Health

Summary

Ms C complained on behalf of her late uncle (Mr A) about the care and treatment he received from his GP practice. Ms C complained that the practice failed to treat Mr A as an urgent patient, even though he was experiencing symptoms that could have been caused by a stroke.

We took independent medical advice from a GP. We found that when Mr A contacted the practice, he did not provide information that suggested it was an emergency and it was reasonable that the GP arranged to see him later that week. However, the next day, Mr A's wife (Ms B) contacted the practice with concerns about Mr A's condition worsening and she spoke to another GP. Ms B asked for Mr A to be seen earlier but this was refused. We found that during this phone call, the GP failed to carry out an appropriate assessment of Mr A's condition, did not communicate reasonably, and inappropriately failed to see Mr A urgently, even though the symptoms Ms B described could have been caused by a stroke. We upheld Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A's family for the failings identified in the care and treatment he received. 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:

• When a patient (or their representative) contacts a GP with concerns, the GP should take an adequate medical history and carry out an appropriate assessment of the patient's condition, in a manner that is in line with the General Medical Council guidance on good medical practice.

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 on behalf of his late father (Mr A) who was diagnosed with and subsequently died as a result of septic arthritis (a serious type of joint infection). Mr C complained that the practice failed to provide reasonable care and treatment in relation to Mr A's shoulder pain, including providing phone consultations rather than face-to-face assessments and that the practice did not refer Mr A for x-ray or to orthopaedics (specialism that deals with diseases and injuries of the musculoskeletal system). Mr C considered that this had caused delays with Mr A being diagnosed with joint sepsis.

We found that the practice's consultations and care and treatment that Mr A received were reasonable, including referring Mr A to physiotherapy. Therefore, we did not uphold this complaint.

Summary

Miss C complained about the care and treatment she received from Ninewells Hospital in relation to the birth of her child. Miss C highlighted that her child has brain related problems. Miss C also complained about the time it took for the board to respond to her complaint.

Following the birth of Miss C's child, the board conducted a Local Adverse Event Review (LAER) to detail the root causes and key learning from an adverse event. The LAER found that the root cause was that Miss C had hyponatremia (low sodium concentration in the blood - a rare complication in low-risk labouring women). The LAER identified a number of concerns in terms of the administration of intravenous (IV) fluids on the midwifery unit, timing of blood tests, confusion surrounding the need to transfer Miss C due to her behaviours and significantly altered conscious state, and the obstetric (pregnancy and childbirth) team not being informed of the transfer and associated concerns. As a result, the board took action to address these issues to ensure learning and improvements.

We took independent advice from a consultant obstetrician and a midwife. We noted that Miss C was a low-risk patient at the beginning of her labour in the midwifery unit. We found that the progress of the first stage of Miss C's labour was unreasonable and she was given excessive fluids orally and by IV infusion which was not recorded on a fluid balance chart or reviewed by medical staff prior to IV fluids being given, after which she became unresponsive.

We also found that, despite not having any sedating analgesia (pain relief), the deterioration in Miss C's condition was not recognised and assistance was not requested. There was an unreasonable delay in transferring her to the labour ward, with unfamiliar staff being involved in the transfer and key information not communicated effectively to the new team. However, we were unable to say what effect earlier detection and treatment would have had on the outcome for her child.

After Miss C's transfer to the labour ward, the medical staff recognised her poor condition promptly and delivered her child. Had Miss C been transferred when the delay in the first stage of labour was diagnosed, it was likely that blood tests would have been taken leading to an earlier diagnosis of the problem. We found that there was a delay in obtaining and acting on the blood results which we considered unreasonable, although this delay would not have affected Miss C's child's outcome. In view of these findings, we upheld this aspect of the complaint. The board has already taken some action in respect of their findings on this case. However, we made further recommendations to ensure learning.

In terms of the board's handling of Miss C's complaint, we found that there was evidence that the complaints department made attempts to arrange a meeting to discuss Miss C's concerns with her and provide the complaint response within good time. However, it appears that there was a delay in clinical staff responding to these attempts. While the update response sent to Miss C was factually correct, in the absence of any evidence from the board justifying the delay, we found that the time taken to deal with the complaint was unreasonable. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for failing to recognise her deterioration and for the delay in dealing with her complaint. 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:

• All relevant staff should be fully appraised and aware of key information.
• All relevant staff should be able to recognise and manage a deteriorating patient.
• Clinical staff should respond to the board's complaint investigations in a timely manner.
• Patients should be appropriately transferred to obstetric care.
• Communication of blood test results should be recorded in a structured and consistent way.
• All staff taking blood tests should take responsibility to obtain the results or communicate with the next shift about any outstanding results.

