Selected Investigations Completed April - September 1999

Parliamentary

Access to official information

Health

Parliamentary

Access to official information

Health

Hot topics

Cymraeg

Freedom of Information

Accessibility

Other Ombudsmen and complaint handlers

Feedback

Satisfied with our service?

Part II - Full Texts of Selected Investigations

Complaint against: Ashford and St Peter's Hospital NHS Trust

Complaint as put by Mrs X

1. The account of the complaint provided by Mrs X was that after a fall from a ladder on 3 July 1997 her husband was taken by ambulance to the accident and emergency (A&E) department of St Peter's Hospital, Chertsey (the NHS hospital). Mrs X saw an orthopaedic senior house officer (the orthopaedic SHO) and was told that her husband would be admitted to the NHS hospital and would undergo an operation on his broken wrists that afternoon. Later that day she received a telephone call at home from the orthopaedic SHO. He told her that no bed was available for her husband, and he could not say when he could be admitted to the ward. He suggested to Mrs X that they use her husband's private health care insurance. She agreed and her husband was admitted to a ward in a private hospital that shares the same site as the NHS hospital (the private hospital). The following morning Mrs X visited the private hospital and found that her husband was in the process of being transferred to the NHS hospital. She was told that he would now have to wait until the following evening (5 July) for his operation, but if she was willing to pay £2000 the operation could be done privately within three hours. Mr X was experiencing considerable pain so they decided to have the treatment done privately. The operation was performed privately on 4 July in the private hospital.

2. When Mr X was discharged from the private hospital on 16 July he received no information about aftercare. At subsequent outpatient appointments at the private hospital, staff told him that he was in urgent need of physiotherapy but that there was a long waiting list for such treatment on the NHS. Similar information was given to his general practitioner. Mr X therefore paid for private physiotherapy. However, the chief executive of the Trust subsequently stated that if Mr X had required an urgent referral he could have been seen by a NHS physiotherapist within three days.

3. On 10 July, Mrs X wrote to the Trust complaining about her husband's care and questioned why she should pay the bill for private treatment because no NHS bed had been available to her husband. The Trust's chief executive replied to Mrs X on 22 August but she was dissatisfied with his explanations and offer of a £500 ex-gratia payment. On 18 June 1998 the Trust's convener wrote to Mrs X refusing her request for an independent review panel.

4. The matters investigated were that:

(a) Mr X experienced an excessive delay in the A&E department;
(b) the Trust provided Mrs X with confusing and incomplete information about when her husband would have his operation done as a NHS patient and about NHS aftercare; and
(c) the Trust unreasonably refused to reimburse the costs Mr X incurred in having his operation done as a private patient.

Investigation

5. The statement of complaint for the Ombudsman's investigation was issued on 28 October 1998. The Trust's comments were obtained and relevant papers were examined, including Mr X's clinical notes. The Ombudsman's investigator interviewed Mr and Mrs X and the Trust staff involved. The Ombudsman's jurisdiction extends only to NHS care. Where events at the private hospital and the actions of staff there are mentioned in this report it is solely to place in context the aspects of Mr X's NHS care which have been the subject of investigation.

Mr and Mrs X's evidence

6. Mrs X told the Ombudsman's investigator that her husband was taken to the A&E department by ambulance at about 12.15pm on 3 July, after a fall from a ladder outside their home. He sustained injuries to his scalp, neck, wrists, elbow, fingers and back. He arrived at the A&E department at approximately 12.30pm. Mr X was seen on arrival by an A&E doctor who sutured the wound to his scalp. He was then taken to the X-ray department and was told by the radiologist that he had fractured both wrists. At about 2.30pm the orthopaedic SHO examined Mr X and explained that he needed to be admitted for an operation to manipulate his wrists back into place. At first, the orthopaedic SHO said the operation would be performed that afternoon. However, after discussing the case with the consultant orthopaedic surgeon (the consultant), he said that Mr X would be admitted to a ward for observation overnight and would undergo his operation the following day. The time was then 4.30pm. Mrs X said that she then returned home to tell her family about her husband's accident. When she left the hospital she was under the impression that he would soon be admitted to a NHS bed.

