Not upheld, no recommendations

Summary

Ms C attended the A&E department at St John's Hospital with a skin problem behind her ear. She thought it had been caused by a reaction to hair dye. She complained that the triage nurse (who decides which patients should be treated first based on how sick or seriously injured they are) wrongly categorised her condition as minor, which meant she would have to wait a long time to see a doctor. She also complained that the nurse gave the impression she was wasting the nurse's time and, when Ms C decided to leave before seeing a doctor, she said the nurse asked her to sign a form, which Ms C did not realise until later was a form to declare that she was discharging herself from the hospital.

We were unable to establish the facts about what the nurse said, or how she said it. However, we concluded that the nurse had acted within triage guidelines in categorising Ms C's condition as minor, which meant she was likely to have to wait some time, while patients with higher priority categories were seen by a doctor. We also concluded that the self-discharge form was easy to read and understand and that Ms C could reasonably have been expected to know that she was signing it to indicate that she was leaving the hospital against advice. If she had not understood the form, she could have asked what it was before signing. We did not uphold the complaint.

Summary

Mrs C complained on behalf of her late mother (Mrs A) about the care and treatment Mrs A received at Monklands Hospital. She had fractured her neck and was admitted to hospital for conservative management (medical treatment avoiding radical therapeutic measures or operations).

Mrs A had a history of chronic obstructive pulmonary disease (a type of lung disease) and was treated for a chest infection whilst in hospital. She was also found to have fractured ribs. Mrs A's chest condition deteriorated and an x-ray revealed a haemothorax (blood in the cavity surrounding the lung). A chest drain was inserted to drain the fluid, and she was transferred to the High Dependency Unit for several days then transferred back to the ward when her condition stabilised. However, a few days later she suffered a rapid deterioration and died.

We took independent advice on this case from one of our medical advisers who found that the decision to transfer Mrs A back to the ward was reasonable given that her breathing rate, oxygen levels, blood pressure, and heart rate were all stable and met the board's transfer criteria in this respect. We also took independent advice from our nursing adviser, and noted that the board had acknowledged that there was delay in a drip being reconnected due to the cannula (intravenous tube) becoming dislodged and that a dose of antibiotics was missed. They provided refresher training for the ward staff, and a member of the nursing staff had apologised to the family. We found this reasonable and our nursing adviser considered that this was not a significant failing that affected the overall outcome for Mrs A.

Although we noted that the board had arranged for staff to have refresher training in relation to chest drains, neither of our advisers identified any evidence of failings with the management of the chest drain. In relation to Mrs C's concerns about staffing on the ward, we found that some of the shifts had lower numbers than planned, but that bank staff and overtime were used to address this, which was reasonable. On balance, we concluded that the medical and nursing care was reasonable.

Summary

Mrs C complained about the treatment she had received from her GP when she reported a lump in her breast. Mrs C attended the medical practice twice before being referred to the breast clinic where she was later diagnosed with breast cancer.

Mrs C said that she should have been referred to the breast clinic sooner and was concerned about the GP's attitude. Mrs C also said that when she was referred, the referral should have been classed as urgent rather than routine.

During our investigation we asked for independent advice from one of our GP advisers. Our adviser found that the GP had conducted a thorough examination of Mrs C and gave her appropriate advice regarding monitoring the lump. The adviser said that it was hard to judge the attitude of the GP through the medical notes, however, based on the record of Mrs C's condition at the time of the referral, and relevant National Institute for Health and Care Excellence (NICE) guidance, a routine referral was appropriate. We did not uphold Mrs C's complaints.

Summary

Ms C, who is an advocate, complained to us on behalf of her client (Mr A) that the board's response to his complaint was inadequate.

Mr A had complained to the board about the conduct of a nurse. The board investigated Mr A's complaint and, in their written response, acknowledged that his experience was distressing and they apologised. The board explained to Mr A that their investigation had been conducted in line with their Management of Employee Conduct Policy, and that they were unable to share any actions arising from the investigation due to the confidentiality of employee matters. In a further letter to Mr A, the board confirmed that he would not be notified of the outcome of any internal board process.

