Report Date

31/07/2024

Case Against

Hywel Dda University Health Board

Subject

Clinical treatment in hospital

Case Reference Number

202303599

Outcome

Not Upheld

Mrs A’s complaint about whether the standard of care provided by Hywel Dda University Health Board’s Glangwili Hospital (“the Hospital”) to her late father (“Mr B”) during his inpatient admission between 21 November to 6 December 2021 was appropriate. Mrs A queried the correct dose of antibiotics being prescribed to her father for the correct period. She questioned whether a chest X-ray on 6 December was suggestive of an unresolved infection which would not have developed if antibiotics had been continued throughout her father’s admission, rather than being started, stopped and re-started and if a further X-ray was needed.

Mrs A questioned if oxygen therapy provided to Mr B was appropriate and whether the fact that he needed a maximum amount of oxygen should have prompted further review and/or suspicion that he was in terminal decline. She also questioned the timeliness and frequency of the referral to the Haematology and the Intensive Care Unit.

The Ombudsman found that Mr B was receiving daily antibiotics, and these continued until 3 December and that he received the full doses of antibiotics for the optimum period. Mr B’s underlying cancer meant that his immunity was severely compromised, and he was therefore not responding to his antibiotic treatment. Given that the chest X-ray taken on 6 December showed Mr B had developed pneumonia the Ombudsman did not consider that clinically, further chest X-rays would have added anything more and would not have been warranted.

The Ombudsman found that Mr B was receiving maximum oxygen therapy. Unfortunately, his pneumonia (an opportunistic infection (these are infections which occur more often and/or are more severe in those with weakened immune systems) resulting from his severely immunocompromised state) hampered the benefit he received from the oxygen. The Ombudsman concluded that a further review by the Haematology Team and ITU would not have altered Mr B’s management or his eventual outcome. In June 2020, the Haematology Team had identified there was nothing further it could do for Mr B and that he was for palliative care only. Against this background, the Ombudsman could not be critical about the timing/frequency of the referrals made to Haematology or the ITU Teams. Mrs A’s complaints were not upheld.