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, an MSP, complained on behalf of his constituents Ms B and Ms A (Ms B's daughter) about the service provided by a community mental health team (CMHT). Ms A was a young adult with Asperger's Syndrome (a form of autism, in which people may find difficulty in social relationships and in communicating) and she received treatment for obsessive compulsive disorder (OCD, a common mental health condition where a person has obsessive thoughts and compulsive behaviours) and depression.

During our investigation of Mr C's complaint, we considered the evidence provided by Mr C and the board. We also received independent advice from a consultant psychiatrist.

Mr C raised concern that the CMHT did not provide Ms A with reasonable mental health care and treatment. We considered that the doctors involved in Ms A's care appropriately took into account her Asperger's Syndrome and we found that the treatment provided for Ms A's OCD and depression was reasonable. We did not uphold this complaint.

Mr C complained that the CMHT failed to provide Ms B with reasonable advice and information to support her as a carer for Ms A. We found that Ms B and Ms A were given details of support organisations and Ms B was offered a carer's assessment. However, we did not find sufficient evidence that general information about management of conditions was provided to Ms B. On balance, we upheld this complaint.

Finally, we considered whether the board provided a reasonable response to Mr C's complaint. We found that the board had accurately identified and responded to many of the complaints raised. However, we noted that the board did not address all the points that Ms B raised separately. We were unable to conclude that the board provided a full response to the points Ms B raised in line with the requirements of the NHS Scotland Complaints Handling Procedure. On balance, we upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms B for failing to provide general information about management of conditions and treatments, and not responding to a number of points raised in her complaint. 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:

• Family members supporting the care of a patient should receive general information about management of conditions and treatments, whilst maintaining a patient's right to confidentiality.

In relation to complaints handling, we recommended:

• Under the NHS Scotland Complaints Handling Procedure an investigation should establish all the facts relevant to the points made in the complaint and to give the person making the complaint a full, objective and proportionate response that represents the final position.

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

Mrs C complained that she had not been provided with appropriate treatment at a dental hopsital. Mrs C said that she had been suffering from severe pain for an extended period, due to a poorly fitting denture.

We took independent advice from a dental advisor. We found that Mrs C had been reviewed appropriately and when she had expressed concerns, her care and treatment had been assessed by a number of different specialists. Mrs C had been treated reasonably and appropriately.

Mrs C also complained that a referral to a specialist at a different health board had been cancelled by Tayside NHS board. Mrs C felt this was also unreasonable. We found that Mrs C had not met the criteria for a referral to a different board, as her treatment could reasonably be provided locally.

We also found that Mrs C's complaint was handled by the board in line with their complaints handling process and whilst we recognised that she did not agree with the outcome, this did not constitute evidence of maladministration on the part of the board.

We did not uphold Mrs C's complaints.

Summary

Mrs C complained about the failure of the practice to refer her late father (Mr A) to hospital skin specialists for investigation of a lesion on his forehead. By the time a referral was made, it was too late to attempt surgery and palliative care was instigated. Mr A had a previous history of skin cancer and Mrs C felt that an early and urgent referral to the skin specialists should have been made. We took independent medical advice from a GP. We found that it was not unreasonable for the practice to have thought that Mr A had a cyst and that it was appropriate to transfer his care to district nursing staff in order that they could dress the wound. When the district nurses requested antibiotics the practice made out an appropriate prescription. It appeared that there was a change in the appearance of the lesion after Mr C had been seen by the practice. We did not uphold the complaint.

Summary

Mr C complained about the treatment he received at St John's Hospital. He said that his GP had been treating him for a suspected urinary tract infection and referred him to hospital. Initially staff felt that he had a viral infection, but subsequent investigations found that he had a prostatic abscess (accumulation of pus within the prostate gland) and had also developed staphylococcus aureus bacteraemia (a bacterial infection). Mr C felt that there had been an undue delay in reaching an accurate diagnosis.

