Not upheld, no recommendations

Summary

C complained on behalf of their partner (A) about the care and treatment provided by the board when A had hip replacement surgery. Specifically, C complained about the management of A’s pain in the post-operative period. The board acknowledged the discomfort experienced by A, but when it became apparent that surgeons could not manage A’s pain effectively, the Pain Management Team was involved. The board considered the care delivered following surgery, and in reducing medication after discharge, was reasonable.

We took independent advice from an anaesthetics and pain management adviser. We found that whilst pain management in the post-operative period is challenging, the board’s management of A’s pain was reasonable following surgery. We did not uphold this aspect of the complaint.

Additionally, we found that, with respect to reducing A’s medication, the advice provided by the board to A following discharge was appropriate. On this basis, we did not uphold this aspect of the complaint.

Summary

C was referred by their local health board ophthalmology (the branch of medicine that deals with the anatomy, physiology and diseases of the eye) department to the general hospital for specialist eye surgery. C underwent a vitrectomy procedure (the surgical operation of removing the vitreous humour from the eyeball) which they felt was not managed appropriately as their retina was still detached following the procedure and they had to undergo further surgery from an independent health provider. The board felt that they had provided an appropriate standard of care and treatment to C.

We took independent clinical advice from an ophthalmology adviser. We found that there were no concerns about the standard of treatment which was provided to C. C had suffered a serious eye injury and although the retina was not fully reattached during surgery, this was a recognised complication of the surgery, and that further surgery would be required at some point. We did not uphold the complaint.

Summary

C complained that there was an avoidable delay by staff at a community hospital in referring them to the specialist clinic at the local general hospital when they suffered a detached retina. C attended four consultations at the community hospital before they were referred to the specialist clinic and they felt that the delay had had an adverse effect on their sight. The board maintained that appropriate treatment was provided.

We took independent advice from an ophthalmology (the branch of medicine that deals with the anatomy, physiology and diseases of the eye) adviser. We found that the clinicians at the community hospital had taken advice from specialists at the general hospital and had monitored C’s condition by regular ultrasound scans. When C’s condition deteriorated and evidence of retinal detachment was found on a scan, C was referred to the specialist for continuing treatment. We therefore did not uphold the complaint.

Summary

C complained about treatment provided to their late parent (A) from the board during a hospital admission. C complained that A had been discharged from hospital when it had been unsafe to do so, that staff had failed to insert an intravenous line so that A could receive fluids, that A had developed a pressure sore on their sacrum (a bone in the spine), and that insufficient investigations had been carried out to establish the cause of A’s refusal of treatment.

The board stated that A had received fluids intravenously on admission but that their cannula (a tube that can be inserted into the body) had become blocked. Further unsuccessful attempts were made to reinsert the cannula before A declined any more attempts to be made. A also had refused to accept oral treatment and did not wish to undergo investigations to establish cause of their illness, preferring instead to be discharged home. The board also stated that A had been non-compliant and had not wished to change position in bed resulting in the development of a pressure sore, for which arrangements were put in place with district nurses upon A’s discharge.

We took independent advice from a consultant geriatrician. We found that the investigations the board had carried out to establish the cause of A’s illness had been reasonable as had the overall treatment provided during A’s admission. We noted that the records showed A had declined several attempts to treat their symptoms and carry out further investigations and that there was no evidence in the available records to indicate that A had lacked capacity to make decisions about the medical treatment that they wished to receive. In relation to A’s discharge, the records also showed that the board had requested an assessment of A to be carried out by their Integrated Assessment Team but that this could not be completed due to A leaving the hospital. We found that management of A’s pressure sore had reasonable.

For these reasons, we did not uphold the complaint.

Summary

C complained that the practice failed to provide their late spouse (A) with appropriate care and treatment. C said that GPs at the practice failed to see their partner at face to face consultations where they could observe their reported symptoms of facial weakness. Phone calls were made on a Friday and Monday but A was still not seen despite contacting the Out Of Hours Service (OOHS) at the weekend. A died a few days later of a stroke.

C felt that the practice should have seen A face to face rather than via telephone consultations. The practice believed that the GPs involved had provided A with appropriate care and treatment based on their reported symptoms at the time.

We took independent advice from an appropriately qualified adviser. We found that the practice had provided a reasonable level of care based on A’s reported symptoms. Therefore, we did not uphold the complaint but provided the practice with feedback concerning the standard of record keeping.

