Some upheld, recommendations

Summary

Miss C suffers from an anxiety disorder, and had been prescribed diazepam (a medicine which helps to control feelings of anxiety) for a number of years. When she requested a repeat prescription, Miss C was told to call the practice. Miss C said she was then told in a phone conversation with her GP that her prescription for diazepam would be stopped after a period of reduction and that, in future, she would have to attend an appointment at the practice before a repeat prescription would be issued. Miss C told us that her prescription had not previously been monitored, and had been increased over the previous years. Miss C considered that it was wrong to stop the medication. She was dissatisfied with the explanation provided by her GP and also the manner in which he responded to the complaint, which she considered to be inappropriate and unsympathetic.

We took independent advice on this case from one of our medical advisers. The advice, which we accepted, was that the practice had not failed in their care of Miss C in relation to prescribing medication. However, in relation to the complaints handling, we found that although the GP provided reasonable explanations, the tone of his letters was unnecessarily sharp and at times insensitive, and his response could and should have been more considerate and empathetic.

Recommendations

We recommended that the practice:

• ensure that they and the GP reflect on the handling of this complaint to ensure that in future complaints are handled in an appropriate manner; and
• apologise to Miss C for the failures identified by this investigation.

Summary

Ms C complained on behalf of an elderly lady (Mrs A) who was admitted to hospital as an emergency. Mrs A had terminal cancer and diabetes and a number of other health problems. Ms C complained that the standard of nursing care was unreasonable, and that Mrs A was discharged in an inappropriate manner. We took independent advice on this complaint from our nursing adviser and our hospital adviser.

In terms of nursing care, Ms C said that Mrs A was given no food or fluids while she was in the hospital's accident and emergency (A&E) department waiting to be admitted to a ward. Our nursing adviser said that these should not generally be provided in A&E, as this may compromise later treatment but that, given her circumstances, Mrs A should perhaps have been offered a drink of water. We saw nothing to suggest that the wait had an adverse impact on Mrs A’s health, but we drew this matter to the board’s attention. Ms C also complained that a nurse on the ward administered the wrong eye drops and did not follow hygiene procedures, and that a disruptive patient received attention while others were ignored. Our investigation found no specific evidence to show that the nursing care was unreasonable. We noted, however, that the board had acknowledged Mrs A’s negative experience and had put in place an improvement plan and a period of supervision for the nurse, which we considered a reasonable response to Ms C's concerns.

On the day Mrs A was expected to be discharged, she did not see a doctor until late in the day. By that time, her husband (Mr A) - who would have driven her home - had left. Mr and Mrs A lived 75 miles from the hospital, and so, although Mrs A was considered fit to go home, the doctor agreed that she should not be discharged until next day. Despite this, Mrs A was discharged that evening, and was sent home alone in a taxi dressed in her bed clothes. The board said this happened due to a breakdown in communication between the ward and the bed manager. When Mrs A arrived at her house, her husband was not there and, as she had no keys with her, she had to wait for a short time in the taxi until he arrived.

We upheld this part of the complaint. Our medical adviser noted that the discharge documents were incomplete, and he was not able to identify who authorised the discharge. As Mrs A required a walking aid, he considered it particularly inappropriate for her to be discharged alone in a taxi. The board had already acknowledged that Mrs A’s discharge was handled inappropriately. They had apologised, and reviewed their policy of discharging patients in taxis without outdoor clothing. However, we made recommendations as we took the view that there were wider issues to be addressed in their approach to discharge, in particular that checks that should be made and patients' individual circumstances recognised.

Recommendations

We recommended that the board:

• further review their discharge planning arrangements in the light of the comments in our decision letter and provide the Ombudsman with a copy of their revised arrangements;
• review communications between wards and the bed manager to ensure that a situation like this does not happen again; and
• draw our decision letter to the attention of the staff involved in Mrs A's discharge to ensure that they learn from the failings identified.

Summary

Mrs C, who is an advice worker, complained to us on behalf of her client (Mrs A). Mrs A was referred to a gynaecology clinic, as she had been experiencing some loss of bladder control. It was agreed that Mrs A would have an operation to try to resolve this. However, after the operation Mrs A was left in pain, and with a feeling of great urgency to pass urine at times. Mrs C complained that Mrs A was not reasonably informed of the risks before the operation and that it had worsened her situation.