7. Mr X said that subsequently, while he was waiting in the A&E department, he was told he would be admitted to Elliott Ward. However, when a staff nurse arrived to collect him she was reluctant to take him there because of his head injury. Mrs X said that at about 5.30pm, she received a telephone call at home from the orthopaedic SHO. He told her that he was unable to find a NHS bed for Mr X and asked if he had any private health insurance. Mrs X confirmed that her husband had a health insurance policy with a private health insurer: she also explained that she was not sure whether it would cover this type of situation. The orthopaedic SHO told her that a private bed was the best option because he could not say when a NHS bed would become available. Mrs X agreed that her husband should be transferred to the private hospital, but said that she would need to check with her insurers. When she telephoned the insurance company later that day, she was told that her healthcare policy did not cover the proposed treatment. She immediately telephoned the orthopaedic SHO but he was not available. He returned her call the following morning—4 July—and she explained the problem with the health insurer. They agreed that Mr X would be transferred back to the NHS hospital and the orthopaedic SHO agreed to facilitate the move. Later that morning Mrs X visited the private hospital as her husband was being moved to the NHS hospital.

8. Mr and Mrs X said that while they were at the private hospital on 4 July the consultant told them that the NHS operating list was now full and that Mr X's operation would take place at the NHS hospital on 5 July, in the evening. He also said that if they were willing to pay the procedure could be performed within a couple of hours at the private hospital. Mrs X told the Ombudsman's investigator that she was very angry because the orthopaedic SHO had told her that her husband's operation would be done on the NHS on 4 July. No-one had explained that by moving across to the private hospital Mr X would lose his place on the NHS trauma list. She discussed the situation with her husband, who was experiencing considerable pain, and they agreed that he could wait no longer. Mrs X therefore signed an admissions agreement on 4 July (as I have seen) and paid a deposit of £2,000 to the private hospital. The operation was performed later that afternoon. (Note: in a letter to the Ombudsman's investigator the Trust said '....There were five trauma lists that week (one per day). The one on 3/7 ended at 17.05 (normal) and the one on 4/7 at 17.25 (late) so the lists were more or less fully booked. The orthopaedic team have a trauma meeting every morning at 8.00am. The list for the day is complied at the meeting and then sent to the theatre ....'.)

9. Mrs X said that her husband was discharged from the private hospital on 16 July 1997. Two weeks later, at a follow-up appointment with the consultant, Mr X asked whether he could revert to NHS status to receive physiotherapy for his wrists. The consultant told him that there was a six to eight week waiting list for physiotherapy in the NHS. Mr X decided to seek private physiotherapy from another private hospital. In a letter dated 14 August 1997 the Trust's director of nursing advised them that Mr X was entitled to NHS treatment and could seek a referral from the consultant or his GP (see paragraph 23). Mrs X said that her husband did not act on that letter because of the earlier advice he received from the consultant about NHS waiting lists.

10. Mr and Mrs X provided the Ombudsman's investigator with a breakdown of the medical expenses they had incurred which totalled £9,010.91 of which £5,921.91 represented the cost of the operation. Mrs X said that she considered the Trust should reimburse the £2,000 deposit they had already paid to the private hospital, and waive all the additional costs which had been imposed on them.

National standards

11. The Patient's Charter states that patients in A&E departments can expect to be seen immediately and have their need for treatment assessed; and, if admitted to hospital through an A&E department, they can expect to be given a bed as soon as possible, and certainly within two hours. Guidance issued by the Department of Health in 1992 makes it clear that where the Charter refers to something which a patient can expect this represents 'a level of service which the patient can expect to be delivered other than in exceptional cases.'

