Clinical treatment outside hospital; Other : Betsi Cadwaladr University Health Board

Ms X’s complaint related to the care and treatment that she received after her medication for Crohn’s disease was increased in 2015. Specifically, Ms X complained that the Health Board failed to properly monitor her while she was taking Humira (a biologic medicine, which made from proteins or other substances produced by the body, used to reduce inflammation by acting on the immune system), or review the medication in terms of it being the possible cause of her new symptoms, after the dosage was increased. She also complained that there was a failure to follow up on her deteriorating condition, despite her repeated requests to be seen by her Consultant, and there was a delay in confirming she had drug induced lupus (lupus is an autoimmune disease where the body’s natural defence system attacks healthy parts of the body and causes inflammation). Lastly, Ms X was concerned that the Health Board’s complaint response incorrectly referred to Systemic Lupus Erythematosus (“SLE”) despite her never having been diagnosed with this.

The investigation found that as a diagnosis of drug induced lupus had not been confirmed and was in fact unlikely, it could not be concluded that there had been a delay in this diagnosis. The Ombudsman also considered it not unreasonable for SLE to have been referred to in the complaint response as part of the Health Board’s considerations about whether Ms X had drug induced lupus. As a result, the Ombudsman did not uphold these complaints.

Following on from this, whilst Humira was not initially considered as a possible cause of Ms X’s symptoms and so stopped at an earlier stage, this did not cause a significant injustice as it was unlikely that Ms X had drug induced lupus. Nevertheless, it indicated the lack of a joined-up approach to Ms X’s care and poor communication between the specialist teams involved.

Overall, the Ombudsman found that Ms X was not adequately monitored or reviewed while she was taking Humira over an extended period of time, which was an injustice to Ms X at a time when she was increasingly concerned with the symptoms that she was experiencing. Although the Ombudsman could not reach a conclusion specifically on Ms X’s concerns about her repeatedly requesting to be seen by her Consultant, broader failings in the communication between specialties and a lack of continuity in Ms X’s care contributed to the confusion about who was to see her and in which hospital. This represented an injustice to Ms X as she felt she was not getting the help that she needed. Therefore, the Ombudsman upheld these complaints.

The Ombudsman recommended that the Health Board:

• Apologise to Ms X for the failings identified.
• Offer a payment of £500 to her in recognition of the distress that these caused.
• The report be shared with the clinicians involved in Ms X’s care to reflect on its findings.

Furthermore, within 4 months of the final report, the Ombudsman recommended that:

• Ensures that there are formalised review processes for patients receiving biologic treatments (such as Humira) in terms of the monitoring of their condition and for when repeat prescriptions are issued.
• Reviews the method of communication between the specialty teams involved in the complaint and to consider what steps should be put into place to satisfy itself that there is a continuity of care for patients when Locum Consultants are regularly used.