The case relates to the care the boy received from the Northern Health Trust over several years up to July 2019.
Northern Ireland Public Services Ombudsman Margaret Kelly launched an investigation after a complaint lodged by the boy’s mother.
The complainant said her son’s behaviour changed towards the end of 2017 and early 2018, when the once “happy and easy-going” boy became so aggressive he had to be “semi-segregated” at school.
His behaviour continued to deteriorate and the school could no longer cope, so the then 12 year old stopped attending altogether.
In mid-2018, the boy’s doctor organised for him to undergo a multidisciplinary assessment under general anaesthetic to see if there was an underlying medical reason for the changes to his behaviour.
The complainant said she understood that the Northern Trust’s Community Dental Service (CDS) would be involved in the assessment, but they did not attend.
Following the assessment, the patient’s difficult behaviour continued.
Ms Kelly’s report states: “The complainant explained the patient’s behaviour included self-harming and aggression, both of which put significant stress on the family, in addition to the impact on the patient.
“The complainant said the patient’s new self injurious behaviours lasted for the entire period, from late 2017 and which manifested ‘24 hours a day’.
“She explained the patient and his family became isolated as they could neither go out or receive visitors because of the potential risks to other people from the patient’s aggressive behaviour.
“The complainant said, prior to this period, the patient was ‘happy and easy-going’.”
On July 1, 2019, the boy’s mother discovered he had a broken double tooth, which is when a tooth cracks vertically in two places, often right to the gum line. This can cause severe pain and requires immediate dental treatment.
The CDS carried out dental treatment on the boy under general anaesthetic on July 19, 2019, after which his behaviour improved, although he never returned to school. Since the onset of the changes in his difficult behaviour, he has not been able to interact with other children.
The boy’s mother said her son had “lost part of his childhood”, and although his behaviour improved, he “was never the same child as before”.
Ms Kelly’s report states: “The complainant believed the patient’s behavioural changes were caused by ‘significant pain’ related to dental issues but, because the patient is non-verbal, he could not communicate this.”
Following a review of all the evidence and input from a medical expert, the Ombudsman found that the Trust failed to apply topical fluoride – which strengthens teeth – to the patient in line with relevant guidance.
Department of Health guidance advises dentists that topical fluoride should be applied twice a year to children, although the CDS only applied this twice to the complainant’s son in a seven-year period from 2012 to 2019.
The Ombudsman also found that Trust also failed to recall or review the patient for dental care as frequently as required.
Furthermore, Ms Kelly found the Trust failed to follow-up with the boy’s family regarding the original multidisciplinary assessment.
“I recognise these failings caused the patient to sustain the injustice of a loss of opportunity for optimum and timely care and treatment,” Ms Kelly said.
“Further I recognise, on the balance of probabilities, the failings caused the patient to sustain the injustice of distress arising from unnecessary pain. I also recognise the failings caused the patient’s family to sustain the injustice of worry and upset at seeing the patient in distress.
“Throughout my consideration of this case, the complainant’s concerns about the patient’s wellbeing and her desire to ensure his needs and best interests were met were clearly evident.
“I hope this report gives the complainant some reassurance in providing answers to her questions about the failures in the patient’s care and treatment.”
The Ombudsman made several recommendations to the Trust, including that it provide the complainant with a written apology.
She also said the Trust should consider facilitating a face-to-face meeting between a paediatric representative and the patient and complainant to communicate the apology in-person.
It was also recommended that the Trust carry out sample audits across various workstreams to identify any shortcomings and that the Trust should give relevant staff “the opportunity to reflect” on the findings of the report.
A Northern Trust spokesperson said: “We are very sorry for the distress caused to the patient and his family, and acknowledge that our failings caused unnecessary suffering, both physically and emotionally.
“It is always our intention to deliver high quality, compassionate care at all times, with every patient’s individual care needs in mind, and we acknowledge this did not happen on this occasion.
The boy suffered from a broken double tooth. Stock image.
News Catch Up – Thursday 13 November
“We offer our assurances that lessons have been learned from this experience. The report and its findings will be shared with all relevant staff for learning and reflection to ensure all of our patients and their families receive the best possible care.”