxiety and distress.
80. There is no evidence of a missed opportunity in transferring Mr A to the cardiac ward or in reducing his risk of a heart attack on 25 December. When Mr A was identified as having increased needs on 25 December he was transferred to the Trust’s heart care unit with input from its critical care unit. There is no indication that an earlier transfer was indicated prior to Mr A’s deterioration on 25 December and decisions were made in line with GMC Good Medical Practice.
Mental capacity, DNAR and medical decisions
81. Miss H says the Trust did not inform the family it considered Mr A no longer had capacity and it did not consult with his next of kin to make decisions on his behalf or to be involved in his treatment plan.
82. Miss H says the Trust made a unilateral decision to put a DNAR in place. It did not discuss this with the family or hold a best interest meeting to explain its reasons. The family are aggrieved their father was not given a chance to recover from this episode. They explain their father had been accepted for a kidney transplant which indicated to them he was healthy enough to fight the infection. The family feel the Trust gave up on their father and this has compounded their grief.
83. The family believe the Trust made its clinical decisions based on inaccurate information. It transpired during the complaints process the Trust believed Mr A was immobile, and he did not leave the house. Miss H says this information is inaccurate, and the family say had the Trust documented the correct information and involved the family in its clinical decisions, it would have removed the DNAR and her father may have had the chance to survive.
84. From its responses, the Trust has said its communication with the family could have been better. It also says its clinical decisions were appropriate.
85. Throughout the medical records we can see Mr A described as ‘confused and disorientated,’ and often ‘not talking or responding to commands.’ On 24 December, Mr A is noted as ‘sat on the floor with cannula pulled out.’ On the same date, following his fall, a nursing record documents, ‘Mr A had a fall at previous shift, under dols 1/1 care, patient looking very drowsy, sleepy, confused, renal team aware.’
86. From the medical records we can see documented on 25 December and similarly again on 26 December, 'Case discussed with wife in view of deterioration. Baseline appreciable as the patient mobilises independently at home, can walk up the stairs, can manage own ADL's and has chosen not to leave the house (essentially housebound) for the last 12 months as he believes any physical exertions is not good for his heart.'
87. We note, Miss H says this is untrue and her mother did not provide this information to the Trust.
88. The records further document on 26 December at 1am, ‘Baseline functional status not entirely clear, letters seem to state he is usually independent and untroubled by symptoms, but wife states patient has been essentially housebound? By choice? Apparently can manage a flight of stairs, however, speaking to patient directly he states he has to stop twice before getting to the top. Unable to get further details from patient as too shortness of breath.’
89. When Mr A deteriorated further we can see a critical care consultant documents a detailed telephone conversation with Mr A’s partner on 26 December at 12.42am, including ‘In view of his extensive medical comorbidities and poor baseline functional status, I think it is exceptionally unlikely that he would benefit from being placing him on a ventilator/life support machine. I therefore do not think we should be proceeding to this treatment. This has also been discussed and agreed with one of my consultant colleagues. I stated that I think he will die tonight. His partner understood our concerns and seemed to accept the management plan. She has requested that she and Mr A’s 6 grown up children can visit tonight.’
90. The Trust completed a Ceiling of Care/DNA-CPR status order at 2.53am, documenting the patient as ‘unable to communicate their wishes,’ and discussed with relatives. The reason for the DNA-CPR is noted as ‘end-stage renal failure, bradyarrhythmia non responsive to therapy, ischaemic heart disease.’
91. The NHS provides guidance on DNAR decisions, it explains the purpose of these decisions, who can make them and how this must be communicated with the patient and their family. The Trust’s actions appear to be in line with NHS guidance.
92. We can see when the family arrived to see Mr A, a further conversation took place with the critical care consultant. An update on the treatment it provided to Mr A, during the course of his admission was explained, and it was explained that sadly Mr A was likely to die that night. The records document ‘the family were clearly upset to hear this but all appeared to understand our concerns and all accepted that he was frail. There was ongoing expressions of resentment towards the dialysis treatment he has been having and they seem to attribute much of his decline to this. We agreed that family members could visit him two at a time and then we would commence end-of-life care. They had no further questions.’
93. We have seen when Mr A arrived at the Trust with an infection, the source of it was unknown and his blood cultures required testing. The results showed there was a staph aureus infection (a bacteria that can cause serious infections on the skin and other parts of the body) which has very aggressive organisms. Our renal consultant adviser said the treatment provided by the Trust for suspected endocarditis was appropriate and it was actively treated. Mr A was not responding to antibiotic treatment. Our renal consultant explained this was because of his significant multi-organ co-morbidities, including end stage kidney disease, previous heart attack with intervention, new heart attack, heart failure, known poor pumping of his heart, disease of heart valves, diabetes type 1 and associated complications. On this basis, the critical care team’s DNAR decision to not ventilate Mr A was appropriate because respiration was not the primary element of his symptoms.
94. The records of the Trust’s two conversations with the family document the key aspects of what should be discussed with a patient or their family in a best interest meeting. There is evidence the Trust discussed Mr A’s level of frailty with his partner, his co-morbidities, his mental state and it explained its decision why it would not commence ventilation treatment.