Trust response to the complaint

12. On 22 August 1997 the chief executive of the Trust wrote to Mrs X stating:

'....There are two orthopaedic wards at [the NHS hospital], Elm and Elliott. Head injury patients are for preference admitted to Elm because of its proximity to x-ray, the CT scanner, and intensive care, in the event of suspected or actual deterioration. In your husband's case, [the orthopaedic SHO] was happy for the admission to be to Elliott, but in fact a bed could have been made available on Elm by transferring a convalescent patient to the bed on Elliott. I must apologise if information given to your husband or yourself was inadequate or unclear in respect of a bed being available, albeit after a few hours' delay.

'While you exercised your own choice in deciding to arrange your husband's admission to [the private hospital], I acknowledge that the information you were given about bed availability at [the NHS hospital] may have been confusing or incomplete, and I apologise for this. The request for a £2000 deposit is a matter you may wish to take up with [the private hospital], but as a gesture of goodwill, I am able to authorize a payment of £500 in recognition of the additional distress and inconvenience that you experienced. .... Additionally, I have arranged with [the private hospital] to waive our charges for the CT scan which your husband had, and they will do likewise.'

13. In his formal response to the Ombudsman's office at the start of this investigation the chief executive wrote:

'.... Mr X was seen by the Orthopaedic [SHO] at 14.30 and the plan was to admit Mr X for neurological observations over the next 24 hour period and thereafter manipulation of both wrists under anaesthesia. Surgery would have been carried out on the next available trauma list due to the obvious risks associated with performing this procedure out of hours, particularly on a patient who had quite a significant head injury. The Bed Manager was then contacted once a decision to admit had been made to find a suitable bed for admission while Mr X remained in A&E.

'A bed was made available later that afternoon at approximately 16.30/17.30 on Elliott Ward (a surgical ward) but this was not initially thought suitable due to Mr X's head injury. Elliott Ward had earlier in the week taken another patient with a head injury whose condition had deteriorated quite suddenly on arrival to the Ward and the Nurse in Charge during the afternoon of 3 July felt reluctant to accept Mr X because of this earlier incident. However, it was agreed that another patient on Elm Ward (which is located on the same floor as ITU, x-ray and the CT scanner) could be transferred to Elliott Ward to allow Mr X to be admitted to Elm Ward (an orthopaedic ward) instead. This would have taken approximately half an hour to an hour to arrange and therefore Mr X's admission to Elm Ward would probably have been delayed until approximately 18.30.

'During the afternoon of 3 July, whilst Mr X was waiting to be admitted, he indicated to the doctor in A&E that he had private medical cover. As the availability of a bed in the hospital was unknown at this time and surgery would not be undertaken until the following day, it was agreed with Mr X that he would be transferred to [the private hospital] under the care of [the consultant]. The Orthopaedic [SHO] contacted [the private hospital] to make the necessary arrangements and subsequently rang Mrs X at home to appraise her of the situation. Because of the uncertainty expressed by Mr and Mrs X about the level of cover provided by their policy, Mrs X was advised to check this with their Insurers. Mr X was subsequently transferred to [the private hospital] ....

'On arrival at [the private hospital], we understand that Mr X was assessed and was scheduled to go to theatre at 13.30 the following day, namely 4 July. Mr and Mrs X signed an Admission Agreement with [the private hospital], which necessitated the payment of a deposit of £2000, with the full knowledge that there might be a problem with .... their private healthcare insurers. Mrs X subsequently telephoned the Bed Bureau and Orthopaedic Department at [the NHS hospital] during the morning of 4 July to advise them that their insurance policy did not cover acute emergency admissions and therefore her husband was not covered for private medical care. Mrs X requested that her husband be transferred back to [the NHS hospital] for his surgery. The Orthopaedic [SHO] then telephoned [the consultant] to inform him of the situation and informed [the consultant] that a bed was available on Elm Ward for Mr X to be transferred back. However, Mr X was advised that his surgery could not take place until the following day, namely 5 July, because the trauma list for 4 July was now full. Mr X had been scheduled to have his surgery undertaken privately at 13.30 on 4 July. Following a discussion between Mr and Mrs X and the Business Manager at [the private hospital] about their insurance policy, it is documented in the records held by [the private hospital] that Mr and Mrs X agreed that Mr X would stay at [the private hospital] and have his surgery done privately which they would finance themselves. We understand that, following surgery, Mr X remained a private inpatient at [the private hospital] for thirteen days.