After considering Mrs A's clinical records and taking independent advice from one of our medical advisers, we found that Mrs A had been counselled appropriately about the risks and benefits of the operation. She signed a consent form that identified the risks and was given a patient information leaflet about the operation, which was clear and informative. This included information about the risk of long-term pain and the risk of developing irritable bladder symptoms.

Although it was clear that the operation had not been successful, we found that that it was reasonable for the board to carry out the procedure, which was performed appropriately and by surgeons with adequate training and expertise. We did not identify any failings by the board that led to the problems Mrs A experienced.

Mrs C also complained about the care provided to Mrs A after the operation. We found that her initial post-operative care was reasonable and appropriate. However, Mrs A had to wait too long for appointments and we found that the aftercare should have been provided in a more timely fashion. It was only when Mrs C complained on her behalf that an appointment with a consultant was brought forward, a complication was recognised and Mrs A was then referred to the pain clinic. Even then, the appointment with the pain clinic initially given to Mrs A was more than three months later.

Recommendations

We recommended that the board:

• issue a written apology to Mrs A for the delays in providing appointments once the complication had been recognised; and
• confirm to the Ombudsman that they have learned lessons from this case and will ensure that, in future, patients who suffer complications after having this type of surgery do not face similar delays in getting appointments.

Summary

Mrs C had her gall bladder removed by laparascopic (keyhole) surgery. She complained that although she felt ill and breathless the board had insisted on discharging her, as she had only been admitted for day surgery. Mrs C also complained that when she was then re-admitted as an emergency, this was under the care of the respiratory medicine department rather than the consultant who had carried out the operation. Mrs C continued to have medical issues, which she blamed on the surgery, and about which she spoke to the consultant the month after her operation. Although she felt he was rude and abrupt, she said he agreed to see her in his clinic. However, despite a letter from her GP, she did not receive a letter until three months later, for an appointment the following month. Mrs C also said that the board’s response to her complaint was inaccurate and did not answer all the points she had raised.

After taking independent advice on this case from three medical advisers, we upheld only one of Mrs C's complaints. After considering her medical records, the advice we received was that the decision to discharge Mrs C after surgery was appropriate, as was the decision to readmit her under the care of the respiratory medicine department. However, it was not reasonable that Mrs C was not seen for over three months by the operating consultant, given that she had discussed her problems with him personally. We found that although the complaint response was delayed and contained some typographical errors, it had appropriately addressed all the points Mrs C raised.

Recommendations

We recommended that the board:

• apologise for the failings identified in Mrs C's care; and
• review their procedures to ensure that following laparascopic surgery, patients are followed up appropriately.

Summary

Mrs C was referred to a hospital chest clinic in 2008 with a troublesome cough, breathlessness and wheezing. A diagnosis of chronic obstructive pulmonary disease (an airways disease) was considered, but excluded several months later following further investigations. A diagnosis of asthma was considered and Mrs C was prescribed treatment to see if this improved matters. Mrs C also had episodes of palpitations and her medical records noted that she had a faster than normal heartbeat (supraventricular tachycardia - SVT), and had been prescribed verapamil (a drug widely used to treat this) from 1991. When she was reviewed by the respiratory consultant in 2011, it was noted that she had different symptoms to the previous ones that might have been related to SVT. She was referred to a consultant cardiologist and tests were carried out. These did not show any abnormalities and the prescription of verapamil was stopped.

Mrs C complained that she was treated for asthma for two and half years when there was no definitive diagnosis, and prescribed verapamil for over 23 years without being routinely reviewed by the hospital cardiology department to update the diagnosis and consider treatment options that might be more relevant. Mrs C also said that the board failed to fully respond to her complaint, to respond within a reasonable time and to take appropriate action.

