Not upheld, recommendations

Summary

Ms C raised her concern that there was an unreasonable delay by clinicians in diagnosing that she was suffering from ovarian cancer.

During our investigation, we took independent advice from a consultant gynaecologist. The advice we received and accepted was that while Ms C had been treated for possible precancer of the cervix from 2005 until 2011 this had no relation to her development of ovarian cancer and that there is no screening test for ovarian cancer. Even had Ms C's ovarian cancer been diagnosed earlier, in her circumstances, the treatment would have been the same - a total hysterectomy. We found no evidence that there had been an unreasonable delay by the clinicians in diagnosing that Ms C was suffering from ovarian cancer. However, we were concerned that while there had been discussions about Ms C's situation during the period she was being treated for possible precancer of the cervix, she was not made aware of these discussions, so we made a recommendation to the board about this.

Recommendations

We recommended that the board:

• report back on the action taken as a result of this case to improve communication with patients.

Summary

Mr C ran a small business and stated that he had no mains water supply or drainage. As a result he complained that Business Stream were unreasonably pursuing him for charges for water and waste water services backdated to 2008. Scottish Water were asked to attend the property on a number of occasions and confirmed that, while Mr C had no direct water supply, he did have access to water and waste water facilities. As such he was liable for the charges applied by Business Stream for services used.

During our investigation we found that there had been errors on the part of Business Stream in relation to Mr C's liability. Mr C's account had been opened and closed on three occasions on the basis of information supplied by Mr C. We were concerned that Business Stream had taken the decision to close Mr C's account without carrying out sufficient investigations and, as a result, Mr C received an invoice covering a longer than normal period. However, while there had been errors on their part, Business Stream confirmed that Mr C was liable for the charges issued.

While we found no evidence that Business Stream were unreasonably pursuing Mr C for water and waste water services we were concerned about the errors on the part of Business Stream with regard to his liability, so we made one recommendation.

Recommendations

We recommended that Business Stream:

• ensure they offer Mr C a suitable payment plan to reflect that he received an invoice covering a longer than normal period.

Summary

Miss C complained to us about the care and treatment she received when she attended A&E at the Royal Alexandra Hospital. Miss C had previously been diagnosed with a suspected inguinal hernia (an opening in the wall of the lower abdomen near the groin) and had been referred for an out-patient ultrasound scan and an appointment to see a general surgeon to discuss the treatment options. Whilst awaiting this appointment, Miss C attended A&E with increasing pain from the area. She was examined by doctors who did not identify any palpable (able to be touched or felt) lump and found that she was clinically well. She was discharged with painkillers. Miss C subsequently went on holiday, but had to cut her holiday short due to worsening symptoms. She was admitted to hospital when she returned from holiday. It was subsequently identified that she had a groin abscess, which had to be drained. Miss C considered that the doctors in A&E had not carried out a reasonable assessment and had failed to identify the abscess.

We took independent advice from a consultant in emergency medicine. We found that it was not likely that the abscess was present when Miss C had attended A&E. The assessment carried out by doctors in A&E had been reasonable. It had also been reasonable for staff not to carry out blood tests or an ultrasound scan and to discharge Miss C with pain relief and to await the ultrasound scan. Although we did not uphold the complaint, we did identify some areas for improvement and we made a recommendation to the board in relation to this.

Recommendations

We recommended that the board:

• remind the staff involved in Miss C's care that they should monitor and record the pain experienced by a patient and also the effectiveness of treatments given to relieve the pain; full documentation of assessments and second opinions should be made to provide contemporaneous notes for each attendance; and they should record what advice is given to patients when they are discharged, particularly in relation to follow-up arrangements, what to do if things get worse and also advice about travel, driving or work.

Summary

Mr C raised a number of complaints about the care and treatment provided to his father (Mr A) before and during his admission to the Royal Alexandra Hospital. Mr A was diagnosed with an unusual form of tuberculosis causing a skin condition. Mr C said that while his father was in the hospital he suffered from peripheral neuropathy (damage to or disease affecting nerves causing weakness in the limbs) and had become immobile.

Mr C was concerned that the medication prescribed to treat his father's tuberculosis, isoniazid, was not properly monitored and had caused Mr A's peripheral neuropathy. Mr C said there had been a failure to discuss with Mr A and his family the potential side effects of this treatment and to tell them that Mr A had also been diagnosed with diabetes. Mr C also considered that Mr A had not been provided with appropriate physiotherapy treatment to address his immobility.

We took independent advice from a consultant in respiratory medicine and a consultant in medicine for the elderly.

