Some upheld, recommendations

Summary

C complained about the care and treatment they received at Ninewells Hospital. C was diagnosed with a small renal (kidney) cyst a number of years ago. This was treated at the time, but C complained that it was not subsequently monitored. They later developed a mass in their abdomen that weighed nearly three kilogrammes when it was removed several years later. C considered that the board delayed in operating when C was referred to the urology team (specialists in the male and female urinary tract, and the male reproductive organs) and that there were further delays in providing treatment when they were later diagnosed with cancer.

We took independent advice from a consultant urological surgeon and a consultant radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans). We found that C's renal cyst was incorrectly categorised as simple, when in fact it had the features of a complex cyst with a risk of malignancy. This should have required a referral to urology for active surveillance or surgical resection at that time. Therefore, we upheld this complaint.

In relation to the delay in operating following a referral to urology, we found that a discussion at a renal multi-disciplinary team meeting and then clinic review and a consent discussion were appropriate when C was subsequently diagnosed with a large left renal mass. We did not uphold C's complaint that the board's urology team had delayed in operating at that time.

Finally, we found that C had a very rare form of renal cancer and that the matter was complex because the final diagnosis was not clear. We did not identify any unreasonable delay in C's diagnosis and treatment of cancer. Therefore, we did not uphold this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failure to correctly categorise the cyst. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Cysts of this nature should be categorised correctly.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the care and treatment provided to their child (A) by the dermatology service at University Hospital Hairmyres regarding skin lesions. In particular, C was concerned about the length of time taken to refer their child to paediatric dermatology at a children's hospital, that this referral was not marked as urgent and antibiotics or a steroid cream were not prescribed earlier. We took independent advice from a consultant dermatologist. We found that the length of time taken to refer A to paediatric dermatology was not unreasonable in the circumstances. It was reasonable that the referral to paediatric dermatology was routine rather than urgent given A's clinical presentation, that antibiotics were not prescribed earlier as there was no indication of increased swelling, pain and increasing size or progression of the lesions, and that topical steroids were not prescribed in the absence of a definite clinical diagnosis. We did not uphold C's complaint about the care and treatment provided to A.

C also complained about the way the board handled their complaint. We found that one of the board's complaint responses did not address all the points raised by C. We upheld C's complaint in this regard.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to address all the points they raised in the complaint response. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

In relation to complaints handling, we recommended:

• Complaint responses should address all the points raised.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the care and treatment a family member (A) received in Monklands Hospital prior to their death. C raised particular concerns that nursing care was not delivered proactively and that the family had to continually ask for care to be provided, including catheter care, oral care, nutrition and pain management. A suffered a fall while in hospital and C also raised concerns about the adequacy of the medical assessment which was carried out following this.

We took independent advice from a nursing adviser. We found that the nursing care was reasonable overall, with appropriate care rounding evidenced in the records. This covered catheter care, pain management and general care. However, we identified an unreasonable two-hour delay in commencing appropriate medication for pain and agitation due to medical staff being unavailable to prescribe. We also identified that prescribed oral care was not administered as prescribed, and that person-centred care planning did not reflect A's needs with regards to oral hygiene and end of life needs. We considered that this contributed to A's noted discomfort in the final days of their life and, on balance, we upheld this complaint.

We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) regarding the medical assessment which followed A's fall. We noted that a thorough and well-documented assessment was carried out which concluded that A had sustained minor injuries only and that no scans or further investigations were required. We did not consider there was a clear connection between the fall and its follow-up and A's subsequent deterioration. We did not uphold this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the delay in commencing appropriate medication for A's pain and agitation; the failure to administer oral care as prescribed; and for the failure to update the person-centred care plan to reflect A's needs. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Person-centred care plans should be updated at every shift change to capture person-centred needs. The board should carry out a review of person-centred care planning in the relevant ward.
• The board should investigate why medical staff were unavailable to prescribe timely medication for pain and agitation. Measures should be put in place to prevent this happening again; and the board should demonstrate compliance with the Scottish Palliative Care Guidelines 2013.
• Treatment should be administered as prescribed, or a code entered in the medicine kardex to indicate why this has not been administered. Ward staff should be reminded, in a supportive manner, of their responsibilities and the policy for the administration of prescribed medication.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C was taken into Queen Elizabeth University Hospital for a kidney removal after the discovery of a cancerous cyst. A few days after the operation they were detained under the Mental Health Act and transferred to Stobhill Hospital. C believed they were not physically fit for discharge at that stage, and that there was insufficient evidence of risk to justify detaining them. In addition, they considered that their medication was mishandled throughout their time in both hospitals and that staff failed to treat them with respect and dignity. C is also blind and felt that the board had failed to reasonably take account of this in the way they interacted with and cared for them.