We concluded that it was reasonable in the circumstances that the board did not tell Mr A whether his complaint was or was not upheld. This was because the standard complaints procedure, under which Mr A submitted his complaint to the board, was superseded by the Management of Employee Conduct Policy due to the nature of the allegations made in Mr A's complaint. This was why the board decided they could not tell Mr A whether his complaint about the nurse had or had not been upheld, as to have done so would breach employee confidentiality. Although we thought that they could have explained the sequence of events more clearly, we considered that the board's response to Mr A's complaint provided relevant information that they were able to share with him in the circumstances, and we did not uphold the complaint.

Summary

Mr C complained that the board had failed to provide his partner (Mr A) with appropriate and timely treatment for a needlestick injury (when the skin is accidentally pierced by a needle), when he attended the A&E department at the Southern General Hospital. He said that Mr A had to wait for two and a half hours to see a doctor and that other people who arrived after him were seen before him. Mr C complained that they refused to give Mr A post exposure prophylaxis (PEP - short-term antiretroviral treatment to reduce the likelihood of HIV infection after potential exposure), despite the fact that the needle had been discarded close to the home of an HIV positive drug user. He also said that Mr A was not offered a polymerase chain reaction (PCR) test (a test that can be used to identify HIV) which can be done around ten days after the exposure.

After obtaining independent advice from our medical adviser, we found that the care and treatment provided to Mr A had been reasonable, appropriate and in keeping with standard care. Patients with a community-acquired needlestick injury are not treated as a priority when they attend A&E. It was not unreasonable that some patients with other conditions who arrived after Mr A were assessed before him. The board had acted in line with their guidelines in relation to providing PEP and it was not given because any benefit would have been outweighed by the risk of side effects. It was also appropriate that a PCR test was not used, as another test was available. In view of all of this, we did not uphold the complaint.

Summary

Mrs C had a history of abdominal (stomach) pain, for which no specific cause had been found. In June 2010, she and her husband (Mr C) went for fertility treatment, and a scan revealed a large endometriotic cyst (a blood-filled sac) on Mrs C's ovary. This was removed and Mr and Mrs C were referred for fertility treatment. At that point, Mrs C's levels of AMH (a hormone that gives an estimate of the capacity of the ovary to provide egg cells capable of fertilisation) were within normal range. Some time after this, a scan showed another large cyst - this was removed and Mrs C was given treatment to reduce the chances of this happening again.

Mr and Mrs C were seen again in July 2012 before starting fertility treatment at Glasgow Royal Infirmary, at which time Mrs C's AMH level had decreased to a 'less than a normal' range. The first cycle of treatment was unsuccessful and the fertility unit recommended a different procedure for the next cycle. Before this could happen, however, the board closed the unit because of poor fertilisation rates (possibly related to contamination from nearby building works). The board wrote to Mrs C explaining this and offering the couple a complimentary treatment cycle.

Mr and Mrs C complained about Mrs C's care and treatment, saying that the cysts were not diagnosed quickly enough and that she should have had regular scans after the first operation. They also said that the board did not provide a reasonable standard of care and fertility treatment, that their communication about the problems was inadequate and their guidance to affected patients confusing. Mr and Mrs C thought they should be offered a third fully funded cycle of treatment.

After taking independent advice on this complaint from two advisers - one a surgeon (adviser 1) and the other a specialist in assisted conception treatment (adviser 2) - we did not uphold Mr and Mrs C's complaints. Adviser 1 said that the board reasonably investigated and treated Mrs C's earlier abdominal symptoms and found no evidence that the cysts were related to these. Adviser 2 also said that care and treatment in relation to the cysts was reasonable, and that Mrs C's decreased AMH levels were likely to have been due to the second operation, rather than any delay in identifying the second cyst.

The board had acknowledged the problems in relation to assisted conception, and had taken steps to address them. Adviser 2 said that it was probable that the first cycle failed because of the environmental contamination, and that the board's offer of one further complimentary cycle was reasonable. They did not think that there was a failure in care and treatment by the board, who were dealing with a complex and fast-changing situation, and we found that the board's communication was reasonable in the circumstances. We were also satisfied that their guidance for affected patients was intended to ensure that no-one was at a disadvantage, so that each couple received two fully funded NHS cycles of treatment.

