Not upheld, no recommendations

Summary

Mrs C complained about the care and treatment provided to her late daughter (Ms A) by the practice. Ms A attended the practice complaining of severe leg pain and was diagnosed some time later with cancer. Mrs C complained that the practice failed to carry out the appropriate investigations in response to Ms A's symptoms and previous history of breast cancer.

We took independent advice from a GP. We found that Ms A's symptoms, which she discussed with the GP on the first two appointments, were not indicative that cancer was a likely diagnosis and the appropriate treatment was provided.

When Ms A began to complain of back pain, and it was noted that she had weight loss, we found that the practice acted appropriately by making an urgent referral for imaging and arranging for blood tests to be carried out. We concluded that the treatment provided was in line with national guidelines and we did not uphold the complaint.

Summary

Ms C complained that the care and treatment provided to her late mother (Mrs A) was inadequate. Mrs A died following a short admission to hospital, following emergency surgery. Ms C was specifically concerned that Mrs A had been diagnosed correctly early in her admission to hospital, but that this had not been properly acted upon. Ms C also suggested that surgery should have been performed earlier and that this had contributed to Mrs A's death. Ms C said that the subsequent morbidity and mortality meetings investigating Mrs A's death had not been appropriately carried out, as they had not identified the reason for her admission correctly.

We took independent medical advice from a consultant gastroenterologist (a doctor specialising in the treatment of conditions affecting the liver, intestine and pancreas). We found that Mrs A had been suffering from a condition which was difficult to diagnose and which shared symptoms with a number of conditions. Mrs A had been given a differential diagnosis, and although this included the condition she was suffering from, it was not accurate to say that she had been conclusively diagnosed early in her admission. We concluded that the process of diagnosis had followed the correct procedures, and that the test result which could most reliably diagnose her condition was inconclusive. Mrs A had undergone surgery within a reasonable timeframe. The morbidity and mortality meetings had reflected on the condition Mrs A had been suffering from, rather the reason her GP had referred her to hospital. We concluded that Mrs A's care and treatment had been reasonable and, therefore, did not uphold the complaint.

Summary

Mrs C complained to us about the care provided to her late husband (Mr A) by the practice prior to him suffering a fatal heart attack. In particular, Mr A had reported chest pains three times over a three month period to his GP. The GP had felt the problems were related to a stomach problem, prescribed Gaviscon (medication for heartburn or indigestion) to Mr A and said they had ruled out a cardiac cause for the chest pain.

We took independent advice from a GP. We found that at the initial consultation it was reasonable that the GP had considered that Mr A's long standing stomach problem was responsible for his reported chest pain, and it was appropriate to prescribe medication. There was a question as to whether Mr A was taking the prescribed medication, which may have resolved the stomach problem, and that it was reasonable to pursue that line of enquiry in an effort to resolve the situation. We found that the GP had carried out an appropriate examination and did not uphold the complaint. We also noted that there was no evidence to suggest that had an earlier diagnosis been made, it would have prevented Mr A's sudden death.

Summary

Mr C complained that the care and treatment given to his late wife (Mrs A) by the board was unreasonable. Mrs A had a history of rheumatoid arthritis (an inflammatory disorder that mainly affects flexible joints) and was later investigated for possible heart disease. The investigations proved negative. However, a year later she was admitted to hospital again and found to have severe problems with the functioning of her heart valves. Heart surgery was considered, but Mrs A developed sepsis and multiple organ failure which increased the risks associated with surgery. However, it was considered that Mrs A would not survive without an operation, which went ahead. After Mrs A was discharged home, she picked up a serious infection and suffered a stoke. She died a few months later.

We took independent advice from a cardiologist (a doctor who specialises in the heart and blood vessels). We found that it was extremely unusual for a patient's heart condition to deteriorate so rapidly and that this could not have been foreseen; there had been no delay in treating Mrs A's symptoms or in diagnosing her heart problems. Mrs A's health was such that surgery was always going to be risky for her, but there had been no delay undertaking it. Afterwards, the serious infection from which Mrs A suffered had a significant associated mortality rate and her health continued to deteriorate despite her treatment. Therefore, we did not uphold the complaint.

Summary

Mrs C complained about the treatment provided to her father (Mr A) while he was a patient at the Golden Jubilee National Hospital. Mr A had been admitted for planned surgery and subsequently his health deteriorated. Mrs C said that Mr A reported problems with his leg/foot and that these were ignored by staff. Mrs C felt that Mr A should have been sent to the high dependency ward after the surgery so that he would have been better observed by staff and that his outcome would have improved. Mr A was then housebound, had limited mobility, and a poorer quality of life.

We took independent advice from a cardiothoracic consultant (doctor specialising in operations of the heart, lungs and other chest organs). We found that the planned surgery was carried out without complications and that it was appropriate to transfer Mr A back to a ward rather than a high dependency ward as there were no concerns noted. When Mr A did deteriorate, he developed respiratory failure (a condition in which the blood does not have enough oxygen or has too much carbon dioxide) which was identified by staff and he was then taken to the high dependency ward. Mr A also had other long-standing medical conditions, which were more likely to have contributed to Mr A's deterioration rather than as a result of the surgery he underwent. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late husband (Mr A). Following surgery to remove a tumour on this lung, Mr A was treated for atrial fibrillation (AF - an irregular and usually rapid heart rhythm) with amiodarone (an antiarrhythmic drug). Mrs C complained that the board unreasonably prescribed amiodarone as a first line treatment for Mr A's AF. Mrs C noted that patients prescribed with amiodarone after thoracic (chest) surgery are vulnerable to side effects, and she considered Mr A would have survived had a less dangerous drug been used to treat him.