The respiratory medicine adviser said the incidence of peripheral neuropathy causing weakness in the limbs is a very rare side effect of isoniazid and that Mr A was not in the category of patient who would be considered to be at greater risk of developing this condition. Also, Mr A had been prescribed pyridoxine, a standard treatment to protect the nerves. The adviser said the doses of medication Mr A received were appropriate and properly monitored and they would not normally mention peripheral neuropathy as a possible side effect of taking isoniazid to a patient such as Mr A. Overall, the adviser did not identify any failings in Mr A's care and treatment.

The evidence showed that medical staff had spoken with Mr A's family to discuss his condition on several occasions and that Mr A's daughter had been advised on at least one occasion that Mr A had diabetes.

The adviser in medicine for the elderly also said that Mr A was seen regularly by physiotherapy staff, and that there had been a very good multi-disciplinary approach to the management of his rehabilitation, and considerable effort had been made to improve the level of his mobility. Unfortunately, the severity of Mr A's state of health meant that physiotherapy could not achieve a better recovery for him.

While we did not uphold Mr C's complaints, we identified issues concerning communication and record-keeping, and we made a recommendation to address this.

Recommendations

We recommended that the board:

• remind relevant staff of the importance of ensuring that when there is discussion about a patient's condition and treatment, the patient and their family clearly understand what is being said and the discussion is clearly recorded in the patient’s medical records.

Summary

Mrs C complained that the Royal Aberdeen Children's Hospital provided her son (Mr A) with inadequate care and treatment. In particular, Mrs C felt that there was not a proper care plan in place and that specific treatment should have been provided. Mrs C also raised concerns that a specialist nurse did not understand Mr A's health problems and acted inappropriately in making a referral to the Reporter to the Children's Hearing (an authority set up to safeguard children).

We took independent advice on this case from a medical adviser and a nursing adviser. We found evidence that the care provided by the hospital was appropriate. In particular, there was good interdepartmental communication between relevant specialities within the hospital and Mr A was reviewed regularly. A second specialist opinion was also appropriately requested from another hospital in England and followed up by the Royal Aberdeen Children's Hospital. Whilst we did not uphold the complaint, we found that the board had not provided Mrs C with a full response to her complaint. Therefore, we made a recommendation to address this.

We also considered that the specialist nurse acted in accordance with professional guidance in making the referral to the Reporter to the Children's Hearing given there was multi-agency concern about Mr A's health and wellbeing.

Recommendations

We recommended that the board:

• share with those staff dealing with complaints the importance of ensuring that full and comprehensive written responses are provided to complaints.

Summary

Mr C complained to us that Business Stream had not disconnected his water supply, and that he had been charged for a water service that he did not need or use.

We reviewed the communication between Mr C and Business Stream and we found that Mr C was liable for water charges, and that this was set out in his lease. We reviewed the evidence from phone conversations Mr C had with Business Stream, and found that Mr C did ask for a disconnection, but he then decided not to pursue this.

However, we were critical of Business Stream's handling of the situation. They were not clear about what was happening with his account, and they did not provide him with the charging information he needed to make a clear decision on his water services, despite several opportunities to do so. We were also critical that they did not do more to facilitate access to Mr C's property when it would have been appropriate to do so.

Recommendations

We recommended that Business Stream:

• remove the second added recovery charge from Mr C's account, in addition to the existing offer to remove the recovery charge and make the ex gratia payment; and
• consider providing customers with more comprehensive information on the costs and options in relation to the disconnection of water services, including information about the charges still applicable during temporary disconnection, and how to request a disconnection.

Summary

Mr C complained that the prison did not have an adequate process in place to allow for the fair selection of prisoners and their families to attend prison events/parties. Mr C was unhappy that, when a party/event was held at the prison, his child was not allowed to attend and, specifically, that he had not been given a place at a recent event. The prison had acknowledged as part of the complaints process that Mr C had likely been told that he had not been allowed to attend the party because he had a misconduct report. However, the Internal Complaints Committee told Mr C categorically that this was not the case and that there was no set criteria for attendance.

Following our enquiry to the Scottish Prison Service (SPS), we could not see any evidence that the prison were required to have in place a specific process to allow for the fair selection of prisoners and their families to attend prison events/parties. We were satisfied with the prison's explanation of the simple selection process and, while we acknowledged that Mr C had been provided with conflicting information about the selection of prisoners, we were satisfied that the prison had followed this process when selecting prisoners for the party. We considered that it would be disproportionate and overly bureaucratic to require the prison to have a written or formal process/procedure in place for such a simple process. Therefore, we did not uphold Mr C's complaint.

