Not upheld, no recommendations

Summary

Mr C complained about the change in the way his medication was administered at the Royal Infirmary of Edinburgh. In the past, Mr C received IV morphine (injection into a vein) but had now been changed to subcutaneous morphine (injection under the skin). Mr C believed that the change meant he was in pain for a longer period of time and that it was not as effective. He believed that the decision to change the method of administration of the morphine was unreasonable.

We took independent medical advice from a clinician and found that the board had implemented a new Recurring Pain Pathway which included guidance in appropriate cases that morphine should be given subcutaneously (under the skin). This would have the effect of a slower absorption with fewer side effects. We also found that the board staff had explained the rationale for the change to Mr C in a sensitive manner taking into account his other health issues. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late husband (Mr A) who had a rare and aggressive form of bladder cancer. Mr A received care and treatment at the Royal Infirmary of Edinburgh and the Western General Hospital.

We took independent advice from urology (specialism that deals with the male and female urinary tract, and the male reproductive organs), oncology (cancer) and general surgery advisers. We found that the time taken to investigate and begin treatment for Mr A's bladder cancer was reasonable and in accordance with the Scottish Government's cancer waiting time targets. We also found that chemotherapy treatment commenced within a reasonable timescale. The level of information about treatment options, including their risks and benefits, provided to Mr A was also reasonable. This included sufficient information about the specific risk of pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs), a complication Mr A subsequently experienced.

In the context of Mr A's rapid deterioration, the level of planning for end of life care was reasonable. When Mr A subsequently experienced bowel obstruction, it was reasonable that he was treated on a surgical ward. While Mr A's pain was difficult to manage, the attempts by the clinical team were reasonable, as was the aim to discharge Mr A home. When Mr A's condition deteriorated, he was transferred to a hospice without unreasonable delay.

We did not uphold Mrs C's complaints.

Summary

Mr C complained to us that his GP practice had unreasonably notified the Driver and Vehicle Licensing Agency (DVLA) that he had alcohol issues. We found that the practice had previously discussed this matter with Mr C and that it had been reasonable for them to contact the DVLA regarding their concerns about Mr C's health and alcohol intake. We did not uphold Mr C's complaint.

Summary

Ms C saw her dentist about a number of issues and agreed to undertake a course of dental treatment which included denture fittings over a number of months. However, Ms C told us that once treatment had been completed the dentures were ill-fitting and the cost of the planned treatment had not been made clear to her.

We took independent advice from a dental adviser. We found that the evidence from Ms C's dental records showed the standard of treatment provided at each appointment during this period was reasonable and that treatment decisions were in line with options under the NHS. We also found that the evidence showed the planned treatment costs were discussed with Ms C and adjustments were made to meet Ms C's communication needs. We did not uphold the complaint.

Summary

Ms C complained about the care and treatment she received when she was admitted to A&E at the Royal Infirmary of Edinburgh. In particular, that she had been catheterised without her consent and against her will. She also complained that unnecessary restraint had been used.

We took independent advice from a consultant in emergency medicine. We found that the care and treatment given to Ms A was reasonable, and that the history, examination and investigations had been appropriate and reasonable. In particular, we found that this had been a potentially life threatening emergency and the decision to insert a catheter had been reasonable. We considered that it was extremely unlikely that Ms C would, at that time, have had the capacity to consent to medical treatment. As such, an adult with incapacity assessment had been completed before the decision to insert the catheter had been made. We also found there was no evidence in the medical records that unnecessary constraint had been used. We did not uphold Ms C's complaint.

Summary

Mr C complained about the care and treatment he received during two admissions at Royal Infirmary of Edinburgh. During our consideration of Mr C's complaint, we received independent advice from a consultant colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus) and a registered nurse.

During Mr C's first admission, he was diagnosed with appendicitis and received surgery to remove his appendix. Mr C was unhappy that his appendix was not fully removed during the procedure. We found that the initial assessment and treatment were appropriate and timely. We noted that whilst part of Mr C's appendix was not removed, this was a rare but recognised complication of the surgery. We did not conclude that there was an unreasonable failing by staff that resulted in this complication. We were also satisfied that Mr C's discharge from the ward was reasonable. We did not uphold this complaint.

During Mr C's second admission, he was diagnosed with stump appendicitis (recurrent inflammation of the residual appendix after the appendix has been only partially removed during surgery). Further surgery was performed to remove the residual appendix tissue. Following the procedure, Mr C's recovery was complicated by infection. We found that the second procedure had been carried out to a very high standard. We considered that the post-operative care was reasonable and we noted that there were appropriate arrangements made for wound care in the community following Mr C's discharge. We did not uphold this complaint.

