Clinical treatment in hospital
Upheld in whole or in part
Non-public interest report issued: complaint upheld
Betsi Cadwaladr University Health Board
Ms X complained about the treatment her father, Mr Y received for multiple myeloma (a type of bone marrow cancer) between January and March 2020. In particular she complained about the appropriateness of the decision making around monitoring and stopping 2nd line treatment, the failure to commence 3rd line treatment sooner, discharge decision making, the failure to admit Mr Y to an appropriate ward following hospital admission and failing to provide appropriate care on that ward, the failure of the Haematology Team to provide timely an appropriate care following this admission and failure to communicate appropriately with the family about Mr Y’s condition and deterioration.
The Ombudsman found that the decision to stop 2nd line treatment based on Mr Y’s paraprotein (protein produced by cancer cells) result and response to treatment was reasonable. He did not uphold this complaint.
While the decision to review Mr Y in clinic 2 months’ after stopping 2nd line treatment was in line with national guidance, as Mr Y’s paraprotein result had increased, whilst not necessarily suggestive of relapse on its own, an urgent paraprotein test would have been appropriate to confirm disease stability once the raised paraprotein test result was known. While this may have resulted in 3rd line treatment being commenced sooner, the Ombudsman found that earlier intervention would not have affected the disease trajectory. These complaints were partially upheld.
Mr Y’s discharge without a clear diagnosis and management plan may have rendered his discharge unsafe and this complaint was upheld to this extent. When Mr Y was re-admitted to hospital, the Ombudsman found the ward he was admitted to was inappropriate and that some aspects of his care were below an expected standard, namely weight monitoring. Mr Y also missed 3 days of chemotherapy treatment which was a shortcoming.
Whilst this would not have significantly impacted on the outcome of his treatment, the omission was a matter of concern. The Ombudsman upheld the complaint about weight monitoring.
The Ombudsman found that during Mr Y’s second admission, it would have been clinically appropriate for the haematology team to have been more active in Mr Y’s management from the date of admission, and that given how ill he was during the admission, he should have been reviewed daily from admission, including over the weekend. The fact that he was not, was a matter of concern. This complaint was upheld.
The Ombudsman found that communication with Mr Y and his family could have been better and that the seriousness of Mr Y’s condition could have been communicated sooner. This complaint was upheld.
The Health Board accepted the Ombudsman’s recommendations, which included an apology, reflection and learning.