'Following an investigation into Mrs X's complaint, it was acknowledged that there may have been some confusion during the conversations with the Orthopaedic [SHO] about how long they may have had to wait in A&E before being admitted. Given the heightened anxiety experienced by both Mr and Mrs X, they were naturally anxious that Mr X should receive treatment as soon as possible and chose to use their private medical insurance to achieve a prompt admission and prompt treatment. As a gesture of goodwill, I therefore offered Mr and Mrs X an ex gratia payment of £500.00 and agreed with [the private hospital] to waive the cost of some of the associated pathological and radiological examinations to ease their financial burden. This offer was rejected.

'Following Mr X's discharge from [the private hospital] we understand that he was advised of the need for physiotherapy and, after writing to [the NHS hospital] about this in August 1997, Mr and Mrs X were advised to contact their Consultant or General Practitioner to arrange an NHS referral. However, Mr X made the decision to have private physiotherapy and incurred additional costs as a result.

'In response to the matters subject to investigation .... :

'a) Mr X did not experience an excessive delay in A&E. He was seen on arrival at 12.31, referred to the orthopaedics team at 13.30 and seen by them at 14.30. A decision was then made to admit Mr X and a bed was made available later that afternoon at approximately 17.30 and Mr X would have been admitted to Elm Ward by approximately 18.30. We accept that four hours is in excess of the recommended two hour delay as outlined in the Patient's Charter but we do not consider this excessive, given the pressures with other emergency admissions to find available beds.

'b) We have acknowledged that the information provided to Mr and Mrs X about the length of time they may have had to wait for a bed was not as clear at it could have been. However, we do not accept that they were given incomplete information about when Mr X would have his operation. [The orthopaedic SHO] told Mr X that he would have his operation on the next available trauma list which was 4 July due to his head injury which required a 24 hour period of observation. With the transfer from NHS to private care, Mr X's surgery subsequently could not take place at [the NHS hospital] until 5 July as the trauma list on 4 July was full. However, Mr X's condition was neither life nor limb threatening.

'The issue of NHS aftercare was not our concern. Mr X had been treated as a private patient and any aftercare was therefore the responsibility of [the consultant] as a private physician and [the private hospital]. At any time, Mr X could have been asked to be treated as an NHS patient and his General Practitioner could have referred him to [the NHS hospital] for further treatment as an NHS patient.

'c) The Trust have not unreasonably refused to reimburse the costs incurred by Mr X having his operation done as a private patient. Mr and Mrs X signed an Admission Agreement with [the private hospital] with the full knowledge that there might be a problem with their private health insurers. They continued to seek private physiotherapy despite being advised to contact their GP for an NHS referral. [The Trust] is not liable to reimburse these costs.'

Documentary evidence

14. Mr X's clinical notes record that he arrived in the A&E department by ambulance at 12.31pm. He was assessed and examined by the A&E SHO who ordered tests, including X-rays of his chest, spine, pelvis, head and wrists. He also received 26 sutures to his scalp laceration. The orthopaedic SHO examined Mr X at 2.30pm and confirmed that he had fractured both wrists. The plan documented in the clinical notes was to admit Mr X to the NHS hospital for neurological observations over the next 24 hours and thereafter manipulation of the wrists under anaesthesia. There is no record in the notes of a telephone conversation between Mrs X and the orthopaedic SHO. The A&E admissions record states that Mr X was transferred to the private hospital at 6.00pm.

15. The Trust's records show that Mr X was the 16th patient to arrive in the A&E department on 3 July 1997. Of these patients, six, including Mr X, were recorded as requiring admission to hospital. The time they spent waiting for admission varied between 40 minutes (for a four year old child experiencing nausea and vomiting) and nine hours 40 minutes (for a 64 year old woman with a suspected fractured ankle who was admitted to Elm Ward).

