Care and treatment
13. Mr E says his wife developed pneumonia after her arrival at the Hospital. He believes she developed infections because of incidents when she received poor care. He says his wife told him she had to wait for more than three hours in a corridor before moving to a ward. He also referred to an incident that happened when he was visiting his wife on 29 October 2023 and found a window open and a fan on. He says his wife was very cold and this was unnecessary.
14. Good Medical Practice says doctors must provide a good standard of care. This includes carrying out adequate assessments, taking account of the patient’s history and examining them if necessary. Doctors should also arrange timely treatment and appropriate investigations or referrals if needed.
15. The Pneumonia Guideline includes recommendations for healthcare professionals about how to identify and treat hospital-acquired pneumonia. It says they should choose an appropriate antibiotic and start treatment within four hours of establishing the diagnosis.
16. The clinical records show Mrs E arrived at the Hospital at 8.13pm on 19 October 2023. She arrived on the ward two minutes later at 8.15pm. There is no evidence to suggest there was any delay in transferring Mrs E to a ward.
17. The Clinical Adviser told us Mrs E’s situation was complex. The admitting doctor noted she had developed vasculitis due to cryoglobulinaemia. The Clinical Adviser explained that the condition can lead to skin rashes, joint aches and problems with organs like the kidneys. A kidney biopsy showed Mrs E’s kidneys were affected. The treatment involves addressing the underlying cause and trying to stabilise the immune system to avoid further damage. Doctors gave Mrs E medication to do this and also gave her a plasma exchange to remove damaging proteins from her blood. This seems to have been successful in removing cryoglobulin from the blood.
18. The Clinical Adviser said the medications and plasma exchange can affect the immune system and makes them more prone to infection. When Mrs E arrived at the Hospital her temperature was normal and breathing rate were normal. There was no specific symptom of pneumonia when she first arrived. But doctors arranged further tests to exclude pneumonia.
19. A renal consultant reviewed Mrs E on 20 October 2023. They noted a chest X-ray suggested fluid in the lungs. They prescribed antibiotics and contacted renal doctors at the other hospital who agreed with the plan to treat for suspected pneumonia. In addition to diagnosing pneumonia, doctors also suspected fluid overload and increased her water tablets.
20. The Clinical Adviser said it is often difficult to establish the exact cause that is making someone unwell when they have the problems Mrs E presented with. It seems there was a combination of factors, mainly pneumonia but also fluid on the lungs.
21. The records show doctors treated Mrs E’s pneumonia by giving her antibiotics. They did this within four hours and appear to have followed the Pneumonia Guideline.
22. A CT scan of the chest showed shadowing in both of Mrs E’s lungs. This was likely due to infection (pneumonia). Despite treatment the pneumonia worsened. Doctors tried different medications to no avail. The Clinical Adviser said this would not be unexpected in a frail patient who had taken strong immunosuppressive medication. That medication was necessary because otherwise her kidneys would have failed completely.
23. We can see no record of the incident Mr E recalled relating to an open window and a fan being used. The Clinical Adviser told us this would not have caused any deterioration in Mrs E’s condition. Mrs E may well have felt cold despite having a fever, this is not unusual. Fan therapy is a recognised method to help relieve symptoms, but it would not have had any effect on how her condition progressed.
24. We would be unable to investigate this incident further because of the lack of any further evidence. That is not to say that we disbelieve Mr E’s account. As this could not have had a significant impact on Mrs E’s health it would not be proportionate for us to investigate further.
25. Before we decide if we should conduct a detailed investigation, 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 indication that clinicians at the Trust failed to follow the relevant standards. The evidence we have seen suggests they followed Good Medical Practice and the Pneumonia Guideline. We do not intend to start a detailed investigation about Mrs E’s care and treatment.
26. We recognise Mr E has strong views that his wife’s care was not good enough. We hope Mr E is reassured that we have seen no indication this was the case.
Communication
27. Mr E complains that staff did not communicate with him about what was happening to his wife while she was in the Hospital. He says neither he nor his wife were told about the diagnosis of pneumonia or further treatment for vasculitis and cryoglobulinemia.
28. The Trust has accepted there were failings in communication. It recognised the impact this had and apologised. It also took action to remind staff about the importance of timely communication with families.
29. We have decided to focus on the more serious complaints that people bring to us, where they may have faced a big impact. For example, these may be about a potentially avoidable death or where someone has suffered prolonged pain. These types of complaints are where we can often make the biggest difference. This will allow us to provide the right level of service to those people, as quickly as possible. This means we are not looking into complaints where we can see there has been a smaller impact. Based on the impact Mr E told us about, and the action the Trust has already taken, this applies to his complaint about communication.
30. We can see how upsetting it must have been for Mr E that there was a lack of communication with him from staff at the Hospital. We have decided it would not be proportionate for us to start a detailed investigation into this issue.
Complaint handling
31. Mr E complains about how the Trust handled his complaint. He says complaint responses were contradictory, particularly in terms of how pneumonia developed. He also says the Trust did not follow its own policy when it took too long to respond to his complaint and did not provide an explanation to him.
32. We have explained above how Mrs E’s condition was complex. This means it is difficult to be certain about when pneumonia developed. There were no obvious signs of pneumonia when she arrived at the Hospital. By the next day doctors had diagnosed pneumonia. We cannot see any obvious contradiction about this in the complaint responses. We can see no indication of any failings in this respect.
33. We can see the Trust’s first complaint response exceeded the timescale of 40 days it aimed to respond by. The response was more than three weeks late and the Trust did not contact Mr E with an explanation. The indications are that this was not in line with the Trust’s policy.
34. As we have set out above, we are attempting to focus on the more serious complaints people bring to us. While the Trust’s complaint response was late, and this was undoubtedly frustrating for Mr E, we do not consider it would be proportionate for us to carry out a detailed investigation about complaint handling delays.
Conclusion
35. We appreciate how distressing his wife’s admission to the Hospital was for Mrs E. We have seen no indications of any significant failings in care and treatment that could have led to her health worsening or that could have contributed to her death.
36. We also do not consider it would be proportionate to start a detailed investigation into his concerns about communication and complaint handling. We appreciate this is likely to be disappointing for Mr E.