Treatment 11. Mrs G complains the Trust did not actively treat her for COVID-19 and a chest infection during her admission in June 2024. Understandably, she is concerned as she told us a community doctor prescribed her with antibiotics and steroids after her discharge which improved her condition. We are sorry to hear she feels the Trust caused her to suffer unnecessarily and delayed her treatment which prolonged her recovery.
12. Mrs G’s records show the Trust admitted her in early June after a fall at home. It carried out a chest X-ray on the same day and noted it showed no evidence of active infection in her lungs. It carried out a CTPA a couple of days later which showed no evidence of a blood clot in Mrs G’s lungs.
13. The day after the CTPA, the respiratory team reviewed Mrs G. They noted she had end stage respiratory failure and was struggling to come off her BiPAP machine for short periods. Mrs G reported a sore throat the following day and the Trust carried out a COVID-19 test on the same day. It noted her COVID-19 test was positive the day after, on 7 June.
14. The respiratory team reviewed Mrs G in mid-June. They noted she had a low-grade temperature (which is slightly above what is considered normal) the previous evening and had deteriorated. It carried out a blood test based on Mrs G’s symptoms. We saw no evidence that Mrs G had a chest infection while in hospital or that the Trust failed to treat one.
15. Mrs G had been suffering from severe respiratory failure for some time and was dependent on her non-invasive ventilation almost constantly. In this context we think the decision not to actively treat her COVID infection but to focus on symptom control was in line with the NICE guidelines.
16. The records show the Trust discussed her mother’s apparent deterioration and the plan for treatment and discharge with Ms F several times during the admission. On 11 June 2024, it is recorded that Ms F asked the medical team if the COVID-19 infection was making Mrs G’s condition worse and the medical team explained that they did not think that this was the case.
17. NICE guidelines on managing COVID-19 says base decisions about escalating treatment within the hospital on the likelihood of a person's recovery. It says take into account their treatment expectations, goals of care and the likelihood that they will recover to an outcome that is acceptable to them.
18. It goes on to say offer steroids to people with COVID‑19 who need supplemental oxygen to meet their prescribed oxygen saturation levels or have a level of oxygen starvation that needs supplemental oxygen but who are unable to have or tolerate it. It also explains do not use antibiotics for preventing or treating COVID-19 unless there is clinical suspicion of additional bacterial co-infection.
19. The CTPA carried out in early June did not show any changes in Mrs G’s lungs which might have been suspicious for COVID-19 infecting the lung. Treatment with steroids was not given at that point because there had been no increase in her oxygen requirement because of the infection.
20. Our adviser explained that Mrs G’s condition appeared to be deteriorating over the longer term with COPD and her life expectancy was affected by this, rather than a severe problem due to COVID-19 infection. As we explained earlier, we have seen no evidence in Mrs G’s records that she had, or the Trust suspected she had, a chest infection during her admission.
21. Based on the information we have seen, it appears the Trust followed NICE guidelines when it did not provide treatment for Mrs G’s COVID-19 infection. We can see Mrs G already required oxygen via a BiPAP machine due to her COPD and did not need more oxygen in relation to her COVID-19 infection.
22. Therefore, in line with guidelines there was no requirement to provide her with steroids during her admission. There is also no evidence the Trust suspected she had a bacterial or chest infection alongside COVID-19. Therefore, in line with guidelines, Mrs G did not require antibiotics during this admission.
23. We can also see that the Trust followed guidelines when it based its decision not to provide Mrs G with treatment for her COVID-19 infection, on her overall likelihood of recovery. We can see from Mrs G’s records that her COPD condition had been slowly deteriorating before and during her admission and the Trust thought she was in the last days of her life. We say more about this in the ‘Communication’ section below.
24. Based on this information, we cannot say the Trust got anything wrong when it made its decision not to treat her COVID-19 infection during her admission as it did not appear to be impacting her overall condition. We will therefore not take further action on this complaint.
Communication 25. Mrs G also told us the Trust did not clearly tell her daughter that it was not going to provide her with treatment for a COVID-19 and a chest infection. Ms F says the Trust led her to believe there was nothing further it could do for her mother. We are sorry to hear how stressful this was for her as she told us she spent several weeks believing her mother was going to die.
26. The GMC guidelines say doctors must be considerate and compassionate to those close to a patient and be sensitive and responsive in giving them support and information.
27. Mrs G’s records show the Trust had several discussions with Ms F about Mrs G’s care and treatment. There was a discussion about what the Trust perceived to be Mrs G’s deteriorating condition on the day before it discharged her in mid-June. It noted it explained to Ms F that its aim was to control Mrs G’s symptoms, and it would not actively treat her. It documented an example of this would be if Mrs G were to develop an infection it would not provide her with curative treatment for it.
28. In the Trust’s final response, it said the medical team decided not to provide treatment as it believed Mrs G was in the process of dying, and treatment would be unsuccessful. It acknowledged Mrs G had ‘turned a corner’ and improved after being discharged and accepted it should have done a better job of explaining things to Ms F at the time.
29. Based on the information we have seen, we think the Trust did discuss Mrs G’s care and treatment with Ms F. We can see it provided Ms F with information and attempted to explain its reasons for its actions. However, it is clear from the Trust’s response to the original complaint that it could, and should, have done better in terms of communication. Therefore, its actions in that regard likely failed to fully comply with the relevant GMC guidance.
30. In its final response the Trust explained the particular doctor who carried out the discussion has reflected on this. It said they acknowledged the discussion could have been better managed and they apologise for the distress it caused the family. It went on to say the Trust was truly sorry for the distress Ms F and her family experienced, and the wider team have reflected on this for learning in the future.
31. Our Principles for Remedy says we would expect organisations to acknowledge mistakes and apologise for the impact these mistakes had. The remedy should be appropriate and proportionate to the injustice sustained.
32. We are satisfied that the apology and the acknowledgement of the impact the events had on Mrs G and Ms F, which the Trust has provided, are in line with the Ombudsman’s Principles. We can also see the team responsible has reflected on Ms F’s experience for future learning which indicates the Trust is committed to preventing the same thing from happening again.
33. We understand Mrs G’s admission was distressing for Ms F and we cannot imagine how difficult it must have been for her when the Trust told her it did not expect her mother to live much longer. We hope this statement clearly explains our decision not to consider her complaint further and gives her reassurance that the Trust took her complaint seriously and addressed the impact of her communication concerns.