Overview
The complainant (Mrs C)'s 19-year-old son had a dental operation at St John's Hospital (the Hospital) in the area of Lothian NHS Board (the Board). His learning disability meant he did not have the mental capacity to make his own decisions about treatment or consent, nor to understand much of what was happening to him at the Hospital. Mrs C complained that she did not have the chance to withhold her consent to all the work being done at one session because she considered that the large volume of work should have been spread across more than one surgical session. She said that she had not been told before the operation of the possibility of so much work. She added that the amount of work done at the one session had caused her son such distress that, amongst other things, he had been chewing his lip, which she said had become an open, infected, sore.
Specific complaint and conclusion
The complaint which has been investigated is that informed consent to the operation was not properly sought (upheld).
Redress and recommendations
The Ombudsman recommends that the Board:
- (i) apologise to Mrs C for the failure to seek informed consent;
- (ii) satisfy themselves that relevant administrators and healthcare professionals at the Board have an appropriate knowledge and understanding of the Adults with Incapacity (Scotland) Act 2000, its Code of Practice and other relevant guidance;
- (iii) share lessons learnt from this case across their hospitals and disciplines;
- (iv) use the events of this case as part of their induction and other training programmes about consent and about communication with carers etc who have a legal say in decisions about the medical treatment of an adult with incapacity;
- (v) ensure that the Board's Consent Policy, in relation to obtaining consent in writing, is followed;
- (vi) advise clinicians across the Board's hospitals that recording only key points of consent discussions will not be sufficient in some cases; and
- (vii) consider revising their consent form in respect of adults with incapacity.