Decision Report 201305953

Summary

Ms C complained on behalf of her client (Ms A) about the care and treatment provided to Ms A for anorexia nervosa (an eating disorder) when she was admitted to New Craigs Hospital (a psychiatric hospital). Ms A had been placed on a short term detention certificate and her medical records show that on admission she had a low body mass index. It was also noted that she was at high risk of refeeding syndrome (a potentially lethal disorder that can occur when a person is recovering from a period of starvation), and it was decided that refeeding should take place in a medical unit at another hospital. There were, however, no beds available there at that point. Ms A was sipping water and was aware of the plan to transfer her to the other hospital, where she might be fed with a nasogastric tube (a narrow tube passed into the stomach through the nose). However, she was not admitted there until five days later. By this time her mental and physical state had deteriorated, and she had lost weight and become unresponsive.

Ms C complained that despite suffering from anorexia and a low body mass index, Ms A was not offered anything to eat or drink for four days. She said that as Ms A was under a short term detention order, staff could and should have started nasogastric feeding. Ms C also said it was inappropriate to transport Ms A in a patient transport vehicle instead of an ambulance, given her serious condition.

We took independent advice on this case from two of our medical advisers. We found that the medical records indicated that Ms A was offered food and fluids, and that it was reasonable to monitor her and allow voluntary feeding instead of nasogastric feeding, particularly in light of the risk of refeeding syndrome. Although, given the nature of her medical needs, our advisers said that Ms A should have been admitted to the medical unit sooner, we were satisfied that the evidence showed that her care and treatment at New Craigs Hospital were reasonable. In the circumstances, we did not uphold the complaint but made a recommendation in light of the advice we received.

In relation to whether Ms A should have been transferred by emergency ambulance, we found that the medical records showed that her condition, while significant, did not indicate that this was required and that it was reasonable to provide the patient transport vehicle, with ambulance assistants.

Recommendations

We recommended that the board:

• review the response from the other hospital in light of one of our adviser's comments to see if any lessons can be learned.