Summary

C complained about the care and treatment they received from the board having required hip surgery following a fall. Specifically, C was concerned about the type of hip surgery they received, their post-operative care, the arrangements made for their discharge home, and the way in which the board had responded to their complaint. In responding to C, the board did not uphold the failings they had identified, and they provided a rationale for the type of surgery C received, and for the care and treatment given.

We took independent advice from an orthopaedic surgeon (specialist in the treatment of diseases and injuries of the musculoskeletal system). We considered the procedure chosen for C to be evidence based and appropriate to their particular circumstances. We also found the post-operative care and discharge planning for C to be reasonable. Finally, we considered the board’s complaint response to have appropriately responded to the matters they had complained about. Therefore, we did not uphold C’s complaints.

Summary

C complained on behalf of their parent (A) for whom they hold power of attorney. C complained that the practice had incorrectly diagnosed and treated A with chronic back pain. C stated that A was later admitted to hospital with a fractured back and pneumonia.

The practice advised that there was nothing to clinically suggest a fracture at the time and it would not have altered treatment. They noted that A did not have pneumonia as per hospital discharge.

We took independent advice from a GP. We found that a thorough physical examination was undertaken which did not raise concerns of a fracture. We also found that appropriate pain relief is the only immediate treatment for vertebral fractures. There were no symptoms of pneumonia when the patient was seen by the GP and no suggestion of pneumonia in the medical records. We did find one mention of pneumonia in a letter between two third party medical professionals, who were not involved in A’s hospital care. Therefore, we did not accept this as evidence of a pneumonia diagnosis. In light of this, we found that the overall care and treatment provided to C was reasonable and did not uphold C’s complaint.

Summary

C complained about treatment they received in relation to an alleged failure to promptly identify and treat developing symptoms of cauda equina syndrome (CES, compression of the nerve roots in the lower back affecting various neurological functions). C was initially admitted to hospital within another health board area before being discharged the following day on the basis that there was no evidence of CES at that time. However, C re-presented to the emergency department at the same hospital four days later with new symptoms thought to be CES. On the basis of advice provided by NHS Greater Glasgow and Clyde’s neurosurgical department at the Queen Elizabeth University Hospital (QEUH) to clinicians at the health board, C was fasted and underwent an MRI scan the following morning, which showed a large disc protrusion compressing the cauda equina nerve roots. C was thereafter taken by emergency ambulance to the QEUH where they underwent surgery the same day.

In order to investigate the neurosurgical advice provided by NHS Greater Glasgow and Clyde to the other health board, we took independent advice from a consultant neurosurgeon. We found that the advice provided had been reasonable given that it was well accepted practice that surgery to decompress the cauda equina nerve roots should be performed within 24-48 hours of a patient presenting to hospital, which had occurred in this case. Therefore, we did not uphold C's complaint.

Summary

C complained that the board did not repeat a test for Helicobacter pylori (H. Pylori, bacteria usually found in the stomach) given their symptoms, abnormalities in their blood tests and low ferritin (a blood protein containing iron) levels. C was of the view that had their symptoms been properly investigated, they would have been found to have H. pylori and would have been treated earlier.

We took independent advice from a consultant gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines). We found that C did not have Helicobacter associated symptoms which would have triggered re-testing (such as indigestion symptoms). As there was no clinical indication to repeat a test for H. pylori, we did not uphold C’s complaint.

Summary

C complained regarding the treatment that they had received from the board in relation to a pharyngeal pouch (a pocket in the lining of the pipe that carries food from the mouth to the stomach). They complained about issues regarding the surgery they had in relation to this and about the information they were given.

We took independent advice from an ear, nose and throat (ENT) surgeon. We found that C was given reasonable information in advance of their surgery and that it was reasonable to examine a pharyngeal pouch through surgery. It was appropriate that C's pharyngeal pouch was emptied of partially digested food as otherwise it would not have been possible to examine it. It was also reasonable that C was offered a cricopharyngeal myotomy (where a surgical cut is made in the muscle that allows swallowing to weaken it) to treat their pharyngeal pouch, as it is one of the treatment options set out in the relevant clinical guidance. Although an external myotomy was recommended, C was given the option to explore alternative approaches, but the clinicians felt the pouch was too small for stapling. In addition, it was reasonable that C's outpatient appointment with the ENT surgeon was cancelled, given they were unhappy to proceed with the proposed treatment option.

Therefore, we did not uphold the complaint.