We took independent professional advice from a consultant physician. We found that staff had performed a number of investigations to establish the cause of Mr C's symptoms and that it was not initially unreasonable to have diagnosed him as suffering from a viral illness. His temperature fluctuated and appropriate antibiotics were administered at an early stage. The staff also arranged further appropriate investigations in case there was a danger of Mr C losing his sight or requiring heart surgery. We did not uphold the complaint.

Summary

Mr C complained about the change in the way his medication was administered at the Royal Infirmary of Edinburgh. In the past, Mr C received IV morphine (injection into a vein) but had now been changed to subcutaneous morphine (injection under the skin). Mr C believed that the change meant he was in pain for a longer period of time and that it was not as effective. He believed that the decision to change the method of administration of the morphine was unreasonable.

We took independent medical advice from a clinician and found that the board had implemented a new Recurring Pain Pathway which included guidance in appropriate cases that morphine should be given subcutaneously (under the skin). This would have the effect of a slower absorption with fewer side effects. We also found that the board staff had explained the rationale for the change to Mr C in a sensitive manner taking into account his other health issues. We did not uphold the complaint.

Summary

Miss C complained about the care and treatment she received following elective abdominal surgery. When Miss C awoke following the surgery, she had considerable pain in her leg. She was given pain medication but her leg became significantly worse the next day. Compartment syndrome (when pressure rises in a compartment bordered by a facial covering because of a reduction in the blood flow to the muscle) was suspected and later diagnosed. Miss C underwent surgery but suffered outer muscle loss on her left leg. Miss C complained that there had been a delay in diagnosing compartment syndrome in light of her symptoms. She also complained that the board failed to provide proper treatment because of this delay. Finally, Miss C complained about how the board handled her complaint.

We took independent advice from a surgeon. We found that there had been an unreasonable delay in diagnosing compartment syndrome. Specifically, the signs and symptoms Miss C experienced should have led to an earlier orthopaedic consultant (specialist in the treatment of diseases and injuries of the musculoskeletal system) review and diagnosis of compartment syndrome. In light of this, we upheld this aspect of the complaint.

In respect of Miss C's second complaint, we considered that her symptoms were well-monitored and recorded. We considered the failing to be in the interpretation of the clinical observations. Outside of this failure, we considered Miss C's management to be good and as expected following significant surgery. Once compartment syndrome was diagnosed, we found the care and treatment to be reasonable. We concluded that the failing had been the unreasonable delay in diagnosing compartment syndrome and not in the treatment provided. Therefore, we did not uphold this aspect of the complaint.

Finally, we concluded that it took an unreasonable length of time for the board to carry out their stage 2 complaint investigation and that Miss C was not appropriately updated about this delay. Furthermore, we did not consider the board's response to clearly reflect the findings of an Adverse Event Review that was carried out. Finally, the board's internal records indicated that Miss C's complaint was upheld but this was not apparent in their stage 2 response. As a result of this, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for failing to diagnose compartment syndrome promptly and for failing to keep her adequately informed about delays in the investigation of her complaint and the progress and outcome of the Adverse Event Review. 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.

Summary

Mrs C complained about the care and treatment provided to her late husband (Mr A) who had a rare and aggressive form of bladder cancer. Mr A received care and treatment at the Royal Infirmary of Edinburgh and the Western General Hospital.

We took independent advice from urology (specialism that deals with the male and female urinary tract, and the male reproductive organs), oncology (cancer) and general surgery advisers. We found that the time taken to investigate and begin treatment for Mr A's bladder cancer was reasonable and in accordance with the Scottish Government's cancer waiting time targets. We also found that chemotherapy treatment commenced within a reasonable timescale. The level of information about treatment options, including their risks and benefits, provided to Mr A was also reasonable. This included sufficient information about the specific risk of pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs), a complication Mr A subsequently experienced.

In the context of Mr A's rapid deterioration, the level of planning for end of life care was reasonable. When Mr A subsequently experienced bowel obstruction, it was reasonable that he was treated on a surgical ward. While Mr A's pain was difficult to manage, the attempts by the clinical team were reasonable, as was the aim to discharge Mr A home. When Mr A's condition deteriorated, he was transferred to a hospice without unreasonable delay.

We did not uphold Mrs C's complaints.