Evidence of Trust Staff

16. An A&E staff nurse, who was on duty on 3 July 1997, told the Ombudsman's investigator that she could not recollect dealing with Mr X. The clinical notes confirmed that he had been treated as a 'priority case', which meant that he would have been seen on arrival by a team of doctors and nurses. She did not think that Mr X had experienced an excessive delay.

17. The staff nurse in charge of Elliott Ward said that she could not recall seeing Mr X on 3 July (paragraph 7). She would normally expect either the A&E department or the hospital's bed bureau to contact the ward once a decision was made to admit a patient. Nurses from Elliott Ward did not normally visit the A&E department. She felt that Mr X might have confused an A&E nurse with a nurse from the ward.

18. The orthopaedic SHO said he could not remember telephoning Mrs X on the evening of 3 July (paragraph 7). It was 'a fact of life' that it often took several hours to complete the process from the patient's arrival in A&E to transfer to the ward. In this particular case, Mr X had had two thorough examinations, where full histories were taken, and also underwent several tests. The orthopaedic SHO said that that, in itself, would have taken some time to complete. He acknowledged that from Mr and Mrs X's perspective, the delay might have seemed excessive. As far as he could recall, there had been no discussion with the nursing staff about transferring a patient from Elm Ward to release a bed for Mr X in the NHS hospital.

19. The orthopaedic SHO said that he also could not remember what information he had given to Mr and Mrs X about when Mr X's operation would be done as a NHS patient. However, he specifically remembered dictating a detailed note of the events shortly after Mr X left the NHS hospital. (Note: the Trust's patient liaison officer told the Ombudsman's investigator that she remembered seeing this note when she was preparing the Trust's response to Mrs X's original complaint. However, the Trust subsequently told him that they were now unable to locate it.) The orthopaedic SHO said that the timing of the surgery would largely depend on the length of the NHS trauma list for that day. The Trust did not have a designated officer to give advice to patients on the procedures for transferring to the private hospital. That responsibility normally fell to the junior doctors. He would normally speak to the consultant about private treatment and then liaise with the private hospital to arrange the patient's transfer. The staff at the private hospital would normally sort out the necessary paperwork. He recalled speaking to Mrs X on 4 July about the difficulty with her health insurer; and he remembered making some arrangements to transfer Mr X back to the NHS hospital. He had no further involvement once Mr X decided to stay in the private hospital.

20. The Trust's internal complaints file includes an undated statement from the pre-assessment and discharge sister of the orthopaedic wards (the sister). In the note she set out reasons why it was preferable for patients, who had suffered any head injury, to be nursed in Elm Ward rather than Elliott Ward. She continued:

'During the previous week a male [patient] had been admitted to Elliott [Ward] suffering from a head injury, he was awake and co-operative, but within a few hours his condition was causing grave concern. The difficulties listed above made the nurse in charge of the ward reluctant to accept another head injured patient. That is why we would have transferred a convalescing patient from Elm [Ward] to the empty bed on Elliott [Ward] thus vacating the bed on Elm [Ward].

'.... I think [I] must have found out from the Bed Manager's records that the bed was available at 5.30pm - maybe somebody was discharged then - it would have taken approx[imately] 1/2—1 [hour] to arrange to swap the patient and bed.'

21. The sister said that she produced this statement in the Summer of 1997, after Mrs X's complaint had been received. The senior nurse manager had asked the sister to produce a report setting out how she would have dealt with the admission. Her report was not based specifically on events relating to this case.

22. The consultant said that the orthopaedic SHO had telephoned him on 3 July to say that he had a patient in the A&E department who wanted to be treated privately. The orthopaedic SHO noted that Mr X had received private treatment in the past for a back injury; and the consultant had assumed that Mr X again wanted private treatment. The consultant said that he was not aware of any difficulty in finding a bed for Mr X in the NHS hospital. He recalled seeing Mr X at the private hospital on 4 July (paragraph 8), but he was unable to recall the precise details of his conversation with Mr and Mrs X. He thought it unlikely that he would have said that Mr X's operation could not be performed in the NHS hospital until the following day. He did not usually have that sort of information to hand. The timing of Mr X's operation would have been decided by clinical priority. He would probably have explained that Mr X would have to take his turn on the next NHS trauma list. The consultant did not think that Mr and Mrs X were given confusing or incomplete information about when he would be operated on as a NHS patient. They had opted for private treatment. He said that Mr X's plaster casts would have been removed from his wrists, six weeks after his operation. He recalled discussing the need for physiotherapy with Mr X in general terms, but could not recall exactly what was said about aftercare.

