Miss A complained that there were missed opportunities to make an earlier referral and/or undertake investigations by Cardiff and Vale University Health Board (“the Health Board”) in respect of her pregnancy losses between April 2021 and September 2022. She also complained that there was maladministration in the handling her complaint and in particular, that delays impacted negatively on her potential treatment options.
The investigation found that Miss A and her partner were referred to the Wales Fertility Institute shortly after they met all of the eligibility criteria. It also found that karyotype (a process used to examine chromosomes) testing was considered at the appropriate time and that it was reasonable of the Health Board not to recommend a hysteroscopy. The investigation found that there was no clinical indication for Miss A to have been prescribed folic acid before she was referred to the Wales Fertility Institute and that the Health Board took reasonable steps to inform Miss A of the results of genetic testing following her fifth pregnancy loss. These parts of Miss A’s complaint were not upheld.
The investigation found that the Health Board’s failure to send tissue from Miss A’s fourth pregnancy loss for genetic testing was a source of lasting uncertainty to her, which was an injustice. It also found that there was a missed opportunity to resolve aspects of Miss A’s complaint sooner. These parts of Miss A’s complaint were upheld.
The Health Board agreed to apologise to Miss A for the failings identified in the investigation. It also agreed to remind staff who investigate complaints of the potential options to provide an early resolution to aspects of complaints.