Summary

Mrs C, an advice and support worker, complained on behalf of her client (Mr A) regarding the decision by a psychiatrist to change Mr A's antidepressant medication. Mr A felt that the change in medication had resulted in him suffering agitation and insomnia and that he had to approach his GP to have the dosage of medication altered.

We took independent medical advice from a psychiatric consultant. We found that it was reasonable from a clinical perspective for the psychiatrist to change the medication. If a patient remains on a particular medication for a prolonged period this can lead to a lack of symptomatic relief. It is accepted practice to gradually reduce the dosage of the previous medication while at the same time gradually increase the dosage of the new medication in an effort to prevent withdrawal symptoms. We did not uphold the complaint.

Summary

Mrs C, an advocate, complained on behalf of her client (Ms A) about the care and treatment they received from the board. Ms A was seen by an ophthalmologist (a specialist in medical and surgical eye problems) and complained that they did not carry out an appropriate assessment and did not record their observation that the discs at the back of her eyes were enlarged. Ms A also complained that her discharge was inappropriately handled and that a mix up regarding her blood test results caused a delay to her discharge.

The board advised that it was determined by the ophthalmologist that no further follow-up was required. The board acknowledged that there was confusion about how long Ms A had to wait following a procedure before she could be discharged and that her blood test results had been misread.

We took independent advice from a consultant ophthalmologist and from a consultant physician. We found that the ophthalmologist's assessment was reasonable and that the swelling identified at the back of Ms A's eyes did not require to be acted upon. We did not uphold this aspect of the complaint. With regards to Ms A's discharge, while we noted that there was a mix up regarding Ms A's blood test results, we considered that the board acted in the best interest of the patient, in light of the information available to them at the time, and it was therefore appropriate to require Ms A to remain in hospital for one further night for observation. Therefore, we did not uphold this aspect of the complaint.

Summary

Mr C reported experiencing unpleasant side effects when taking methadone (a drug used medically as a heroin substitute) and felt the prison health centre unreasonably dismissed his symptoms. Mr C also complained that the board would not ask for a second opinion from someone outwith the health centre.

The board explained that clinical and nursing staff felt the symptoms reported by Mr C were likely caused by opiates, rather than methadone. It was noted that Mr C did not accept that position, but the board explained medications were prescribed based on evidence that indicated their effectiveness whilst remaining mindful of guidelines in place. The board told Mr C that methadone was considered the best option available for those with opiate misuse.

We took advice from an independent clinical adviser. We found that the board had appropriately considered Mr C's concerns about the side effects of methadone. We considered that the board had explained their position reasonably to Mr C and their actions were in line with good practice guidance. We also found that the steps taken by the board in having another doctor from the health centre review the matter was in line with good medical practice.

We concluded that the board responded reasonably to Mr C's reports of unpleasant side effects from methadone and dealt with Mr C's request for a second opinion reasonably. Therefore, we did not uphold the complaints.

Summary

Miss C complained about the care and treatment provided to her late mother (Mrs A) prior to her death. Mrs A was admitted to Hairmyres Hospital after having a fall and developing chest pain. Miss C had a power of attorney (POA, a legal document appointing someone to act or make decisions for another person) in respect of her mother.

Miss C complained that the POA was not appropriately taken into account; communication in relation to Mrs A's deterioration was unreasonable; and the nursing care and treatment provided to Mrs A was unreasonable.

The board in response to the complaint carried out a local review of Mrs A's care and also held a debrief action plan meeting, following the local review.

We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) and a nursing adviser. We found that the POA was respected and there was no indication it was disregarded.

In relation to communication concerning Mrs A's deterioration, the clinical records showed that medical staff engaged with Miss C frequently to discuss Mrs A's condition, symptoms and how these were being managed. There was also evidence of frequent and detailed discussions between Miss C and clinical staff at the point at which Mrs A's condition began to deteriorate. We, therefore, found that communication was of a reasonable standard.

Miss C raised a number of issues with regards to Mrs A's nursing care. Our investigation confirmed that the shortcomings identified within the local review would not have had an impact upon Mrs A's condition and subsequent deterioration. Whilst we recognised the board had apologised for a number of aspects of Mrs A's nursing care, overall, we considered that Mrs A received care of a reasonable standard. We considered that the local review and work carried out by the board was thorough and showed Miss C's complaint was taken seriously.

As a result, we did not uphold Miss C's complaints.