However, as part of our enquiries, we were told by the prison that, in fact, initially, priority was given to prisoners who had been report free for a certain period. The paperwork provided by the prison, although not clear, appeared to support this explanation. This was in direct contradiction to the information Mr C was provided during the complaints process that there was no set criteria for attendance. Therefore, we recommended that the prison apologise to Mr C for failing to give him a clear and accurate explanation of what happened in relation to the selection of prisoners for this party/event.

Recommendations

We recommended that SPS:

• apologise to Mr C for failing to give him a clear and accurate explanation of what happened in relation to the selection of prisoners for the party/event.

Summary

Miss C complained to the council after they refused to provide her with a bigger bin. She stated that the current provision was not sufficient for her needs as she had a large household. However, the council had carried out assessments of her waste and found material they said could have been recycled or disposed of in other ways. They stated that, had this taken place, she would have had sufficient capacity for her needs but Miss C disputed that the assessments had been accurate.

On investigation, we found that the council had photographic evidence to support their statements and, while this was not conclusive due to the nature of the assessments, there was no evidence available to suggest that they had acted incorrectly. We therefore did not uphold the complaint.

However, we also identified that the council's second stage complaint response had been very brief and lacked sufficient detail to fully explain the reasons for their decision. As such, we made recommendations in relation to this failing.

Recommendations

We recommended that the council:

• apologise to Miss C for the lack of detail provided in their complaint response; and
• reflect on this to ensure that relevant staff are aware of the level of detail required in a second stage response.

Summary

Mrs C complained that the practice failed to take her late husband (Mr C)'s symptoms seriously between January and March 2014, in particular his weight loss. She also said that they were given inaccurate information about the length of time Mr C would be admitted to a hospice.

We took independent advice from a general practitioner and we found that Mr C had a history of back pain and diabetes, and in 2013 had been given advice about his diet. He lost weight as a consequence and, when he went to the GP a few months later suffering from leg pain, it was noted that he was still losing weight but this was considered to be because of his healthier diet. Nevertheless, Mr C's pain was investigated: blood tests were taken, he was referred for physiotherapy and an MRI (magnetic resonance imaging) scan of his back was carried out. Mr C's blood tests showed an abnormality, and he was, therefore, referred to hospital where he was later diagnosed with cancer. Mr C's pain was very difficult to control and he was admitted to a hospice on two occasions. On the second occasion, Mrs C felt that she had been misled as it was indicated his stay would only be short. However, because of the complexity of his needs, it took a considerable time to provide a solution to his pain.

We acknowledged that Mrs C had coped with a very stressful situation but we did not uphold her complaint. However, as we found that Mr C's referral to hospital should have been an urgent one (because of the presence of weight loss), we made a recommendation for the practice to familiarise themselves with appropriate guidance.

Recommendations

We recommended that the practice:

• ensure that GPs in the practice familiarise themselves with the appropriate guidance and discuss this as a learning point.

Summary

Ms C complained about the care and treatment she received from the Early Pregnancy Assessment Service (EPAS) at the former Southern General Hospital in Glasgow following a positive pregnancy test. Ms C had been referred to the EPAS by her GP practice as she was in the early stages of pregnancy and had a three-week history of constipation, vaginal bleeding and abdominal pain. When Ms C called the EPAS, a midwife advised her that she may be having a miscarriage and she was given an appointment for the following week to have a scan.

The following evening, Ms C called the EPAS again as she was in pain but as the service was closed her call was passed to a midwife at the maternity assessment unit. Ms C said she was offered no new advice as it was too early in her pregnancy. When Ms C attended her appointment at the EPAS, the scan revealed she had an ectopic pregnancy. As a result, Ms C required emergency surgery. Ms C felt the midwives at the EPAS should have acted sooner.

We took independent advice from a midwife adviser. We found that the midwives involved in Ms C's care and treatment appeared to have followed the relevant guidance which included the health board's Early Pregnancy Assessment (EPA) guidance for dealing with phone calls, and that their actions were reasonable. We also found that there did not appear to have been any unreasonable delay before the scan was carried out as the guidance suggested that women presenting with symptoms like those Ms C presented with are given a non-urgent appointment. We did not identify any failings in Ms C's care and treatment and, therefore, we did not uphold Ms C's complaint. However, we did find some issues with record-keeping and the EPA guidance, and we made recommendations to reflect these findings.

Recommendations

We recommended that the board:

• feed back to relevant staff that advice given to patients should be clearly documented in the patient's medical records and patients are given as much information as possible about what they might expect, especially while they wait for a scan; and
• consider our findings in relation to providing a clear definition in the EPA guidance for specific stages of pregnancy with combinations of symptoms; and 'non urgent' appointments and the women who fall into this category.