23. The director of nursing said that in a letter dated 12 August 1997 Mrs X mentioned her husband's physiotherapy and aftercare requirements. In her reply of 14 August the director of nursing stated '.... Your husband will be entitled to NHS treatment, and I would like to recommend therefore that you contact either your husband's Consultant or his GP urgently and for him to be referred to [the NHS hospital] for physiotherapy ....'. The director of nursing said that if Mr X had acted upon her invitation, his physiotherapy could have been undertaken within the NHS and it would not have become an issue.

24. The chief executive said he regretted that Mr and Mrs X's insurers were unwilling to cover the cost of Mr X's private treatment. Mr X was given the option of transferring back to the NHS hospital on 4 July, but decided to remain in the private hospital. He sympathised with Mr and Mrs X's financial difficulties; but he reiterated that they had chosen private treatment despite the offer of an NHS bed and a place on the NHS trauma operating list. As the Trust's accounting officer he could see no justification for reimbursing the costs Mr X incurred in having his operation performed as a private patient. However, the offer of a payment of £500 which he had made to Mr and Mrs X (paragraph 12) remained open, as did the offer to waive the charges for Mr X's CT scans—a further £900.

Advice from the Ombudsman's internal professional adviser

25. One of the Ombudsman's internal professional advisers—a hospital consultant—has advised me that there were no pressing clinical reasons why Mr X should have been admitted to a ward before 6.00pm. However, he considers that, bearing in mind his injuries, it was unreasonable that he had to wait in the A&E department for such a length of time without, apparently, any indication about when and how he might be admitted. Similarly, he also considers that although it would have been preferable if the operation had been performed on 4 July, it was reasonable, from a clinical point of view, for it to be undertaken the next day.

Findings (a): wait in A&E department

26. Mr X arrived in the A&E department on 3 July 1997 at about 12.30 pm. He was assessed and treated quickly; and at 2.30 pm he was examined by the orthopaedic SHO, who decided that he should be admitted. Up to that point I do not consider that there was any undue delay. However, the evidence relating to the period from 2.30 pm to 6.00 pm, when he was eventually admitted to the private hospital, is confusing: contemporaneous documentary evidence does not establish the position, and it is unsatisfactory that the detailed note prepared by the orthopaedic SHO (paragraph 19) cannot be located. I have no reason to doubt that at some stage during the afternoon of 3 July, Mr X was told that he would be admitted to Elliott Ward, but that concerns were subsequently expressed by nursing staff that that ward would not be appropriate for him because of his head injuries. It would appear from the sister's statement (paragraph 20) that, in the event, a bed did become available on Elm Ward at 5.30 pm. However, there is no firm evidence to support the Trust's contention (paragraph 13) that Mr X would have been transferred there by approximately 6.30 pm. Indeed, Mrs X's account of her telephone conversation with the orthopaedic SHO supports the view that it was not known when an NHS bed would become available. I suspect that during their handling of the complaint the Trust might have incorrectly assumed that the sister's statement was specifically referring to this case. I have not seen any evidence that either Mr and Mrs X, the orthopaedic SHO or indeed any other member of staff responsible for Mr X's care at the time were told about the availability of that bed on Elm Ward. If they had, I find it hard to see why Mr X should have agreed to proceed with the transfer to the private hospital at 6.00 pm. It is unfortunate that the option of seeking private treatment became such a complicating and dominating feature in this case. The Trust have acknowledged that the information Mr X was given about bed availability in the NHS hospital might have been confusing and incomplete. I believe there was a serious failure in communication in this regard and a lack of co-ordination in the admission arrangements. I consider that, against that background, the time Mr X had to wait in the A&E department after 2.30pm was unreasonable. To that extent I uphold this complaint.