We took independent clinical advice from an adviser. We found that guidance supported the use of amiodarone at the time of Mr A's treatment as it is the drug most likely to restore normal heart rhythm and thereby avoid the consequences of low blood pressure, heart failure or stroke, and its use remains common. We acknowledged that amiodarone may not always be the most appropriate first line treatment option in all cases of AF, however, we were satisfied that it was reasonable for medical staff to reach the view that the benefits of treatment with amiodarone outweighed the risks in Mr A's case. Therefore, we did not uphold Mrs C's complaint.

However, we provided some feedback to the board that, despite referring to it on a number of occasions in their response to Mrs C's complaint, they did not have a written protocol on treating post-operative AF following lung surgery. We suggested the board may wish to review their practice on the routine use of amiodarone as a first line therapy in all cases of post-operative AF, and consider producing a protocol on the management of AF after thoracic surgery. We also provided feedback with respect to the content and lack of accuracy of the board's response to Mrs C's complaint and invited the board to make a further apology to Mrs C having reflected on the findings of our investigation and feedback with respect to their complaints handling.

Summary

Mr C complained about the treatment which his child (Child A) received at Forth Valley Royal Hospital. Mr C said that Child A had been unwell for many months following a viral diagnosis and that they had continued to experience symptoms which had affected their life, including missing school for multiple periods. Although Child A had been referred to otorhinolaryngology (medical treatment of ear, nose and throat) and paediatrics (medical care of children), Mr C felt that a diagnosis should have been reached after such a long time.

We took independent advice from a consultant paediatrician. While there was a lack of advice and support provided to Mr C on how to manage Child A's symptoms in the interim, which would have helped to allay their fears, we found that appropriate investigations and assessments had been carried out in an effort to arrive at a diagnosis, including referrals to specialist services. We did not uphold the complaint.

Summary

Mrs C complained about the nursing care provided to her cousin (Mr A) during an admission to Forth Valley Royal Hospital. Mrs C raised concerns about various aspects of the nursing care provided to Mr A in respect of his hygiene and whether he was being provided with appropriate support to eat and drink properly.

We took independent advice from nursing adviser. We found that there were daily entries in the nursing notes to indicate Mr A's needs were met. We noted that the care plan documentation had not been completed until some time after admission. However, while it would be good practice to do so earlier, this does not necessarily mean the nursing care provided was not of a reasonable standard. We acknowledged that the account provided in the nursing records was not Mrs C's experience. However, we did not consider there to be independent evidence that could verify her view. Therefore, based on the available evidence, we did not uphold this complaint.

Mrs C also complained about communication issues she experienced as Mr A's power of attorney. The board had previously provided an apology for Mrs C's experience but there were still a number of areas Mrs C was unhappy about. On balance, we concluded that staff's communication with Mrs C was reasonable in the context of a busy hospital environment. We acknowledged that communication was not as good as it could have been, but we did not consider it to be unreasonable. We provided some feedback to the board but, on balance, did not uphold the complaint.

Summary

Ms C, an advocate, complained on behalf of her client (Ms A) about the treatment which Ms A received at the practice. Ms A had reported concerns about hip pain on a number of consultations, but the GPs wrongly diagnosed a soft tissue injury when Ms A had actually suffered a fracture of the hip.

We took independent advice from a GP. We found that Ms A had an extensive medical history of hip problems and was under the care of the orthopaedic (conditions involving the musculoskeletal system) team. When Ms A reported hip pain following a fall it was not unreasonable for the GPs to conclude that Ms A had suffered a soft tissue injury as she was able to weight bear. Although it would appear that the fracture had occurred by the time Ms A was seen by the GPs, this was not an indication that the care and treatment was unreasonable. We did not uphold the complaint.

Summary

Ms C attended hospital for minor surgery under anaesthetic. She said that she made it very clear in advance of attending for the surgery that she did not want to have any opioid drugs (common pain relief) administered. However, despite communicating that prior to and on the day of surgery, an opioid was administered whilst Ms C was under anaesthetic. Ms C also had concerns about the staff present in the anaesthetic room. She said no one introduced themselves or explained their role to her; she did not know who one individual was even though they squeezed her arm as a method of tourniquet (device for stopping the flow of blood through a vein or artery) during the insertion of the cannula; and she questioned the appropriateness of the method of tourniquet used.

We took independent advice from a clinical adviser. It was noted that staff denied not having introduced themselves to Ms C. They said they had acknowledged Ms C's anxieties and to help with that she was moved to first on the theatre list. We also reviewed a patient leaflet produced by the Faculty of Pain Medicine which indicated that squeezing a patient's arm was an acceptable method of tourniquet.

In turning to Ms C's concern that she was administered an opioid against her expressed wishes, the board confirmed the anaesthetist was aware of Ms C's previous unpleasant experience with morphine and recalled reassuring her that they would not use that drug or any long acting opiates. They were not aware that Ms C wished to avoid all opioids. We found that it would have been unreasonable not to administer pain relieving drugs to Ms C during her surgery, because she could have suffered acute pain and distress.

Finally, we were satisfied that the board had taken reasonable steps to identify the staff present in the anaesthetic room. In light of the information we saw in Ms C's case, we did not uphold the complaints.