Ambulance should have taken frail, sick, older woman to hospital

What happened

Mrs D had diverticular disease and lived alone with visits from carers three times a day. In spring 2013 she started vomiting and developed diarrhoea. She sat in an armchair all night and the following morning, her carer found she had soiled herself.

The carer called an ambulance, and a clinician called back to assess Mrs D. A paramedic was sent to carry out a face–to–face assessment and decided that Mrs D's condition could be managed at home. He made a referral to the local admission prevention service for Mrs D to receive a carer visit in the afternoon to check on her.

The evening carer made a further 999 call and contacted Mrs D's son–in–law. The paramedic did not want to take Mrs D to hospital and her son–in–law had to call her daughter, Mrs A, to speak to him about Mrs D's medical history and conditions. The paramedic agreed reluctantly to take Mrs D to hospital.

Mrs D died soon after. The death certificate said she had septicaemia caused by diverticulitis and also acute kidney failure.

Mrs A complained to the Trust about the initial decision not to take Mrs D to hospital after the first 999 call and the inadequacy of the support for her. She also complained about the poor assessment and attitude of the second paramedic, particularly his view that hospitals are reluctant to take older patients with diarrhoea and vomiting because of the risk of cross infection.

What we found

We partly upheld Mrs A's complaint. Mrs D should have been taken to hospital after the first 999 call. Although she did not appear to have life–threatening symptoms, she was not able to use a commode without help, so it was not appropriate to leave her alone. The failure to take Mrs D to hospital sooner caused her avoidable distress, discomfort and loss of dignity.

The delay in getting hospital attention did not cause the sad outcome.

There were failings in the attitude and assessment of the second paramedic and some shortcomings in complaint handling.

Although there is a risk of cross infection from older patients with diarrhoea and vomiting, the decision to transport them to hospital must be based on an assessment of each person's condition, circumstances, and the risks associated with alternative courses of action. The primary consideration is the best interests of the individual patient.

Putting it right

The Trust fully acknowledged and apologised for failings in the second ambulance attendance. It has taken reasonable steps to prevent a recurrence. The Trust acknowledged and apologised for shortcomings in complaint handling and we believe that no further action is needed. As we consider that the Trust has done enough to put things right, we did not uphold this part of the complaint.

However, the Trust did not acknowledge failings in relation to the first ambulance attendance. The Trust's medical director should review this case and consider what action should be taken to learn from it so that it will not happen again.

The Trust apologised for the failure to take Mrs D to hospital in the first ambulance and for the impact this had. It has provided details of the action it has taken to improve its service.