Decision Report 201901733

Summary

C has Crohn's disease (a condition where parts of the digestive system become inflamed) and had received various treatments, including two previous surgical procedures to remove lengths of small bowel. C attended Forth Valley Royal Hospital with abdominal pain. A CT scan showed inflammation of the ileum (a portion of the small intestine) at the site of the joint that had been created by the previous bowel resection (partial surgical removal of an organ). The decision was made to operate as an elective procedure (surgery that is scheduled in advance because it does not involve a medical emergency). The operating surgeon considered the length of small bowel identified on previous imaging was not causing an obstruction, and decided not to remove it. C continued to experience difficulties following the surgery, including a number of further hospital admissions.

C complained that the care and treatment they received from the board was unreasonable. We took independent advice from a general and colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We found that, while the level of investigations carried out were reasonable, a midline incision (a vertical cut made in the abdomen to allow access for a medical procedure) should have been performed in C's case. We noted that if a midline incision was employed, then it is likely that the resection would have been carried out as planned. We were also critical of the level of documentation provided by the board. As a result, we upheld this element of the complaint.

C further complained that the communication they received from the board was unreasonable. We found that there was no evidence to show that appropriate explanations were given to C following the surgery, and no evidence to demonstrate the board's clinicians effectively communicated with C about their condition. As a result, we upheld this element of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings this investigation has identified. The apology should meet the standards set out in the SPSO guidelines on apology available at HYPERLINK "http://www.spso.org.uk/information-leaflets" www.spso.org.uk/information-leaflets .

What we said should change to put things right in future:

• Clinicians must communicate effectively with patients, and make adequate records of these communications.
• The board should have appropriate pathways in place for the management of Crohn's disease, to ensure surgery to address this condition is carried out appropriately.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.