An independent provider in the City of Bristol area

3.Mrs W complains about the care and treatment provided to her father, Mr A by the Trust on 13 January 2023. Mrs W specifically complains that:

• A paramedic failed to correctly read the results of an ECG scan for Mr A or take account of his presenting symptoms • The Trust have failed to ensure that the paramedic has undertaken the training recommended in the review, learn and improve process by South Western Ambulance Service NHS Foundation Trust (SWAFT) • The Trust have provided contradictory information from the complaint response to the review, learn and improve process completed by SWAFT.

4.Mrs W states that Mr A died due to the negligence of the paramedics who failed to appropriately treat Mr A. Mr A's death has had a huge impact on the whole family and left them all feeling angry that the lack of action by the paramedics led to his death. The investigation by the Trust into Mr A's death has left the whole family feeling more distressed.

5.Mrs W would like the Trust to acknowledge the mistakes made, put in place service improvements and to achieve a financial remedy.

6.What follows is a brief background to the complaint. We have not included all details as both parties are aware of the details.

7.Paramedics from the Trust attended Mr A’s home on 13 January 2023 following a 999 call from Mrs W. They completed an assessment including an Electrocardiogram (ECG) and discharged Mr A on scene. An ECG is a painless test that records the electrical activity of your heart, including the rate and rhythm.

8.Mr A’s son called an ambulance the following day on 14 January after Mr A had been found unresponsive at his home. He was pronounced dead by the ambulance crew who attended. On 15 March 2023, it was decided that this case met the Review Learn Improve (RLI) criteria at SWAST. SWAST completed the RLI report on 17 August 2023.

9.Mrs W and her sister raised a formal complaint with the Trust on 14 November 2023. The Trust provided a response to the complaint on 29 January. SWAST had a meeting with the family on 15 January to discuss the complaint and also provided a complaint response on 21 May 2024.

10.Mrs W raised her complaint with our office on 30 August 2024.

13.The law (HSCA 1993) says we cannot investigate a complaint where a person has (or had) the option to take legal action, unless we consider this is (or was) unreasonable in the circumstances. We have discussed this with Mrs W to understand her circumstances and the outcomes she wants. We do not consider whether legal action would succeed but whether it would be a reasonable option to look in to.

14.This translates into our own policy, the service model guidance and referred to as a ‘two stage legal test’ that we must look at before any consideration of a complaint. The two stages being are, is there a legal route and is it reasonable for the complainant to pursue?

Is there a legal route?

15.In reaching our view, we consider if a complainant has an opportunity to pursue their complaint legally. We refer to this as an ‘alternative legal remedy’ in relation to their complaint, based on the remedy they are seeking, one that a court could reach determination on.

16.Mrs W stated in her complaint form to our office that she believes the actions of the paramedics constitute clinical negligence. This was also detailed in the original complaint email to the Trust sent on 14 November 2023 by Mrs W and her sister.

17.The clinical negligence Mrs W is referring to is that a paramedic failed to correctly read the results of an ECG scan for Mr A or take account of his presenting symptoms when assessing him on 13 January 2023. Mrs W states that this led to her father’s death as he was not given all the information necessary to decide whether to attend hospital or not.

18.Mrs W adds that this has had a huge emotional impact on her and the rest of the family as well as a financial impact by missing work to attend meetings and deal with the complaint.

19.Mrs W is therefore alleging clinical negligence in that her father’s death could have been avoided had the paramedic correctly read the results of the ECG scan and taken account of his presenting symptoms.

20.Some of the points of Mrs W’s complaint would not be deemed as potential clinical negligence such as contradictory information in the complaint response and a failure to ensure highlighted training has taken place. However, it is clear from speaking to Mrs W that the main focus of her complaint, the primary issue, is the incorrect reading of the ECG scan results and failure to take account of Mr A’s presenting symptoms when assessed on 13 January 2023.

21.If there are any outstanding outcomes that cannot be achieved through the legal claim or Mrs W would like us to look at issues separately after legal action has concluded, she can bring the complaint back to us to consider further.

