Royal Devon University Healthcare NHS Foundation Trust

3. Mrs D complains on behalf of her husband, Mr D, about the care and treatment provided by Royal Devon University Healthcare NHS Foundation Trust (the Trust).

4. She says the Trust placed a Do Not Attempt Cardiopulmonary Resuscitate (DNACPR) decision on 14 April 2023 and later changed this to Allow Natural Death (AND) decision on June 2024, in Mr D’s records without obtaining consent from Mr D or his family.

5. Mrs D says this caused Mr D significant psychological distress and left him feeling fearful and disregarded. She also says the events deeply affected their family, including triggering manic episodes in their autistic son.

6. As an outcome to her complaint, she wants an apology, service improvements and financial remedy.

7. On 14 April 2023, Mr D was admitted to hospital with breathing difficulties. He has chronic obstructive pulmonary disease (COPD), a group of lung conditions that cause breathing problems.

8. Mrs D says Mr D was confused and disoriented during this admission. She says a doctor discussed a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision with him. A DNACPR decision records that cardiopulmonary resuscitation (CPR) should not be attempted if a person’s heart or breathing stops.

9. Mrs D says Mr D agreed to the DNACPR decision while he was confused. She says he later told the doctor he did not want a DNACPR decision in place and asked for it to be removed.

10. Mrs D says she and Mr D later had a further discussion with the doctor and the DNACPR decision was removed.

11. Mr D was admitted to hospital again in June 2024. The Trust reinstated the DNACPR decision.

12. Mrs D says a further discussion took place with the treating doctor. Following this, the doctor removed the DNACPR decision and replaced it with an Allow Natural Death (AND) order.

13. Mrs D says Mr D later asked for the AND to be removed. She says the doctor decided to keep the AND order in place because it believed it was in Mr D’s best interests.

Issue 1 – the Trust placed a DNACPR decision, later reviewed and replaced with AND decision

16. The records show Mr D was admitted with pneumonia and reviewed by a consultant on 15 April 2023. During the consultant ward round, the consultant discussed Mr D’s Treatment Escalation Plan (a record of a personalised recommendation for a patient’s treatment and care in an emergency) and resuscitation wishes with him.

17. The consultant recorded Mr D agreed he would not want cardiopulmonary resuscitation if his heart or breathing stopped but wished to receive all other appropriate treatment, including non-invasive ventilation and intensive care if clinically appropriate.

18. The DNACPR form completed the same morning records that Mr D had mental capacity to make decisions about his care.

19. The Mental Capacity Act requires clinicians to presume a person has capacity unless there is evidence to suggest otherwise. We appreciate this was a worrying time for Mrs D and her family and she was concerned about her husband’s state of mind at the time. We have not seen evidence that Mr D lacked capacity. Although the records refer to intermittent confusion during his admission, no clinician recorded concerns about his decision-making ability, and there was no diagnosis of significant cognitive impairment.

20. Mr D discussed his medical history with the consultant in detail. This suggests he was lucid; he was able to understand what the doctor asked, recall the information and respond in a clear way. We have therefore not found evidence that the Trust needed to complete a formal mental capacity assessment before discussing the DNACPR decision.

21. The RCU guidance says a DNACPR decision is a clinical decision made by the responsible consultant. While clinicians should involve patients with capacity in discussions wherever practicable, consent from the patient or family is not required before making the decision.

22. The records demonstrate this happened. The consultant discussed the decision with Mr D before completing the DNACPR documentation and recorded his wishes.

23. Later that afternoon, when Mrs D and their son raised concerns, the consultant explained why the DNACPR decision had been made and apologised for any misunderstanding.

24. The records show that the consultant then spoke with Mr D again. It is documented in the records that Mr D wished the DNACPR decision to be withdrawn, and the consultant rescinded it immediately.

25. We consider this demonstrates the Trust listened to the concerns raised and reviewed the decision appropriately.

26. Mr D was admitted to hospital again in June 2024. The nurse noticed the previous DNACPR decision had been crossed through and questioned whether this had been done in error. The nurse reinstated the DNACPR decision. Mrs D and Mr D discussed this decision with the treating doctor.

27. Mrs D says the Trust changed the decision to AND decision without consent. The evidence indicates AND was simply an alternative description of the existing DNACPR decision.

28. We recognise why Mrs D found these events distressing and understand why she believes the Trust had decided not to continue treating her husband. We have not found evidence that support this.

29. The RCU guidance and the BMA guidance are clear that a DNACPR decision relates only to whether cardiopulmonary resuscitation (CPR) should be attempted if a person’s heart or breathing stops. It does not apply to any other aspect of a person’s treatment or care.

30. The records are consistent with this guidance. Following the DNACPR decision, Mr D continued to receive active treatment for his pneumonia, including intravenous antibiotics, oxygen therapy, investigations, regular nursing observations and ongoing consultant review.

31. The evidence shows the decisions was discussed with Mr D while he had capacity, reviewed after concerns were raised and rescinded following a further discussion with him.

32. For these reasons, we do not consider there is any indication that the Trust acted contrary to the relevant law, national guidance or professional standards., or that there are indications of maladministration in relation to this complaint.

1. We have carefully considered Mrs D’s complaint about the care and treatment provided by Royal Devon University Healthcare NHS Foundation Trust (the Trust).

2. We recognise the events complained about were upsetting for Mrs D and her family. Having considered all the available evidence alongside the relevant law, policy and national guidance, we have not found evidence the Trust acted wrongly when it made and later reviewed a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision for Mr D.