Clinical treatment in hospital : Swansea Bay University Health Board

Mr A’s complaint centred on his care and management at Morriston Hospital (“the Hospital”). He complained that the Swansea Bay University Health Board (“the Health Board”) failed to accurately diagnose giant cell arteritis (“GCA” – inflammation in the lining of the arteries especially in the temple) and provide timely treatment following his visit to the Emergency Department (“ED”) on 21 February 2021. The Health Board also failed to inform Mr A that it did not offer a temporal artery biopsy (a procedure to remove a section of the artery for testing) to rule out GCA despite him being told in the ED it would be done urgently. Mr A said that the Health Board did not monitor his blood infection marker and manage his medication (prednisolone) in line with national guidance and that his GP was not informed of his management plan. Finally, Mr A said that the Health Board did not provide a robust complaint response.

The Ombudsman’s investigation concluded that Mr A was diagnosed with GCA when he attended the ED in February, the medication was started and he was monitored as recommended by national guidance. The Ombudsman, having considered evidence, found no reason to believe that Mr A’s GP was not informed about his management. The Ombudsman welcomed the Health Board’s introduction of a new IT system which would enable seamless access to patient records. For these reasons the Ombudsman did not uphold these aspect of Mr A’s complaints.

The Ombudsman was satisfied with the explanation provided by the Health Board about how suspected GCA’s are managed. The investigation however, found shortcomings in communication with Mr A about the unavailability of such biopsies, as he had been given contrary information that he would require an urgent biopsy. The Ombudsman concluded that the Health Board’s failure to update Mr A regarding biopsies was an injustice caused to him and his family as this unnecessarily prolonged additional stress and anxiety which could have been avoided. The Health Board had identified shortcomings in its handling of Mr A’s complaint and measures had been put in place to address these. The Health Board, as redress to Mr A, for the inconvenience caused to Mr A by its poor complaint handling, had offered Mr A an ex-gratia payment of £500. The Ombudsman was disappointed that the Health Board’s investigation and subsequent complaint response was not sufficiently robust or transparent. Given that this added to the inconvenience, distress and additional stress caused to Mr A, these aspect of Mr A’s complaints were upheld.

The Ombudsman recommended that the Health Board apologise to Mr A for the failings identified by the investigation, and offered to make a payment to him of £500 in recognition of the inconvenience caused to him as a result of its poor complaint handling. The Health Board was asked, to share, at an appropriate clinical forum, the points of learning from this case to raise awareness of the sight-threatening complications of GCA and the importance of timely intervention in accordance with national guidelines, and to explore the potential for development of a temporal artery biopsy service once theatre capacity normalises following the COVID-19 pandemic.