"I was in the middle of town and crossing the bridge," he recalls. "I had left my brother-in-law with Lilibeth and told her I had some things to do like sort out my van. But for some reason I just felt very uncomfortable walking along the bridge so I rang the hospital on my mobile. They told me I had better come back to the hospital quick."

Sadly, he discovered his wife had died 30 minutes before he reached Raigmore. It was their 22nd wedding anniversary.

The last words his wife spoke to him were: "I'm getting better".

Mr Ooms, of An-Teallach, Daviot, has been at odds with NHS Highland ever since because he believes serious doubts still surround the treatment she received in the weeks leading up to her death.

Mrs Ooms had been on kidney dialysis for 17 years, receiving treatment three times a week. She was admitted to Raigmore three times in April 2006 suffering from abdominal pains and was discharged twice but, on the third visit, bowel obstruction was suspected.

On 1st May she had surgery which revealed she had sclerosing peritonitis (SP) — a rare but serious complication of peritoneal dialysis. She was moved to the hospital's high dependency ward and in mid-May developed breathing difficulties and a lung infection.

Mrs Ooms died while dialysing on 7th June. Her heart stopped and there was no attempt to resuscitate her because a Do Not Attempt Resuscitation (DNAR) order had been added to her notes.

Since then Mr Ooms has been trying to find out why SP was not diagnosed earlier and why a DNAR order was made. He has complained directly to the NHS and the Public Service Ombudsman, who upheld his complaint that Raigmore failed to manage the DNAR order properly. However, the procurator fiscal decided not to investigate Mrs Ooms' death saying it was not in the public interest.

Mr Ooms admits the last two years have tested both his energy and spirit. He has a stack-full of folders, with "Beth" written on the side, containing medical research, notes and letters and has also set up his own website detailing concerns about his wife's death at [http://www.freewebs.com/medicalneglect2] It has been a draining battle but he takes comfort from talking to people throughout the UK who also have unanswered questions about their loved ones' deaths.

"Some days I can't face it," he admits. "Complaining makes you unpopular and it's very tiring, mentally and physically, and time consuming.

"I have spoken to people throughout the UK in a similar position but when there is any criticism or questions of any authorities it is impossible for the ordinary person. There is no advocacy for complaints."

Mr Ooms still does not know why SP was not diagnosed before his wife's operation and why a DNAR order was made without the agreement of either his wife or himself.

"It's strange that the procurator fiscal said investigating her death was not in the public interest but the ombudsman then concluded that the procedures for the DNAR order were not followed," he said.

NHS Highland points out that the ombudsman's medical advisers concluded Mrs Ooms received "reasonable care and active treatment" up until her death.

"We recognise that there were omissions in the recording of informed consent and some details in the DNAR order," a spokeswoman said.

Jan Ooms with some of the files relating to his campaign over his wife Lilibeth. Alasdair Allen

"We have accepted the recommendations in the report and are acting on them and are conducting a review of the consent processes and have a system in place to identify and address issues."

That cuts no ice with Mr Ooms, who has now initiated a legal claim against the health authority. But money, he insists, is the last thing on his mind.

"I'm not interested in compensation and it's not about revenge," he said. "I still have questions about my wife's treatment which I want answered."

Mr Ooms also questions the medical advice given to the ombudsman by the advisers, one of whom he has reported to the General Medical Council.

"The point of an investigation is to scrutinise, but one of the advisers didn't even see my wife's medical notes before 2006," he added.

Dr Roger Gibbins, NHS Highland's chief executive, told Mr Ooms in a letter he believed the complaint had been comprehensively investigated and detailed explanations about the care and treatment his wife received had already been provided.

Andrew Laing, area procurator fiscal for the Highlands and Islands, said a full investigation had been carried out into the circumstances of Mrs Ooms' death, including a post mortem and witness statements.

However, Mr Ooms feels he is left battling on his own against medical professionals and NHS management who, he claims, do not take kindly to questions from members of the public about the health profession.

"These people are paid massive salaries for their experience and knowledge, so who can question them?" he asked. "When I question them, I don't go to an adviser.

"I have to do my own research. There are hundreds of people who reach a dead end and give up and nobody can afford judicial reviews which cost thousands of pounds. But I'm strong and I don't want my case to set a precedent.

"There's no doubt that the NHS kept my wife alive over the years of her treatment which she was very grateful for.

"She had her good days and her bad days but never complained.

"People were always saying she looked well, even on dialysis. But I still have questions I need answered."

h.ross@inverness-courier.co.uk 

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