Case Studies / IMCA Client E

IMCA Client E

E was a hospital patient in Cardiff. Prior to her admission, E had been living in her own home, receiving assistance from a private carer who stayed overnight for two nights of the week. E was found on the floor of her property by the carer and it was later discovered that she had fractured her fibula and tibia. E expressed great concern at the prospect of having the cast on her leg removed. E did not believe that she was on the correct ward and believed that she required more of a neurological input in terms of her health.

Barriers faced in being heard:

On meeting, the IMCA found that E was both coherent and adamant in her sentiment that she would be more appropriately treated on a neurological ward. E felt she has deteriorated since her admission to hospital, detailing her time on the ward as being “bad for her mental health.”

E expressed that one of her main points of concern was she felt there was no consistency in her treatment from ward staff. E said some members of staff would assist her in walking to the toilet, whilst others would use a combination of a hoist and wheelchair. E stated that this inconsistency had resulted in her being non-compliant with medication.

On several occasions, E stated that she did not trust ward staff. E’s mistrust of the staff is likely attributed to an earlier incident in which E fell from the hoist, leaving her shaken and distressed. Staff informed the IMCA that on several occasions E had been due to have an x-ray to determine the appropriateness of removing her leg cast. Staff stated that in each instance E had refused to allow it. On questioning E, the IMCA identified that when the cast had been removed previously, E’s leg had been manipulated into a particularly painful position. Following this incident, E had raised her concerns to medical staff, however such concerns had never been addressed.

E told the IMCA that since her admission to the ward a number of her personal belongings had gone missing. Such items include clothing and a £300 set of dentures. E is restricted and unable to eat certain foods resulting from the fact that she does not have the appropriate dentures.

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Advocacy undertaken:

  • On accessing E’s medical records, it was apparent to the IMCA that the two stage capacity assessment in relation to medical treatment and discharge planning had not been conducted.
  • E was subject to a Deprivation of Liberty Safeguard (DoLS) containing three conditions in conjunction to the standard authorisation. The IMCA noted that that none of the conditions had been satisfied. One condition was the requirement of a financial capacity assessment in relation to E’s finances. This assessment was never carried out and so E’s friend continued to manage E’s financial affairs, without the prerequisite legal framework being implemented.
  • Subsequent to the IMCA’s discussions with E and various member of staff, the IMCA requested a part 8 review of the standard authorisation.
  • The IMCA highlighted E’s wishes and views to the hospital staff in relation to her experiences on the ward and so in this respect E’s concerns were being heard for the first time.
  • The IMCA presented concerns in respect of the non-compliance with her DoLS authorisation to the relevant signatory for the deprivation and subsequently a part 8 review was held which the IMCA attended.

Outcomes:

Following the Part 8 review request by the IMCA, the DoLS was allowed to lapse due to the fact that E’s capacity was called into question by her consultant.