95. The BMA Ethics Toolkit, Mental Capacity Act, section 4 and 5 describes who can assess the capacity and best interest for patient. It stipulates that any doctor can assess the capacity at any point for a patient.
96. The two documented conversations between the Trust and the family are in line with the Mental Capacity Act 2005, which provides best interest guidance in consulting with the family about clinical decisions. The guidance is about consulting the views only, it does not say to follow the views of the family to make clinical decisions. The decision about treatment is always in best interest of the patient irrespective of capacity.
97. Similar best interest guidance can be found within the GMC, Decision Making and Consent guidance, titled, Making a decision when the patient lacks capacity: overall benefit. Section 89 states, ‘If there is no evidence of a legally binding advance refusal of treatment, and no one has legal authority to make this decision for them, then you are responsible for deciding what would be of overall benefit to your patient.
In doing this you must: • consult with those close to the patient and other members of the healthcare team, take account of their views about what the patient would want, and aim to reach agreement with them • consider which option aligns most closely with the patient’s needs, preferences, values and priorities • consider which option would be the least restrictive of the patient’s future options.’
98. We have seen there was a period over 24 December, when Mr A became less orientated and the infection was diagnosed and treated, and the family did not receive updates which the Trust have acknowledged. We know the restrictions around the COVID-19 pandemic meant visiting was not permitted in the usual way. So, there was less opportunity for the family to make their own assessments and receive updates in an informal fashion. Once Mr A was transferred to the high care ward appropriate discussions took place with the family.
99. Our cardiology consultant adviser said the Trust’s decision not to attempt further resuscitation was made only when it became clear that Mr A’s condition had deteriorated, and he would be unlikely to survive. This was discussed with Mr A and his family.
100. We next asked our advisers about Miss H’s concerns the Trust made inappropriate medical decisions based on inaccurate information.
101. Our renal consultant adviser said the disputed information on Mr A’s medical records stating he was housebound and immobile did not affect any medical treatment, as Mr A received full active treatment giving him an appropriate chance to respond. This included referral and review by the critical care team. The critical care consultant noted Mr A’s housebound status which is a factor to be considered while looking and putting his co-morbidities into context. This is the interpretation used by clinicians in this context, there is no evidence it solely relied and made its medical decisions based on this information alone.
102. We have seen despite receiving active treatment Mr A’s condition deteriorated which was likely to be due to his multi-organ co-morbidities. His oxygenation was 98% on 24 December which dropped the following day while his consciousness was still impaired. He continued to receive antibiotics and test results had confirmed the infection. He was moved to the cardiology ward and to critical care which was part of active management. Our renal consultant adviser said the further escalation needed was ventilation as his respiratory system was then impacted which shows a sign of deterioration from his infection. The rise in his cardiac enzymes suggested a heart attack, and his liver also was involved with the illness, suggesting his organs were failing.
103. The records show he received cardiopulmonary resuscitation (CPR, which combines chest compressions and rescue breaths to give a person the best chance of survival following a cardiac arrest) at around 2.30am on 26 December for low heart rate. This again confirms he was receiving active treatment. Following this, the critical care team discussed with the family in detail about why ventilation would not be suitable. Mr A died at 8.51am on 26 December which is around four hours after the Trust’s discussion with the family. With this background, our renal consultant adviser says putting Mr A on a ventilator would not have changed his outcome.
104. Our cardiology consultant adviser is of a similar view Mr A received appropriate and timely treatment. They said his condition was not survivable. The nature of his terminal event was bradycardia (heart beats slowly than expected) in the context of pulmonary oedema (build-up of fluid in the lungs) and non-operable coronary artery disease (type of heart disease, affecting the main blood vessels which supply blood to the heart). Even if the Trust had attempted resuscitation, it is unlikely it would have resulted in a successful recovery.
105. We are sorry to hear of Miss H’s concerns. Being informed a family member is likely to die is traumatic and we understand how devastating this news was for the family.
106. We have decided the Trust’s assessment of Mr A’s mental capacity and its DNAR decision was made in line with the Mental Capacity Act, BMA guidance and GMC Decision Making and Consent guidance. There is evidence the Trust discussed Mr A’s declining condition with the family and it explained its rationale as to why ventilation would not be suitable for him.
107. Turning to the complaint about the Trust’s medical decisions being based on inaccurate information, we recognise the way in which things are said and how they are meant are open to interpretation. Each person involved in the same conversation can come away with a different perception of its contents and what happened. One person’s perception of what was said does not invalidate another person’s opposing perception of the same comment. Whilst we do not dispute Miss H’s version of events that her mother did not inform the Trust that Mr A was immobile and did not leave the house, unfortunately, we were not present at the time to independently know what, and how, things were said.
108. It is our view Mr A was treated appropriately, and the Trust did not place too much emphasis on the information it says it had received from the family regarding his mobility and this did not adversely impact its medical decisions. Mr A’s condition was actively treated during his admission at the Trust, and he was appropriately escalated to the critical care team when he was sadly, deteriorating.