Report Date


Case Against

Hywel Dda University Health Board


Clinical treatment in hospital

Case Reference Number



Not Upheld

Ms X complained that on 12 February 2021, clinicians at Bronglais Hospital Emergency Department (“ED”) failed to adequately investigate her symptoms of chest pain and associated difficulty with breathing which she developed following a cardiac ablation procedure (a procedure that can help correct arrhythmia, a problem with the rhythm of the heartbeat) at a hospital in another Health Board area. The investigation considered whether Ms X was misdiagnosed with costochondritis (an inflammation where the ribs join the bone in the middle of the chest which can cause sharp chest pain, especially when moving or breathing), whether clinicians failed to suspect pulmonary embolism (“PE”) which was eventually diagnosed on 16 February when Ms X returned to the ED with worsening symptoms, and whether the provision of a formal complaint response to Ms X’s complaint was excessively delayed.

The Ombudsman found that the diagnosis of costochondritis was not outside the bounds of acceptable clinical practice and one that a body of ED clinicians would have reached based on Ms X’s presentation. In addition, she found that it was not outside the bounds of acceptable clinical practice that PE was not suspected as it was not a diagnosis that a body of ED clinicians would have suspected based on Ms X’s presentation on 12 February. The time taken to respond to Ms X’s complaint fell outside the timescales set out in the regulations/guidance (“the guidance”) that NHS bodies should follow when responding to complaints. That said, the guidance makes allowances for complaint responses to exceed the timescales in exceptional circumstances and the impact of COVID-19 pressures was relevant in this regard. In addition, the Health Board regularly updated Ms X to explain the reasons for the delay (in line with the requirements of the guidance) and it acknowledged the additional distress caused by the delay. Ms X’s complaints were not upheld for these reasons.