We took independent advice from a nephrologist (a doctor who specialises in kidney care and treating diseases of the kidney), a psychiatrist and a nurse. We found that C's care and treatment was generally reasonable, with the exception of the handover between the two hospitals, which was insufficient and led to problems with the dosage of C's medication. On this basis, we upheld C's complaint that the board failed to provide reasonable clinical treatment, but did not uphold their other complaints.

Recommendations

What we said should change to put things right in future:

• Reasonable handover notes should be provided when patients are transferred between hospitals, to ensure continuity of care.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C complained to us about the care and treatment that his late mother (Mrs A) received at Glasgow Royal Infirmary. Mrs A had vascular dementia (a common type of dementia caused by reduced blood flow to the brain, which can cause problems with mental abilities and the physical activities of daily life). Mrs A was admitted to hospital with a fractured collarbone, following a fall at home. During her hospital admission, Mrs A had difficulties swallowing and eating. Her condition worsened and she was diagnosed with aspiration pneumonia (an infection caused by food, saliva or stomach acid being inhaled into the lungs). After Mrs A was discharged home, she was readmitted to the hospital around a week later. Her condition failed to improve and she died in hospital.

Mr C complained that the board had failed to provide Mrs A with reasonable medical care and treatment. In particular, Mr C felt that Mrs A's swallowing difficulties were wrongly attributed to her having advanced dementia. Mr C felt that Mrs A was not given appropriate treatment for her pneumonia because of this. We took independent advice from a consultant geriatrician (a doctor specialising in medical care of the elderly). We found that it was reasonable that Mrs A's swallowing difficulties were attributed to her having advanced dementia. We also found that overall, Mrs A's pneumonia was treated appropriately; and there was no evidence that it was left untreated because of her having advanced dementia. We did not uphold this aspect of the complaint.

Mr C also complained that the board failed to provide Mrs A with reasonable nursing care; in particular, that she was not given appropriate nutritional care in light of her difficulties swallowing and eating. We took independent advice from a nurse. We found that the nursing staff took reasonable action to try to address Mrs A's nutritional needs. However, we found that on one occasion, Mrs A was given the wrong meal for her diet. We also found that when Mrs A's condition worsened during her first admission, nursing staff failed to escalate this to medical staff. These failings had been identified and acknowledged by the board.

In light of these failings, we upheld this aspect of Mr C's complaint.

Recommendations

What we said should change to put things right in future:

• Patients on a restricted diet should receive the appropriate meal.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C, a patient adviser, complained on behalf of their client (A) in relation to the care and treatment provided to A's child (B) by the board. B was diagnosed with a type of slow growing brain tumour and subsequently underwent a surgical procedure to treat build-up of fluid in the brain. B experienced a neurological deficit following the procedure and the surgeons identified that the burr hole (a small hole drilled into the skull) was not placed at the intended site. Over the following months, the neurological deficit improved but B continued to experience severe headaches following the procedure. Follow-up care was provided by paediatric oncology (specialists in treating children with cancer) and paediatric neurology (specialists in treating children with disorders of the nervous system) as well as other specialties over the following years.

We took independent advice from a consultant paediatric neurosurgeon and a consultant paediatric neurologist.

Firstly, C raised concern that the board did not obtain informed consent for the surgery and that the surgery was not performed to a reasonable standard. We found that there was limited reference to complications within the consent form and the written notes, whilst a number of known serious complications were not included in the consent form. We also found that the incorrect placement of the burr hole was unreasonable and that this likely caused the neurological deficit that B experienced. We upheld these aspects of C's complaint.

C also complained that the board did not manage B's pain reasonably following the surgery. We found that this aspect of B's care had been reasonable, with close involvement from both a consultant paediatric oncologist and a consultant paediatric neurologist over a number of years. We did not uphold this aspect of C's complaint.

Finally, C raised concern about the communication between the board and the family about B's care. We found that the documentation of discussion with B's parents about the surgical complication was poor. We found that the communication in relation to B's headaches was, on balance, reasonable. However, we noted that there should have been better communication from the paediatric oncology team. Therefore, we upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to B and B's parents for the failings identified in the consent process, in the surgical procedure and in communication with the family. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Adequate systems should be in place to ensure that technical errors are minimised.
• In accordance with the professional duty of candour, health professionals must tell the patient (or, where appropriate, the patient's advocate, carer or family) when something has gone wrong and apologise for what happened. This should be clearly documented.
• Informed consent should be obtained in accordance with the General Medical Council's guidance on this matter.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about a psychiatric consultation at Falkirk Community Hospital. They complained that they did not receive adequate support from the psychiatrist and that the psychiatrist made inappropriate comments regarding the impact of suicide on others and the best way to complete suicide. We took independent advice from a consultant psychiatrist. It was not possible to confirm from the notes the way the psychiatrist communicated with C or exactly what was discussed surrounding suicide. The board explained that it was the psychiatrist's normal practice to discuss the impact of suicide on others but refuted that C was advised of the best way to take their own life. We considered that the psychiatrist carried out a reasonable assessment and proposed an appropriate management plan. We did not uphold this complaint.

