Decision report 201100756

Summary
Mrs C complained that aspects of her mother (Mrs A)'s care and treatment in hospital before her death were of an unreasonable standard. On investigating the complaint, we found that much of the care and treatment that the board provided to Mrs A was reasonable and appropriate. We also found that the board had acted reasonably when they had discharged Mrs A after a previous admission to hospital. We found that there was no requirement for the board to discuss with the family or seek permission from them when they subsequently put a Do Not Attempt Resuscitation order in place, as Mrs A was able to make her own decisions at that time.

However, one of Mrs C's complaints was that the board had delayed in diagnosing a brain tumour. We received medical advice that a mini mental state examination (MMSE) should have been carried out when Mrs A was first admitted to hospital, as she was confused on admission. A brain scan should also have been considered if the MMSE results were abnormal. That said, an MMSE was carried out several months later and this was normal. Therefore, it was not possible to comment on what, if any, difference carrying out an MMSE on Mrs A when she was first admitted would have made to her prognosis. The board had written to Mrs C to apologise for the distress caused as a result of the delay in diagnosing her mother's condition.

We found that the board's communication did not meet the needs of Mrs A's family. The board had written to Mrs C stating that communication could have been improved. They said that a number of measures would be taken to improve communication between staff and to relatives. They also apologised that communication had been poor. We upheld the complaint because of these failings. However, in view of the board's response to Mrs C on these points, we had no recommendations to make.