Clinical care of an older man was appropriate

What happened

Mr M was in his late seventies. In 2011 he was admitted to the Trust's hospital from another hospital for continued investigation. He suffered from liver abscesses and possible strictures in his biliary duct (tubes to carry bile) that were related to either infection from a stent (a tube previously inserted to keep his biliary duct open) or a tumour. He also had fluid in his abdomen.

After Mr M had been in the hospital for about two weeks he wanted to go home and his Family talked to doctors about outpatient, rather than inpatient, treatment for him. His doctors had misgivings about outpatient treatment because this would mean that they could not monitor or treat Mr M in a way that they wanted to. Doctors wanted to perform a procedure to replace Mr M's stent, but when they talked to him about this he refused to have it done without a general anaesthetic. So doctors discharged Mr M home with oral antibiotics.

Doctors continued to review Mr M in outpatients and when his condition deteriorated (partly as a result of a side effect of his antibiotics), he was readmitted. Mr M stayed in hospital for almost a month before he was discharged home again with oral antibiotics. Again there were side effects, so Mr M stopped taking his antibiotics. He died a few days later.

What we found

We did not uphold this complaint. It would have been established good practice to have administered six weeks of intravenous antibiotics. Had this happened, it was likely that Mr M would have recovered from his illness, although this was not certain. However, the reason Mr M did not receive continuous intravenous antibiotics was because he had insisted on leaving the hospital. Mrs M argued that she and her Family did not know how important it was that her husband should remain in hospital. We found that doctors' communication with Mr M and his Family had been frequent and clear, and that on occasion Mr M had not followed their advice or had refused treatment or procedures.

Mrs M also said that her husband should have been fed intravenously, but the advice we received was that this would not have been appropriate. Mr M needed to eat normally or agree to having a nasogastric tube (a tube inserted through the nose to allow him to be fed directly into his stomach) inserted, but he refused this.

Doctors in the hospital had assessed Mr M's condition and arranged the investigations and treatment he needed in line with the General Medical Council's Good Medical Practice. It would clearly have been better if Mr M had remained in the hospital, but given his apparent dislike of hospitals, his refusal to eat and his desire to leave hospital, the decisions the doctors made about his care and treatment were based on all relevant considerations.