Summary

Since 2010, Mrs C had been attending her medical practice complaining of stomach and breast pain. She said that she was incorrectly treated for thyroid problems and an ulcer and complained that the extent of her pain was never recognised and that she was not referred for tests. More recently Mrs C was diagnosed with a carcinoid tumour in her liver (a rare cancer). She felt that as a fit and healthy patient attending the doctor a lot, with symptoms that were not resolving, the practice should have sent her for tests and sought specialist help.

We took independent advice from one of our medical advisers and, after considering this, we did not uphold the complaint. Our investigation showed that over the period of time concerned, Mrs C was treated correctly in accordance with her symptoms. Amongst other things, she had symptoms suggestive of an underactive thyroid and an ulcer, for which she was treated appropriately. She also had a breast scan that showed a breast lump, but this was benign. It was only in late 2013 after an emergency admission to hospital and extensive investigations, including an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body) and a scan of her abdomen, that Mrs C was diagnosed with the tumour, which was noted to be extremely rare. Our adviser said that until then doctors had always provided reasonable diagnoses to explain Mrs C's symptoms.

Summary

Mr C complained that prison healthcare staff behaved unreasonably towards him, after he complained about another matter regarding one of the staff. Mr C told us that he had a meeting with two nurses - one of them the person about whom he had complained - during which the nurses were confrontational and threatened him.

In general terms, it is not unusual for prison healthcare staff to visit complainants to discuss their complaint face-to-face at an early stage, to see if they can resolve the matter quickly. However, even at such an early stage, it is important to ensure that the complaint is dealt with impartially. This is in keeping with the NHS' Can I Help You? Guidance, and we agreed with the board’s comment in their response to Mr C’s complaint that the nurse he previously complained about should not have attended the meeting.

Where there are differing accounts of what was said or what happened in a particular situation, however, it can be difficult to prove what actually happened. In such cases, we primarily base our findings on written records. There was no audio recording of the meeting and, therefore, there was no way to determine what was said, or how people behaved. We could not resolve Mr C's complaint given these differing accounts. However, that did not mean we believed one account over another. As there was insufficient evidence to ascertain what was said, we did not uphold the complaint.

Summary

Mr C complained to us about the care and treatment he had received from his prison health centre in relation to pain in his wrist and jaw. Mr C had been prescribed tramadol (a strong painkiller) and the dosage had been gradually increased. He was then reviewed by a doctor, who considered that the tramadol he was receiving was inappropriate. The doctor recorded that the tramadol should be reduced and stopped and that it should be replaced by other painkillers. Mr C was unhappy with the decision to stop the tramadol. We took independent medical advice and found that the overall management of Mr C's pain had been reasonable. It had also been reasonable to reduce and then stop the tramadol and to try other medications to see if they addressed his pain. Consequently, we did not uphold this aspect of Mr C's complaint.

Mr C also complained about the board's handling of his complaint. However, we found that the board had adequately investigated and responded to the issues he had raised and we did not uphold Mr C's complaint about this.

Summary

Mrs C complained about the medical care her late mother (Mrs A) received at University Hospital Ayr. Mrs A had suffered from diabetes for over 40 years. She was admitted to the hospital and diagnosed with diabetic ketoacidosis (a condition where consistently high blood sugar levels can result in severe insulin deficiency). Mrs C said that Mrs A did not receive appropriate medical treatment, was discharged home on too high a dosage of insulin, and that her blood sugar was not monitored at home. Mrs A's condition deteriorated at home and she was re-admitted to the hospital five days later having collapsed. She went into a coma and died around four weeks later.

We did not identify any failings in the medical treatment of Mrs A. There was evidence to show that she was given appropriate treatment in the form of intravenous fluids and insulin. We noted that Mrs A had a history of poor diabetic control. However, the insulin dosages were appropriate and, after she returned home, the specialist diabetic nurse had contacted Mrs A to monitor her condition and make changes in her prescription.