Background
A woman complained to my Office following the birth of her first child in the National Maternity Hospital, Holles St in January 2011. She had been scheduled to have an elective Caesarean section, with epidural, and this was documented in her birth plan. The woman made two complaints - one in relation to the lack of information she received about the type of epidural which was to be administered to her and the process of obtaining her consent to it; the second issue related to the level of information provided to her about the complaints process itself and the fact that information for patients who wanted to make a complaint was not available on the hospital’s website.
In this case, the woman said that she was not provided with an opportunity to ask questions about the C-section or about the anaesthetic she was to receive before it had been administered to her. She said that prior to the procedure, she was met by a doctor who explained that an epidural was an anaesthetic administered through the spine. According to the woman, he then signed the consent form and pointed to the form where she was required to sign. When she told the doctor that she wanted to read the form before signing it, she claimed that he walked away. The woman felt that she had no option but to sign the form if she wanted the C-section to go ahead.
According to the woman, the doctor made four failed attempts to insert the epidural before a more senior doctor inserted it higher up her spine without difficulty. After the surgery, the woman said she was badly bruised along her spine and experienced back pain and numbness in her right arm, hand and fingers. Some time later, she discovered she had received a spinal epidural rather than an epidural anaesthesia, and she wrote to the hospital to complain that she was not given the information regarding the epidural in a clear and comprehensive manner to allow her to make an informed decision about her care.
She told the hospital that she was made to feel that the consent process was a mere formality and an annoyance to the medical team. The hospital responded to the woman’s complaint, telling her that the junior doctor should have given her an opportunity to read the consent form and to ask any questions. It also said that she should have had a better explanation of the spinal anaesthetic prior to its insertion. The hospital undertook to improve the distribution of information both verbal and written to patients prior to and on admission to the hospital. As the woman was not fully satisfied with the hospital’s response, she wrote to my Office.
Examination
In dealing with complaints about care and treatment in a hospital setting, I am precluded from examining issues pertaining to clinical judgement of doctors. That means that I cannot examine, by law, the judgement doctors use in diagnosing, treating or discharging a patient. However, I can examine issues relating to the seeking of consent to surgery as this is an administrative matter. My Office has a contract with the UK Parliamentary and Health Service Ombudsman which allows my staff seek independent expert clinical advice which helps to inform us on clinically related issues. In this case, my Office sought clinical advice with regard to how the woman’s consent to surgery and anaesthesia was obtained. The advice clarified that while it was normal practice to administer a spinal epidural (as distinct from an epidural anaesthesia which is most commonly used for emergency C-sections) when performing elective C-sections, the patient’s verbal consent to it should be obtained and documented in the records. While the woman in this case had given her written consent to the surgery itself, her verbal consent for spinal anaesthesia was not obtained. My Office wrote to the hospital and subsequently met with it to discuss this issue.
A spinal epidural is where medicine is injected into the fluid in the spinal cord whereas an epidural anaesthesia is where medicine is injected just outside the sack of fluid around the spinal cord.
Outcome
As a result of my Office’s involvement in this complaint, the Secretary/General Manager of the hospital wrote to the woman acknowledging that she should have been given a more thorough explanation of the spinal anaesthetic prior to its insertion. The hospital apologised for the fact that her verbal consent was not sought prior to administering the anaesthetic. It explained to her how the spinal anaesthetic was the preferred technique for elective caesarean sections being the simplest and most reliable to perform. As a direct result of this woman’s complaint, the hospital put arrangements in place to ensure that medical staff seek and record verbal consent to anaesthesia in the patient’s medical chart prior to surgery.
In relation to the complaints process within the hospital, it was clear from my Office’s examination of this particular complaint that the hospital had not published details of the complaints process on its website. Each hospital has a service level agreement with the HSE which compels it to advertise its complaints process, and a hospital’s website is an ideal location to do so. The hospital confirmed that it was reviewing its website and assured me that details about the complaints process would be published as part of the new website, which is now available.
Since the passing of the Ombudsman (Amendment) Act 2012, public bodies under my remit are legally obliged (under Section 7) to give reasonable assistance and guidance to members of the public and deal with them properly, fairly, impartially and in a timely manner. I would expect all public bodies including public hospitals to clearly advertise the complaints process so that service users who wish to complain understand how to go about it and are facilitated to do so.