Summary
Miss C complained about how the board had treated her finger injury, and how they dealt with her complaint. Miss C was employed on a dairy farm, where she suffered a crush injury to her left ring finger. Miss C was taken to the Dumfries and Galloway Royal Infirmary where she underwent surgery. Miss C said she had been told that her finger would undergo a partial amputation, which she had consented to. This procedure would have allowed her to return to work in the shortest possible time period.
Miss C said that she had asked to speak to the board's complaints team to make a formal complaint whilst still on the ward, but that no action had been taken by the board. She had subsequently submitted a formal complaint, but the board had maintained the surgery she underwent was the surgery she had consented to.
We took medical advice on Miss C's treatment and the consent process undertaken by the board. The advice said that Miss C had not had her consent properly recorded. The procedure that was undertaken was not that listed on the form. Additionally no record had been made of any discussions with her, despite the form containing clearly marked sections for this. The advice said no treatment plan was recorded, nor was the rationale for performing surgery other than a partial amputation recorded. The advice stated the failure to perform a partial amputation on Miss C's finger had significantly prolonged the healing process and it was clear from her submissions that her primary motivation was to return to work as soon as possible.
We found the board's records of the consent process were inadequate and that the operation performed on Miss C was not the procedure she had consented to. The board were unable to explain this, instead maintaining that Miss C had undergone the appropriate surgery. We also found the board's investigation into Miss C's complaint had been inadequate. It had failed to identify the lack of records supporting her consent as a concern and had failed to obtain a statement from the doctor responsible for documenting this and performing the surgery for his actions. Additionally the board's complaint response misrepresented the records of Miss C's interactions with medical staff and failed to address Miss C's concerns about the financial impact of the surgery on her.
Redress and recommendations
The Ombudsman recommends that the board:
- review their process for obtaining informed consent, taking account of the failings this investigation has identified and relevant guidance in this area;
- provide evidence Doctor 1 has undergone training and suitable continuing professional development courses to improve their communication skills and understanding of the consent process;
- carry out a significant event analysis ensuring that Doctor 2 reviews his understanding of the consent process and the definition of a finger terminalisation procedure;
- provide evidence that both Doctor 1 and Doctor 2 have reflected on the failings identified in this report as part of their appraisal process;
- review their complaints investigation in light of the comments from the adviser;
- review their handling of Miss C's complaint in order to identify areas for improvement and ensure compliance with their statutory responsibilities as set out in the 'Can I Help You' guidance; and
- apologise for the failings identified in the report, acknowledging that the procedure performed on Miss C was not the one that she wished to have carried out.