Decision Report 201204323

Summary

Mr C complained about issues arising when his late wife (Mrs C) was admitted to hospital. He said that at first it was believed that Mrs C was suffering from pneumonia and had suffered a slight heart attack. This was confirmed by a heart scan. However, during her stay in hospital, Mrs C began to show symptoms of confusion. A psychiatric opinion was obtained which confirmed that she was suffering from fluctuating delirium (confusion). Despite Mr C's concerns about his wife's mental health, he said he was told that she was not detainable in hospital and was subsequently discharged. Mr C said that at this time she was in a very confused state.

A few days later, Mrs C was readmitted to hospital as an emergency. Mr C said he was advised that his wife had not suffered another heart attack and that no procedures would be carried out. He was told that he could go home, which he did. However, after short time, Mrs C died without her family beside her.

Mr C complained that his wife was discharged from hospital despite being in a very confused state. He also alleged that the board failed to explain the seriousness of Mrs C's condition to him and said that she had not suffered a heart attack.

As part of our investigation we obtained independent clinical opinions from two of our medical advisers, who are consultants in geriatric medicine and forensic psychiatry. Having considered her medical records, they confirmed that Mrs C's state of mental health was not such that the board could detain her, and concluded that she was not unreasonably discharged from hospital. We did not uphold this complaint. However, we found that the notes taken at the time of Mrs C's final admission were insufficiently clear to confirm what Mr C was told about her condition. It was clear, though, that his wife had in fact suffered a very serious heart attack from which she was unlikely to recover. It was, therefore, arguable whether Mr C was given appropriate information from which he could make an informed decision about whether to leave the hospital. We upheld Mr C's complaint about the information provided.

Recommendations

We recommended that the board:

• make a formal apology for the circumstances on the night of Mrs C's death; and
• remind staff in Accident and Emergency and the Coronary Care Unit of their obligation to properly record the information given to families about the condition of their relatives who have suffered a heart attack.