Summary
Mr A had collapsed at home. He had phoned for an emergency ambulance and explained that he had a condition called idiopathic thrombocytopenic purpura (ITP - a disorder that can lead to excessive bruising and bleeding including bleeding into the brain which can be fatal). Mr A also had alcohol-related health issues, and was in contact regularly with healthcare services. When the ambulance arrived at his home, he explained to the paramedic and technician that he suffered from ITP. After assessing him, the ambulance crew did not transport him to hospital. The following day he was found dead at home, and ITP was recorded as one of the causes of death. Mrs C, who complained on behalf of Mr A's son, complained that the ambulance crew should have taken Mr A to hospital when they attended, and was concerned they did not do so because of his alcohol-related health issues and the fact that he had previously called for an ambulance on several occasions. The ambulance service said that from the records, it appeared that Mr A had been observed appropriately, and he had declined hospital treatment.
I took independent medical advice on the complaint from a paramedic adviser, who told me that the assessment of Mr A was not reasonable, as Mr A's symptoms (along with the readings taken at the time and his pre-existing ITP diagnosis) indicated that he needed assessing at hospital, and he should have been advised of this. The paramedic's statement that reflected on the number of Mr A's previous hospital visits should not have influenced the decision-making as to his treatment on that occasion.
Whilst my adviser recognised that the paramedic should not necessarily have had knowledge of the condition ITP, the records show no sign of them having tried to get more information about it: they should have sought more specialist advice before diagnosing a simple faint and advising Mr A, on that basis, that he did not need to go to hospital. The advice I received is that the paramedic involved failed a significant number of professional standards, and this led to Mr A being given insufficient information, or a reasonable assessment to make a decision as to whether he should go to hospital.
It is also clear to me that the ambulance service's investigation into what happened was extremely poor. They appeared to have taken the crew's statements at face value without further investigation, and they failed to recognise the clinical failings and take action to address them. I upheld the complaint and made a number of recommendations.
Redress and recommendations
The Ombudsman recommends that the Scottish Ambulance Service:
- (i) consider the Adviser's comments in relation to the paramedic and ensure they take appropriate action;
- (ii) provide evidence they have procedures in place for paramedics to obtain clinical advice when on scene with complex patients;
- (iii) inform us of how they intend to improve and monitor record-keeping;
- (iv) inform us of how they intend to ensure their investigations into complaints are thorough and robust; and
- (v) apologise to Mr A's family.