Source · PSOW (Public Services Ombudsman for Wales)

Cardiff and Vale University Health Board

PSOW (Public Services Ombudsman for Wales) Not Upheld Reference PSOW-202001340 Sector Health Category Clinical treatment in hospital Decided 12 July 2021

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Full decision

Mrs G complained about Cardiff and Vale University Health Board’s (“the Health Board”) care, treatment and actions following her daughter’s, Mrs D, endoscopic retrograde cholangiopancreatography (“ERCP” – an examination of the pancreatic and bile ducts using a thin tube with a light and camera on the end). Mrs G said it caused her daughter internal bleeding, further health complications, and led to her premature death 6 weeks later.

The Ombudsman’s investigation found that whilst the ERCP procedure carried out by a Radiologist caused Mrs D to suffer a splenic bleed, which is a very rare occurrence, this was an accepted known risk of the procedure and Mrs D was made aware of this risk beforehand. The Ombudsman could find no evidence that the Radiologist was at fault.

Finally, the Ombudsman concluded that whilst Mrs D’s splenic bleed complicated her subsequent treatment following her previous diagnosis of pancreatic cancer, timely and appropriate action was taken, especially when Mrs D suffered pulmonary embolisms.

The Ombudsman did not uphold Mrs G’s complaint.

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Reference Date Summary Outcome
PSOW-202410002 30 Apr 2026 Ms C complained about the care and treatment provided to her late mother-in-law, Ms D, when she was investigated and … Partly Upheld
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PSOW-202510196 23 Apr 2026 Mr A complained that the Health Board inappropriately submitted three Multi Agency Referral Forms (“MARFs”) to the Council in relation … Resolved / Early Resolution
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