Health

Summary

Mr C complained to us that his GP practice had unreasonably notified the Driver and Vehicle Licensing Agency (DVLA) that he had alcohol issues. We found that the practice had previously discussed this matter with Mr C and that it had been reasonable for them to contact the DVLA regarding their concerns about Mr C's health and alcohol intake. We did not uphold Mr C's complaint.

Summary

Ms C complained to us that a dentist had failed to provide reasonable care and treatment to her. She said that the dentist inappropriately removed an inlay despite the fact that this had not caused her any problems.

We took independent advice from a dental adviser. We found that it had been reasonable for the dentist to remove the inlay, as there was evidence of decay, and to carry out drilling on the tooth to do so. We also found that it was reasonable for the dentist to refer Ms C to a specialist for root canal treatment. There were no failings by the dentist that led Ms C to develop an infection. The presence of decay meant that there was a risk of infection for Ms C, with or without treatment, and this risk would increase through time, given that the decay would most likely spread further. However, we found that there was insufficient evidence that the dentist gave Ms C adequate information about the likelihood of infection. Therefore, we upheld the complaint for this specific reason.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for this failing. 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:

• Dentists should ensure that, where appropriate, patients are given adequate information about the likelihood of infection and that this is 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

Ms C complained about the nursing care she received at St John's Hospital during two separate admissions. Ms C had a complex medical history and was assessed by a range of clinical professionals during each admission. Ms C was unhappy with the way nurses behaved towards her and communicated with her.

We took independent advice from a registered nurse. We considered Ms C's account, staff statements and the clinical records available. Based on the evidence available, we were unable to establish that there had been failings in the way nursing staff behaved towards or communicated with Ms C. We did not find that the care provided was unreasonable and we did not uphold Ms C's complaints about care.

We also considered whether the board investigated and responded to Ms C's complaints appropriately. We did not identify failings in the level of investigation performed or the accuracy of the complaint response. However, we found that the board did not meet the timescales for issuing a response set out in the procedure. For this reason, we upheld this complaint. We were satisfied that the board had taken appropriate action to address this issue since the time of the complaint and we did not make any recommendations.

Summary

Ms C saw her dentist about a number of issues and agreed to undertake a course of dental treatment which included denture fittings over a number of months. However, Ms C told us that once treatment had been completed the dentures were ill-fitting and the cost of the planned treatment had not been made clear to her.

We took independent advice from a dental adviser. We found that the evidence from Ms C's dental records showed the standard of treatment provided at each appointment during this period was reasonable and that treatment decisions were in line with options under the NHS. We also found that the evidence showed the planned treatment costs were discussed with Ms C and adjustments were made to meet Ms C's communication needs. We did not uphold the complaint.

Summary

Ms C complained about the care and treatment she received when she was admitted to A&E at the Royal Infirmary of Edinburgh. In particular, that she had been catheterised without her consent and against her will. She also complained that unnecessary restraint had been used.

We took independent advice from a consultant in emergency medicine. We found that the care and treatment given to Ms A was reasonable, and that the history, examination and investigations had been appropriate and reasonable. In particular, we found that this had been a potentially life threatening emergency and the decision to insert a catheter had been reasonable. We considered that it was extremely unlikely that Ms C would, at that time, have had the capacity to consent to medical treatment. As such, an adult with incapacity assessment had been completed before the decision to insert the catheter had been made. We also found there was no evidence in the medical records that unnecessary constraint had been used. We did not uphold Ms C's complaint.

Summary

Mr C complained about the care and treatment he received during two admissions at Royal Infirmary of Edinburgh. During our consideration of Mr C's complaint, we received independent advice from a consultant colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus) and a registered nurse.

During Mr C's first admission, he was diagnosed with appendicitis and received surgery to remove his appendix. Mr C was unhappy that his appendix was not fully removed during the procedure. We found that the initial assessment and treatment were appropriate and timely. We noted that whilst part of Mr C's appendix was not removed, this was a rare but recognised complication of the surgery. We did not conclude that there was an unreasonable failing by staff that resulted in this complication. We were also satisfied that Mr C's discharge from the ward was reasonable. We did not uphold this complaint.

During Mr C's second admission, he was diagnosed with stump appendicitis (recurrent inflammation of the residual appendix after the appendix has been only partially removed during surgery). Further surgery was performed to remove the residual appendix tissue. Following the procedure, Mr C's recovery was complicated by infection. We found that the second procedure had been carried out to a very high standard. We considered that the post-operative care was reasonable and we noted that there were appropriate arrangements made for wound care in the community following Mr C's discharge. We did not uphold this complaint.

Summary

Mr C complained on behalf of his wife (Mrs A) about the care and treatment she received at Western General Hospital. Mrs A was admitted to the surgical assessment unit in the evening with a serious bowel condition. She experienced severe pain in the overnight period whilst she waited to receive surgery. The following morning surgery was successfully performed. Mrs A remained critically unwell for a number of weeks following the procedure.

In response to Mr C's complaint, the board acknowledged that better care could have been provided overnight and the operation should have been performed sooner. Mr C remained concerned about what happened and brought his complaint to us.

We took independent advice from a colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus), a consultant radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques) and a registered nurse. We identified a number of issues with the care and treatment provided to Mrs A in the overnight period. In particular, we found that the CT scan performed was not reported accurately as it failed to mention the radiological evidence of mesenteric ischemia (a serious condition involving sudden interruption of the blood supply to a segment of the small intestine). We also found that the medical review and nursing monitoring in the period under consideration were unreasonable, and we noted issues with record-keeping.