Our investigation took account of the information Mrs C provided, alongside her medical records, and we took independent advice from one of our medical advisers. The advice, which we accepted, was that both the diagnosis of Mrs C's symptoms and potential conditions, and the resulting treatment, were reasonable. In 2009, it appeared that Mrs C's symptoms were well controlled by treatment for asthma. As soon as it became apparent in 2011, however, that this was potentially exacerbating the symptoms of her fast heart rate, she was referred promptly to cardiology. In relation to the prescription of verapamil, we found that the care and treatment provided by the relevant consultants was reasonable. Our adviser said that where medication controls the symptoms, as in Mrs C's case, then it can reasonably be continued without regular review. As soon as her symptoms could be interpreted as relating to her heart, the medication was stopped and alternative treatment was considered. We did not, therefore, uphold Mrs C's complaints about her care and treatment.

We did uphold her complaint about the complaints handling. We were satisfied that the time the board took to deal with the complaint at first was reasonable. They responded within 20 working days and addressed three of the issues, saying that the consultant would address the remaining issues. The consultant then said that these would be difficult to put in writing and easier to discuss. As our adviser confirmed that the issues were extremely complex, we took the view that this was reasonable. In addition, the consultant followed up the discussion with a written record, which was good practice. The board, however, did not at first tell Mrs C that they could not address a complaint she raised about her GP practice, although they later told her about the practice’s position and arranged a meeting with them. We also found that the board failed to respond to Mrs C's complaint about the long-term prescription of verapamil, until we investigated this. Given the significance of the issue in her complaint, we criticised the board for this.

Recommendations

We recommended that the board:

• take steps to ensure that, in future, all elements of a complaint are responded to; and
• apologise to Mrs C for failing to fully address her complaint.

Summary

Mrs A had Parkinson's disease (a progressive neurological condition in which part of the brain becomes more damaged over many years) and an Alzheimer's-type condition and needed help with a number of day to day tasks. Her son (Mr C) was her next of kin, carer and power of attorney. He complained that when Mrs A was admitted to hospital, staff failed to recognise his status and include him in discussions about her treatment. Mr C felt that he had to actively seek information from staff, rather than this being openly discussed with him. He also complained about the quality of the nursing care and the appropriateness of a decision to discharge Mrs A.

We found that, although Mr C was eventually appropriately included in discussions about Mrs A's treatment, he was not adequately involved during the first days of her admission. As such, important background medical information was not gathered, as Mrs A could not provide this herself. We noted that the board have useful tools for staff to establish whether there is a carer available, but these were not used. We were satisfied that appropriate consideration was given to Mrs A's suitability for discharge and that there was clear evidence of Mr C being consulted and of his comments influencing the decision-making process. However, we were critical of the board's handling of Mr C's complaints, as their investigation into his concerns was substantially delayed.

Recommendations

We recommended that the board:

• review their processes for establishing and communicating the level of involvement in care for patients with a welfare guardian or power of attorney;
• introduce a process that ensures that the relatives or carers of any patient who lacks capacity or is confused are engaged in meaninful communication from the earliest point practicable following admission; and
• ensure that they have a structured process in place to act upon all points of learning arising from complaints.

Summary

Mrs C complained on behalf of her daughter (Ms A), who had been diagnosed in 2003 with bipolar disorder. Mrs C said that in 2011, despite her concerns, Ms A's diagnosis was changed, as was her medication. Ms A was not offered a second opinion and Mrs C said that her daughter’s condition went into 'free fall', reaching a crisis point in the summer of 2012. She complained that Ms A was offered little in the way of psychiatric support, and that appointments with a community psychiatric nurse were often cancelled without being rescheduled.

We gave all the relevant documentation, including the complaints correspondence and Ms A's medical records, careful consideration. We also obtained independent advice on the case from a consultant forensic psychiatrist and a mental health nurse. Our investigation found that despite Mrs C's concerns, it was entirely correct for Ms A's diagnosis and medication to be kept under review and that the board had acted appropriately and reasonably in doing so. Mrs C's disagreement with this was well recorded, and was not discounted. However, in the circumstances, our adviser said that it might have been prudent to offer Ms A a second opinion.

The investigation also established that there had been no delay in providing new appointments when some were cancelled. However, there was evidence that the frequency of appointments was inconsistent and not as planned.

Recommendations

We recommended that the board:

• make a formal apology to Mrs C and Ms A for inconsistencies in the timing of appointments.

