Decision Report 201300199

Summary

Ms C complained on behalf of her brother (Mr A). In April 2012, Mr A was admitted to hospital as an emergency suffering from an arteriovenous malformation (AVM - an abnormal collection of blood vessels in the brain where bleeds can occur, and which can be life-threatening). There are three approaches to treat an AVM, two of which the hospital considered, but thought unsuitable. Mr A was then discharged and told that he would be referred to a hospital in England for the third type of treatment. Ms C complained that there was an avoidable delay in providing this.

As part of our investigation, we took independent advice from one of our medical advisers, who is a consultant neurosurgeon. Evidence obtained during the investigation showed that on admission, Mr A's treatment was appropriate and reasonable as were the attempts to address the AVM. We found that the three types of treatment were options (not requirements) and that Mr A's case had been appropriately referred to the English hospital for consideration, although after a long delay. Ultimately, that treatment was also found to be unsuitable, as in the clinicians' view, it could cause more harm than good. (This had not been Ms C's understanding, as she had thought the treatment was essential.)

After careful consideration, although no treatment was ultimately available to Mr A, we upheld the complaint because of the avoidable delays in referring his case on for consideration.

Recommendations

We recommended that the board:

• formally apologise to Ms C and her brother for the delay and confusion over his referral;
• review referrals within the department of neurosurgery and satisfy themselves that these are made in a timely manner and that communication is clear; and
• review the situation in the department of neurosurgery with regard to discharge letters and satisfy themselves that they are typed and issued within appropriate time limits.