We also found that nursing and medical staff had failed to escalate matters to senior medical staff when this would have been appropriate. Finally, and in line with the board's findings, we found that there was an unreasonable delay in transferring Mrs A to theatre for emergency surgery. We considered that earlier surgery would not have impacted on the extent of surgery required, but might have mitigated the severity of Mrs A's critical illness. We upheld Mr C's complaint and made a number of recommendations.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs A and her family for the failings in CT reporting; failings in medical review; failings in nursing record-keeping; and failure to escalate the deterioration. 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:

• CT imaging should be accurately reported. Arrangements for supervision of on-call radiology registrars should conform to Royal College of Radiologists guidelines. The service should be satisfied that they have minimised the contribution of any systems deficiencies to radiological error.
• Nursing records should be maintained in line with the standards required by the Nursing and Midwifery Council Code.
• Nursing staff should have appropriate expertise and confidence in identifying deteriorating patients and escalating concerns to medical staff.
• Surgical staff should be alert to a patient's clinical condition and respond promptly to contact from medical colleagues.
• Where there is a risk that patient safety may be compromised, prompt action should be taken to escalate the matter to appropriate senior staff.
• The board should have an appropriate pathway in place for emergency laparotomy 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

Mrs C, an advice and support worker, complained on behalf of her client (Mr A) regarding the decision by a psychiatrist to change Mr A's antidepressant medication. Mr A felt that the change in medication had resulted in him suffering agitation and insomnia and that he had to approach his GP to have the dosage of medication altered.

We took independent medical advice from a psychiatric consultant. We found that it was reasonable from a clinical perspective for the psychiatrist to change the medication. If a patient remains on a particular medication for a prolonged period this can lead to a lack of symptomatic relief. It is accepted practice to gradually reduce the dosage of the previous medication while at the same time gradually increase the dosage of the new medication in an effort to prevent withdrawal symptoms. We did not uphold the complaint.

Summary

Mrs C, an advocate, complained on behalf of her client (Ms A) about the care and treatment they received from the board. Ms A was seen by an ophthalmologist (a specialist in medical and surgical eye problems) and complained that they did not carry out an appropriate assessment and did not record their observation that the discs at the back of her eyes were enlarged. Ms A also complained that her discharge was inappropriately handled and that a mix up regarding her blood test results caused a delay to her discharge.

The board advised that it was determined by the ophthalmologist that no further follow-up was required. The board acknowledged that there was confusion about how long Ms A had to wait following a procedure before she could be discharged and that her blood test results had been misread.

We took independent advice from a consultant ophthalmologist and from a consultant physician. We found that the ophthalmologist's assessment was reasonable and that the swelling identified at the back of Ms A's eyes did not require to be acted upon. We did not uphold this aspect of the complaint. With regards to Ms A's discharge, while we noted that there was a mix up regarding Ms A's blood test results, we considered that the board acted in the best interest of the patient, in light of the information available to them at the time, and it was therefore appropriate to require Ms A to remain in hospital for one further night for observation. Therefore, we did not uphold this aspect of the complaint.

Summary

Ms C complained on behalf of her in-law (Mr B) about the care and treatment provided to his wife (Mrs A). Mrs A was diagnosed with breast cancer and a full computerised tomography (CT) scan was carried out. The CT scan of Mrs A's chest, abdomen and pelvis showed liver and bony metastases (the development of secondary malignant growths) at a distance from a primary site of cancer. The head scan showed a 6mm lesion of uncertain significance on the left frontal lobe of Mrs A's brain. The consultant oncologist (a doctor who specialises in the diagnosis and treatment of cancer) involved in Mrs A's care advised her of the liver and bony metastases. However, they did not share the results of the head scan. Following this, the board's records indicate that the results of this scan were not shared with Mrs A by the consultant oncologist, the clinical nurse specialist (CNS) involved in her care, or any other member of staff.

Ms C complained that the board had unreasonably failed to disclose information about the lesion on Mrs A's brain. We took independent advice from an oncology adviser. We found that it was unreasonable for the board not to disclose this information to Mrs A. The board had advised that the medical professionals involved did not disclose this information to avoid causing further anxiety or upset to Mrs A. Even if the board had good intentions, we considered the evidence to strongly indicate that this was not a reasonable course of action to take and, under the circumstances, was not a medical professional's choice to make. This evidence included the General Medical Council's (GMC) guidance Good Medical Practice and Consent: Patients and Doctors Making Decisions Together. We concluded that it was not reasonable for information about the head scan not to be shared with Mrs A. Therefore, we upheld this aspect of the complaint.

Ms C also complained that, following the head scan, the board unreasonably failed to provide appropriate treatment to Mrs A or manage her condition appropriately. We found that, overall, Mrs A received a good quality of care and treatment. However, we noted that it would have been reasonable for a Magnetic Resonance Imaging (MRI) scan to be carried out, in line with the recommendations of the consultant radiologist (a specialist in the analysis of images of the body). This would have resulted in clearer information about the lesion on Mrs A's brain and identify whether there were other smaller lesions. Further MRI or CT scanning would also have helped identify whether brain radiotherapy would have been an appropriate or effective form of treatment.

We found that the evidence suggested that further scanning would not have extended Mrs A's life but may have made some difference to her treatment. We concluded that, by not carrying out further MRI or CT scans, the board failed to provide appropriate treatment to Mrs A or manage her condition appropriately. Therefore, we upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to both Ms C and Mr B for the failings my investigation identified. 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:

• Staff should be aware of the circumstances in which it is acceptable to withhold information from a patient.
• The board should reflect on their position on disclosing information to patients, as detailed in their response to my enquiries.

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.