C also complained that a board run GP practice refused to continue their prescription for gabapentin (an anticonvulsant medication primarily used to treat partial seizures and neuropathic pain) until C had been seen by the psychiatrist. This medication had been prescribed overseas and C noted that it was for restless leg syndrome (RLS) and not a psychological condition. The board explained that gabapentin is a controlled drug in the UK which can only be prescribed in specific circumstances and with specialist input. They noted it is unlicensed for RLS. We took independent advice from a GP, who noted that gabapentin can be prescribed 'off-label' to treat RLS and they saw no reason for changing this if C had been taking it with good effect and was established on a reasonable dose. However, if the practice had concerns and wished to change this, it should have been gradually reduced and not stopped suddenly. We concluded that it was unreasonable to have refused to prescribe C gabapentin pending a psychiatric review. We upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the stoppage of their gabapentin without a reduction regime. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The board should ensure the practice GPs familiarise themselves with gabapentin reduction regimes and the indications for the same.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the consent process and the standard of surgery for a procedure they had received from the board. C was listed for a surgical procedure with the aim of removing a stoma (an opening in the abdomen formed during a colostomy procedure) and a para-stomal hernia (a weakness in the abdominal wall beside a stoma which allows the bowel to protrude outwards). The surgeon was unable to safely perform the procedure as planned and the decision was made to create a new stoma site. C experienced complications with the wound following surgery and was unhappy with the outcome.

We took independent advice from a consultant colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We found that C should have been informed about the risk that it might not be possible to complete the intended procedure successfully and the implications of this. In the absence of evidence that C was informed of this, we concluded that the board had failed to obtain appropriate consent for the procedure, in line with recognised guidance. We upheld this aspect of C's complaint.

In relation to the surgical procedure, we found that this was performed to a reasonable standard and the decisions made by the surgeon during the operation were reasonable. Given the findings, we did not uphold this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C that the risks for the surgical procedure were not fully outlined as part of the consent process. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• A patient's medical history should be considered to anticipate difficulties in a procedure and the likely scenarios that could emerge. Patients should receive information about the risks in a way they can understand (including side effects; complications; or failure of an intervention to achieve the desired aim), taking into account the information they want or need to know. This should be fully documented.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about matters relating to their previous GP practice. C had been removed from the practice list as in the practice's view there had been a complete breakdown in the doctor/patient relationship due to the way C was using a prescribed antibiotic medication. The practice wrote to C to inform them of their decision.

C had concerns about the practice's decision to remove them from the list. We found that the practice had failed to provide C with a warning before removing them from the practice list. Therefore, we upheld this aspect of the complaint.

C was also unhappy with the factual accuracy of a letter sent by the practice regarding the removal decision. We did not find that the practice's letter contained inaccuracies and we were unable to conclude that it was unreasonable. We did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failure to issue a warning before removing C from their practice list. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Reconsider any application to register received from C.

What we said should change to put things right in future:

• A breakdown in a doctor/patient relationship should be managed in line with General Medical Council guidance and the relevant legislation.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C, a postgraduate student, complained that she had paid for classes and seminars which had been cancelled due to industrial action.

We found that the University had taken appropriate steps to minimise the academic impact of the industrial action by giving students advance notice of the industrial action and ensuring that students would only be assessed on work that they had an opportunity to cover in the course of their studies.

We noted that students may expect to learn about a particular subject and if they do not receive the teaching they are supposed to get, it is not necessarily sufficient for the provider to purely decide not to test them on it. In light of this, we also considered whether the university had taken steps to make up for the lost teaching hours and the learning opportunities these represented. We did not consider that this had to be a like-for-like replacement of the teaching hours that were lost.

During the semester affected by the industrial action, Ms C was taking three courses. These courses were formal components of Ms C’s postgraduate programme. Three of Ms C’s classes were cancelled due to the industrial action across two of the courses. Regarding two of the classes, the university offered to discuss course material with Ms C on a one-to-one basis and offered to give feedback on an essay regarding a particular topic. Regarding the third class, no steps were taken by the university to make up for the lost teaching hours. Given that the university made attempts to make up for the teaching hours lost for two out of the three classes cancelled, on balance, we did not consider the university had acted unreasonably.

We also noted that five seminars out of 22 were cancelled due to the industrial action. These seminars were academic events rather than formal components of Ms C’s course. We did not consider that the university were obligated to take steps to make up for the learning opportunities lost due to the cancellation of these seminars and we noted that the majority of the seminars went ahead. We did not uphold Ms C’s complaint in this regard.

Ms C also complained that the university failed to handle her complaint reasonably. We found that there was a delay in responding to Ms C’s stage 1 complaints and she was not informed of the reasons for the delay or provided with a revised timescale for when she could expect a response. We upheld this aspect of Ms C’s complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the delay in responding to Ms C’s stage 1 complaints and that she was not kept updated or provided with a revised timescale. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.