Ref: MD/DP/3202

13 August 2010

Dear Mr Kinloch

Thank you for your letter of 5 July 2010, regarding the treatment you received at Doncaster Royal Infirmary following your stroke. I am very sorry it has taken us so long to reply.

I have copied your letter to the staff involved in your care and asked them to comment on your observations. Judith Clarke, (Matron for Medicine and Emergency Medicine), has also assisted me in the investigation of your concerns. Matron Clarke has discussed your medical care with Dr Chadha (Consultant Physician) and also with Sister Shirley Fearn who is in charge of nursing on the Stroke Unit (also known as ward 16).

I understand from Dr Chadha that you were admitted to the Medical Assessment Unit (MAU) on 7 April 2010. Dr Chadha saw you the following day and requested a bed be arranged for you on the Stroke Unit. I regret that a bed did not become available for you on the Stroke Unit until 9 April 2010. However, Dr Chadha ensured that you received the appropriate medical treatment during the time you were awaiting a bed on the Stroke Unit. I apologise if this delay caused any concern for you.

Dr Chadha notes that during the course of the previous day on MAU, you had been reporting symptoms of feeling cold. He felt there was a progression of your symptoms and this reflected that the effects of your stroke were still continuing to evolve.Dr Chadha notes your question about whether your treatment would have been different if you had a stroke on a different day, however he would like to assure you that there was no different treatment which could have been undertaken to halt the progression of the stroke. He feels that treatment being given to you was the correct and most appropriate treatment.

Sister Fearn advises that when you were transferred to the stroke unit, your care needs were fully assessed on the ward and it was noted that your ability to carry out normal day to day tasks varied at different times. Sometimes you were able to carry out these tasks on your own and at others you needed assistance. Throughout the day on 10 April you had been able to carry out tasks such as transferring from the bed to the chair with minor assistance of a member of staff. However, at 6pm that day the nursing team noted that although you had been able to manage earlier in the day,you now appeared to be reluctant to transfer without persuasion from nursing staff. However, it was documented that you had a comfortable night and all of your medical observations were normal.

On 11 April you were seen by a Stroke Nurse Specialist who discussed with you the concerns you had raised about a feeling of right sided weakness the previous day. She was concerned by this and discussed it with nursing staff who advised that this weakness appeared to be intermittent and that nursing staff had noted times when you would use your right side and times when you would not. Following this assessment, she discussed the weakness with the on-call doctor who in turn consulted with Or Chadha. Dr Chadha again felt this was an indication that the stroke you had already suffered was continuing to evolve. There was no further intervention he could offer for the symptoms as you were already receiving the appropriate medication. However, he did prescribe clexane (to reduce the risk of blood clots in your leg related to reduction in mobility) and request that an MRI should be conducted.

On 12 April, you were advised that an MRI had been arranged. Staff noted that night you were uncomfortable with right sided shoulder pain. Pain relief was given at 00:15hrs and the nurse advised you to use the buzzer if you needed anything. It is then documented that you used the buzzer to call a nurse at 01:00hrs. The nurse records that you were sat on the edge of the bed and that you reported that you could not sleep in the bed any longer and it was making you feel sick. The nurse discussed with you the type of mattress you had on the bed (called a nimbus mattress) and that she would try and arrange for this to be changed for you in the morning. It is recorded you asked questions about the MRI and brain haemorhages and the nurse reassured you that the doctor would discuss any diagnosis with you in the morning. Sister Fearn accepts that the prospect of an MRI would have likely made you anxious and that following the discussion with the nurse you seemed reassured and the nurse left you to go back to sleep.

At 02:50hrs you called the nurses again and reported that you felt dizzy and that the walls were moving. The nurse who attended to you contacted the on-call doctor who was not unduly concerned as it had already been deemed likely that the effects of your stroke were still unfolding. However, he requested that an ECG (ElectroCardioGram) tracing of your heart be carried out and that he would come up to the ward and see you when he was able. The nurse carried out the ECG and also took medical observations. Although your blood pressure was elevated, this was likely due to the anxiety you were experiencing and did not cause significant concern to the nursing staff. It is documented that whilst waiting for the on-call doctor, you called for the nurses a number of times stating that you were lonely. On each of these occasions nursing staff tried to reassure you about your condition.

At 05.30hrs you pressed the call button by accident and when the nurse attended you asked why the on-call doctor had not come to see you. As you continued to be agitated, the nurse contacted the on-call doctor again who came up to the ward to speak to you at 05:50hrs. I understand from Sister Fearn that the doctor confirmed that there was no change needed to your medication and that he felt nothing further needed to be done as you were already receiving the correct medications.

At 06:00hrs when the nursing staff came to take your observations again, it was noted that you were sat on the edge of the bed again and were now able to move your right side again. You advised that you no longer felt sick or dizzy and both Sister Fearn and Matron Clarke feel that it is likely that the worries that you had about the MRI had magnified the symptoms of your stroke and that being reassured by a doctor helped to ease the symptoms for you.

Later that day a physiotherapist assessed your needs again and reminded staff that you would prefer a different mattress. This mattress was changed the following day. However, it is recorded that during your remaining time on the ward whilst you appeared settled during the day, at night times you became anxious and nursing staff came to talk to you on a number of occasions each night to reassure you that medical intervention was not required. I understand that after being transferred to Rowan Lodge, Dr Chadha diagnosed you with night-terrors and prescribed medication to try and help you with this.

Sister Fearn and Matron Clarke are sorry that you were distressed during your time on the ward. The time immediately after a stroke can be very anxious for patients and unfortunately there can be instances when, despite the best efforts of staff to allay those fears, patients can continue to feel anxious and worried. Sister Fearn advises that she will reiterate to the staff the need to communicate and explain to patients about their condition as fully as possible to try and prevent anxiety.

I would like to thank you for bringing this issue to my attention. I hope this letter has answered the concerns that you raised.