Summary

Mrs C complained about several aspects of her hospital care and treatment immediately before, during and immediately after the birth of her son. Mrs C's son was born by a forceps delivery which necessitated an episiotomy (a minor surgical cut that widens the opening of the vagina during childbirth). She also suffered a third-degree tear (a serious tear between the vagina and anus). She suffered a major haemorrhage (escape of blood) minutes later and required extensive life-supporting treatment. Mrs C was concerned that the complications she suffered might have been the result of poor care and treatment. She was also concerned that she and her husband were unsupported after such a traumatic experience and that this was causing her long-term health problems.

After taking independent advice from one of our medical advisers, our investigation found that while Mrs C had undoubtedly had a very traumatic and difficult birth experience, it was not caused by poor care or inadequate treatment. We were, however, very critical that the need to refer her to counselling services was noted in the post-natal ward but not acted on. This meant that Mrs C and her husband were not properly supported after the birth. We upheld this aspect of her complaint and made recommendations.

Recommendations

We recommended that the board:

• apologise to Mrs C and her husband for the failure to refer her for appropriate counselling while she was in the post-natal ward; and
• review the failure to refer Mrs C to counselling services and identify any improvements that can be made to the referral process in the future.

Summary

Mr C leased and operated a pub that shared its water supply with a residential property. He complained that Business Stream unreasonably delayed in issuing their initial invoice – he had run the pub since 2007 and only received an invoice in 2010 – and that when it arrived it was unreasonably high. Mr C felt that this was at least partly attributable to the meter serving more than one property.

Although Mr C maintained that he had notified Scottish Water of his occupancy of the premises concerned in 2007, our investigation did not find evidence to confirm this and noted that as soon as Business Stream knew of his occupancy in 2010, they began issuing bills. However, the bills were for both business and domestic premises. We did find that took too long for Business Stream to provide an appropriate meter in Mr C's premises. Because of this, the bills issued were incorrectly based and Mr C had paid twice for his domestic use (through both the metered charges and his council tax).

Recommendations

We recommended that Business Stream:

• make a formal apology for their role in the delay in providing an appropriate meter; and
• in the event of Mr C providing information to allow Scottish Water to refund overpaid charges, agree to refund him any difference in the cost.

Summary

Mr C's business occupied premises in a large office building. His office did not have its own water supply, but had access to the building's communal water facilities. In January 2013, Business Stream contacted Mr C and told him that he was liable for drainage charges accrued over five years. Mr C did not feel that his business should be liable for these charges, as his occupancy was agreed under a license with the property owner rather than a tenancy agreement. He said his office was not directly connected to a water supply and the terms of his license placed full responsibility for the building's fixtures and fittings on the licensor. Mr C also raised concerns about Business Stream's handling of his complaints.

Mr C had questioned whether his premises were 'eligible premises' as defined by the Water Services etc (Scotland) Act 2005. This defines premises that are eligible for water and drainage charges as those that are (or are to be) connected to the public water and sewerage systems. Although it is not for us to interpret this legislation, we investigated whether Business Stream gave proper consideration to relevant factors when reaching their decision. We found that they were obliged to set up their charges in accordance with the market code (which sets out the duties of participants in the water market, and provides technical specifications). Business Stream's treatment of Mr C's premises as an 'eligible premises' was in line with the code, which in turn was based on the legislation.

Mr C felt that all water and drainage charges for his premises should be charged to the property owner (licensor) rather than him, given his status as a licensee. Again, it was not for us to determine what status Mr C's license gave him, or what difference this might make in terms of who should be liable for charges. However, we were satisfied that Business Stream made appropriate enquiries to establish who should be charged, and reached a reasonable conclusion based on the information provided to them.

We were critical that Business Stream did not clearly explain to Mr C the reasoning behind their decision to charge his business for drainage, but we found that they responded to all of his correspondence in good time.

Recommendations

We recommended that Business Stream:

• take steps to improve the level of detail in their customer correspondence so that full explanations are given as to the reasoning behind their decisions; and
• apologise to Mr C for their failure to properly explain the reasoning behind charging him for drainage.