22.We do not consider whether legal action would succeed but whether it would be a reasonable option to look in to. Should clinical negligence be proven through legal action, the compensation could be a very significant sum. We are unlikely to be recommend financial remedy at the same level as that which can be achieved through legal action. Mrs W stated in that she would be looking to achieve financial remedy at the top end of level five at £12,450.

Is it reasonable to pursue a legal claim?

23.Next, after establishing there is a legal route, we have gone onto explore with Mrs W if it is reasonable for her to pursue. When considering reasonableness, the factors we take into account are based on the individual circumstances of a complaint.

24.I spoke with Mrs W regarding legal action during a call on 4 November 2024. Mrs W said that her family would find it stressful to pursue legal action. However, pursuing a legal remedy though the courts will often involve having a dedicated solicitor/ legal professional on a case who has a vested interest in winning the case. Mrs W would be required to discuss her complaint in the same way that she would be required to do if complaining to our office. It should not therefore involve any further stress than bringing the complaint to our office would involve.

25.I spoke to Mrs W on 28 November 2024 to clarify if there were any other barriers to taking legal action which Mrs W confirmed that there was not.

26.Mrs W is looking to achieve service improvements as well as acknowledgment of mistakes made and financial remedy of £12,450 which is the top of level five on our severity of injustice scale (a scale we use to determine levels of severity and financial redress). Mrs W is looking to achieve a high amount of financial remedy. Service improvements is not something that can be achieved through legal action although the Trust may choose to implement these as a byproduct of the issues raised if a claim is successful.

27.There is a limited amount of time to raise a clinical negligence claim and therefore it would not be appropriate to use this time up by investigating the complaint for service improvements. If Mrs W is looking to achieve service improvements and these are not achieved as a byproduct of a legal claim, then she can bring the complaint back to our office once legal action has been pursued. This would need to be within our 12-month time limit.

In conclusion

28.The law says we cannot investigate a complaint where a person has (or had) the option to take legal action, unless we consider this is (or was) unreasonable in the circumstances. We have engaged with Mrs W to understand her outcomes and if it is reasonable to pursue legal action.

29.Mrs W has until January 2026 to seek legal advice and pursue legal action if legal advice confirms she has a claim. We do not want to disadvantage Mrs W with regards to the amount of compensation she could achieve via legal action or the time she has to make such a claim. We may not be able to achieve the amount that legal action could achieve. Mrs W has the option to refer the complaint back to us if legal action is not an option to her or if all outcomes are not achieved.

30.We would not consider it fair to the Trust to potentially have to deal with two concurrent investigations if we were to investigate at the same time as legal action taking place. The main part of Mrs W’s complaint is the paramedic not correctly reading the ECG results or assessing Mr A’s symptoms appropriately.

31.We consider Mrs W has an alternative legal remedy available for the main part of her complaint. We also consider it is reasonable for her to pursue this. Therefore, this complaint by Mrs W has an alternative legal remedy.

32.Mrs W can return to us with any outcomes not achieved through the courts afterwards. There are time limits to the Ombudsman considering complaints (details can be found here https://www.ombudsman.org.uk/making-complaint/what-we-can-and-cant-help)

33.Should legal action not be available to Mrs W, then she can contact our office directly by contacting her caseworker by email or phone. In approaching solicitors please keep correspondence, names and account of activities. If Mrs W returns to us unable to pursue a legal route, then we may need to satisfy that this legal route has been exhausted.

34.For the reasons we have provided, we shall take no further action on the complaint as an alternative legal route exists and is reasonable to pursue. We appreciate how difficult it has been for Mrs W to speak about the events that occurred within this complaint and thank her for doing so.

1.We have carefully considered Mrs W’s complaint about Bristol Ambulance Emergency Medical Services (the Trust). We consider Mrs W could take legal action on the matters she has brought to us by way of a clinical negligence claim.

2.In conducting our work, we recognise the grief Mrs W has experienced with the death of her father and understand her concerns that had the appropriate care been given to her father, then his death may not have occurred. We acknowledge that the loss of her father in January 2023 is immeasurable.