Coroner hits out after family kept in the dark over plans not to revive a patient
09:10 04 February 2013
The Norfolk and Norwich University Hospital has been told to change its policy for dealing with relatives of patients after a family wasn’t told of a decision not to revive a 69-year-old.
Norfolk coroner William Armstrong said it was of “grave concern” that the family of James Noble, who died at the hospital on March 15 last year, had not been given the information.
The condition of Mr Noble, from Hingham, was worsening, and the decision not to revive him was made by his doctor in the days before his death.
But Mr Noble’s son and daughter, Tim and Sarah, were not informed, and therefore not given the right to challenge the decision, the inquest heard.
Mr Noble’s children attended Friday’s Norwich inquest and expressed concerns at the lack of communication. They called for a solid policy to be introduced regarding contacting families.
Mr Noble said that he would have challenged the decision not to resuscitate his father - even though there was no evidence it was not the correct one - had he known about it.
The family said they only found out about the decision due to a hospital error, as an attempt had been made to revive their father on the day before he died, because the doctor’s decision not to revive him had not been passed on.
They said they had also not been told of the deterioration in their father’s condition, so were not given the chance to spend more time with him before he died.
Dr Kimuli Ryanna, who treated Mr Noble at the hospital, apologised to the family for the lack of communication.
She said there was a generic policy to inform a patient’s family of such decisions, but it had obviously not been done.
However, there was nothing in the trust’s policy dated November last year to say that relatives must be informed of such decisions.
She said: “Mr Noble was not able to make the decision, and unfortunately, the family was not present in the ward. The hospital has acknowledged that it was a matter of distress for them that they did not know about the decision.
“There is an existing policy at the trust regards communication with the patient’s family about decisions not to resuscitate, but it was not adhered to in this case.
“Due to this case, we have reviewed the practice and improved communications.”
She said that on March 14 last year, Mr Noble went into cardiac arrest and his condition deteriorated throughout the course of the day.
She added: “There was an attempt to resuscitate him, sadly because my notes had not be communicated to the ward. This attempt should not have been made.”
Mr Noble was pronounced dead the following morning and the cause of death was given as a strain of bronchial pneumonia.
Dr Ryanna added: “I would like to add my condolences to the family, and the points the family have made about communications have been noted and taken forward.”
She added that hospital staff always tried to contact the patient’s family should there be a deterioration in their health.
Mr Armstrong recorded a verdict of death from natural causes, and said: “I will ask the hospital trust to consider whether there needs to be a revision in its policy, and whether it should be made clear that, when a patient lacks capacity, the family should be told of any decision not to resuscitate.”
Mr Noble, a retired builder’s merchant, also suffered from a heart condition, renal impairment and diabetes.
Mr Armstrong added: “From what the family has told me, Mr Noble was a good, caring, jovial family man, who gave of himself to others. His life is worth celebrating.”
After the inquest the family said in a statement that they were pleased with the verdict and shared his concerns about the current hospital policy with regards to their obligation to communicate with and involve the family when making life and death decisions about their close relatives. They added: “We hope that this may help to bring about a change to hospital policy to save other families going through similar distress to ours, and that something positive will emerge from our father’s death.”
Professor Krishna Sethia, medical director for the hospital, said afterwards: “We can confirm that the trust has a clear policy which states that relatives are consulted and their views are considered where attempting resuscitation is not appropriate for a patient. We will review the policy in light of any comments the coroner may make.”
The case comes just four months after a family spoke of their anguish at being unable to say goodbye to a brother, after medical staff failed to tell them he was in hospital, despite requests recorded on medical notes that his next of kin should be informed.
Terry Raper, 66, from Norwich, died at the Norfolk and Norwich University Hospital before he could be visited by his sisters and the rest of his family. The hospital has since changed its policy.