Findings (b): information about when operation would be done and about aftercare

27. I deal first with information about when the operation would be done. Again I have no reason to doubt Mrs X's evidence that the orthopaedic SHO told her that Mr X's operation would be done on the NHS on 4 July (paragraph 8); and if Mr X had been admitted to the NHS hospital on the evening of 3 July there would, presumably, have been no undue complication about that. However, by spending the night of 3/4 July in the private hospital Mr X effectively removed himself from the list on 4 July for such an NHS operation. That was an important consideration which should have been properly explained to him before he agreed to transfer to the private hospital. I have seen no evidence that it was, and to that extent I uphold this aspect of the complaint.

28. Turning to information about aftercare, the chief executive has said (paragraph 13) that that was not the Trust's concern. Mr X had been treated as a private patient, and any aftercare was therefore the responsibility of the consultant as a private physician and the private hospital. Mr and Mrs X have said that the consultant told them that there was a six to eight week waiting list for physiotherapy in the NHS. The consultant could not recall exactly what was said about aftercare. However, at that stage the consultant was acting in his private capacity so it is not open to the Ombudsman to comment on any advice he might have given. The subject of physiotherapy and aftercare was raised with the Trust in Mrs X's letter of 12 August 1997 (paragraph 23). The director of nursing responded promptly, suggesting that Mr X seek an urgent NHS referral from the consultant or Mr X's GP. Mr and Mrs X chose not to follow that advice. I can see no grounds for criticising the Trust in respect of information about Mr X's aftercare, and therefore I do not uphold this aspect of the complaint.

Findings (c): refusal to reimburse costs

29. The chief executive has said (paragraph 13c) that he does not consider the Trust have unreasonably refused to reimburse the costs incurred by Mr X having his operation done privately because Mrs X signed an admission agreement with the private hospital in the full knowledge that there might be a problem with their private health insurers; he also continued to seek private physiotherapy despite being advised to contact their GP for a NHS referral. Questions of liability are for the Courts to decide, not the Ombudsman. The purpose of this investigation has been to determine whether Mr and Mrs X have suffered hardship or injustice as a result of maladministration by the Trust and, if so, whether reimbursement of their costs might be a reasonable remedy.

30. In recognition that the information given about bed availability in the NHS hospital might have been confusing or incomplete, the Trust have offered Mr and Mrs X an ex-gratia payment of £500. They have also arranged with the private hospital to waive the charges for the Mr X's CT scans - a further £900. This investigation has shown that Mr and Mrs X were given inadequate information about the availability of an NHS bed on the evening of 3 July. However, it has also shown that on the following day Mr and Mrs X were given an account of the situation and the choices open to them. Mr X decided to opt for private treatment despite the offer of a bed in the NHS hospital and in the knowledge that he and his wife were likely to be asked to meet the resulting costs. It is unfortunate that this situation arose and I do not underestimate the pain and discomfort that Mr X experienced on 3/4 July. However, I consider that he and his wife must accept some responsibility for their own decision to opt for private treatment. I am advised that it was reasonable from a clinical point of view for it to have been undertaken on 5 July. I can understand his wish to have it done earlier but I do not consider the private option was the only course open to him on 4 July. In the circumstances, I do not think it would be appropriate to expect the Trust to reimburse all the costs incurred in having his operation done as a private patient. During the course of the investigation, the Trust's chief executive confirmed that the offer an ex-gratia payment and the waiving of Mr X's CT scan charges remain available to Mr and Mrs X. I consider that offer to be reasonable. I do not uphold the complaint.

Conclusions

31. I have set out my findings in paragraphs 25-30. The Trust have asked me to convey—as I do through my report—their apologies for the shortcomings which I have found.

Previous < Contents > Next

Short text of this investigation

Last updated: 9 January 2006