Not upheld, no recommendations

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.

Summary

Mr C complained about the treatment provided to his late father (Mr A). Mr A had complained about poor memory and poor balance over a number of weeks. The board carried out a number of investigations, however, due to the wait for follow-up appointments, Mr A decided to seek private treatment and he was subsequently diagnosed with Creutzfeldt-Jakob Disease (CJD - a rare degenerative brain disorder). Mr C complained that the board failed to carry out the appropriate investigations, and that the board inappropriately discharged Mr A when his condition was getting progressively worse.

The board confirmed they were satisfied that the appropriate investigations were undertaken. They acknowledged that they could not offer Mr A an earlier appointment and explained that this was due to the service being understaffed.

We took independent advice from a consultant neurologist (a doctor who specialises in the brain and nervous system). We found that the appropriate investigations were carried out. Due to the nature of Mr A's condition, a number of conditions had to be ruled out first and there is no single test that can be performed in order to reach a diagnosis. The board subsequently informed us that the staffing issues have since been resolved. We also considered that it was appropriate to discharge Mr A as the risks of complications was much lower at home than in hospital. We did not uphold Mr C's complaints, however, feedback was provided regarding the board's communication with the patient and his family and the manner in which Mr A was prioritised.

Summary

Ms C complained about the care and treatment provided to her by the practice for a number of symptoms over period of several months. We took independent advice from a GP. We found that the assessments, investigations, referrals and treatment provided to Ms C were reasonable. We did not uphold the complaint.

Summary

Mr C was admitted to A&E following a road traffic accident. He was concerned that inadequate investigations were carried out to determine the extent of his injuries. Following an MRI scan, it was found that Mr C had a neck injury which required surgery. Mr C also felt his complaints of pain were minimised and often ignored by staff.

We took independent advice from an emergency medicine consultant. We found that proper assessments and investigations were carried out in light of the injuries Mr C presented with. We had no concerns about the way staff managed Mr C's reports of pain and that he was given appropriate pain relief. We found that there was no indication that an MRI of Mr C's neck should have been carried out sooner. MRI scans are required to identify injuries to the soft tissues in the neck or the spinal cord and are normally only carried out when patients have symptoms consistent with spinal cord injury or when, in the presence of a normal CT scan, there is a significant suspicion of a ligamentous injury. In Mr C's case, it was noted that when he displayed a foot drop and weakness in his hand, the decision was taken to obtain an MRI scan.

We found that the board provided reasonable care and treatment for Mr C's neck injury and, therefore, we did not uphold the complaint.

Summary

Ms C complained that the care and treatment she received from the practice was unreasonable. Ms C attended the practice on a number of occasions complaining of a sore lump. She was referred to the treatment room (the treatment room is staffed by nurses who are trained and specialise in wound care) for assessment and management of a post-operative wound she had. Ms C also attended the hospital and was informed she had cellulitis (an infection of the deeper layers of skin).

We took independent advice from a GP. We found that the practice had assessed Ms C's wound, arranged an appropriate referral to the treatment room and arranged appropriate treatment. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment he received from a number of different clinical areas provided by the board. In particular, Mr C raised concerns about the care and treatment he received while he was a patient of the Physical Disability Rehabilitation Unit, the treatment he received from occupational therapy and the treatment of his urine infections and acid reflux symptoms.

We took independent advice from a physiotherapist, an occupational therapist, a consultant urological surgeon and a neurologist regarding Mr C's concerns. We did not find any failings regarding the care and treatment Mr C received.

We did not uphold Mr C's complaint.