Health

Summary

Mr C reported experiencing unpleasant side effects when taking methadone (a drug used medically as a heroin substitute) and felt the prison health centre unreasonably dismissed his symptoms. Mr C also complained that the board would not ask for a second opinion from someone outwith the health centre.

The board explained that clinical and nursing staff felt the symptoms reported by Mr C were likely caused by opiates, rather than methadone. It was noted that Mr C did not accept that position, but the board explained medications were prescribed based on evidence that indicated their effectiveness whilst remaining mindful of guidelines in place. The board told Mr C that methadone was considered the best option available for those with opiate misuse.

We took advice from an independent clinical adviser. We found that the board had appropriately considered Mr C's concerns about the side effects of methadone. We considered that the board had explained their position reasonably to Mr C and their actions were in line with good practice guidance. We also found that the steps taken by the board in having another doctor from the health centre review the matter was in line with good medical practice.

We concluded that the board responded reasonably to Mr C's reports of unpleasant side effects from methadone and dealt with Mr C's request for a second opinion reasonably. Therefore, we did not uphold the complaints.

Summary

Mrs C complained on behalf of Mr B about the care and treatment provided to Mr B's late wife (Mrs A). Mrs A had an underlying heart condition and her medication had to be carefully balanced to avoid kidney damage. Mrs A saw her GP about problems with bowel function and her deteriorating general condition. The GP referred her to the colorectal (relating to or affecting the colon and rectum) clinic. Blood tests taken around the same time showed her kidneys were deteriorating and she was referred for an urgent renal (relating to the kidneys) appointment.

During her colorectal consultation, Mrs A was offered various investigations but a CT scan (a scan that uses x-rays and a computer to create detailed images of the inside of the body) and colonoscopy (examination of the bowel with a camera on a flexible tube) both involved some kidney risk, so she wished to wait for her renal appointment before making a decision. She received a renal appointment four months after her GP appointment and was admitted the following day for further tests including a CT scan performed without contrast (contract material is a dye used to help highlight areas of the body being examined) as this was safer for her kidneys. Around a month after admission for tests, stage 4 cancer was found in bowel, stomach and lungs, which Mrs A was advised had been present for months. A decision had been taken to downgrade Mrs A's renal referral without seeing her, and without informing her GP. Mrs C complained that this decision was unreasonable.

The board confirmed that Mrs A's urgent renal referral was downgraded without her being seen, based on the likelihood that her renal dysfunction was a composite of her heart disease and medication. As her blood test results were relatively stable the board had considered there was no need for an urgent referral. The board apologised that the GP had not been informed. We took independent advice from a nephrology (the branch of medicine that deals with the physiology and diseased of the kidney) adviser. We found the downgrading of the referral to be reasonable under the circumstances. Therefore, we did not uphold this aspect of Mrs C's complaint.

Mrs C also complained that the board unreasonably failed to offer Mrs A a CT scan without contrast at an earlier stage. We took independent advice from a colorectal adviser. We found that although this could have been offered, the consultant responsible reasonably balanced consideration of establishing a diagnosis and of investigating only should her symptoms recur, given the severity of her underlying disease. Therefore, we did not uphold this aspect of Mrs C's complaint.

Finally, Mrs C complained that the communication between specialisms involved in Mrs A's care and treatment was unreasonable. We found that the decision to downgrade the renal referral was not conveyed to Mrs A's GP or her cardiac consultant and that Mrs A's cardiac consultant had delayed in informing her about the availability of the advanced heart failure specialist nurse. We also found that communication between medical staff had not been copied to the Mrs A, noting that if this had done, the perceived lack of communication could have been avoided. Overall, we found that the board's systems were reasonable, in that all Mrs A's records were available to those involved in her care. However, we upheld this aspect of Mrs C's complaint on the basis that the board had accepted errors and delays.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr B for the failings in communication, with a recognition of the cumulative impact of these failings on Mrs A's treatment experience. The apology should acknowledge the impact of these failings on Mrs A and her family. 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

Miss C complained about the care and treatment provided to her late mother (Mrs A) prior to her death. Mrs A was admitted to Hairmyres Hospital after having a fall and developing chest pain. Miss C had a power of attorney (POA, a legal document appointing someone to act or make decisions for another person) in respect of her mother.

Miss C complained that the POA was not appropriately taken into account; communication in relation to Mrs A's deterioration was unreasonable; and the nursing care and treatment provided to Mrs A was unreasonable.

The board in response to the complaint carried out a local review of Mrs A's care and also held a debrief action plan meeting, following the local review.

We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) and a nursing adviser. We found that the POA was respected and there was no indication it was disregarded.

In relation to communication concerning Mrs A's deterioration, the clinical records showed that medical staff engaged with Miss C frequently to discuss Mrs A's condition, symptoms and how these were being managed. There was also evidence of frequent and detailed discussions between Miss C and clinical staff at the point at which Mrs A's condition began to deteriorate. We, therefore, found that communication was of a reasonable standard.

Miss C raised a number of issues with regards to Mrs A's nursing care. Our investigation confirmed that the shortcomings identified within the local review would not have had an impact upon Mrs A's condition and subsequent deterioration. Whilst we recognised the board had apologised for a number of aspects of Mrs A's nursing care, overall, we considered that Mrs A received care of a reasonable standard. We considered that the local review and work carried out by the board was thorough and showed Miss C's complaint was taken seriously.

As a result, we did not uphold Miss C's complaints.

Summary

Mrs C complained about the care and treatment she received at University Hospital Monklands where she had surgery to remove her gallbladder. Mrs C said that she developed a number of unpleasant symptoms following the surgery and, despite seeking treatment for these from the board, including attendance at the hospital's emergency department, they remained unresolved.

We took independent medical advice on the complaint from a consultant general surgeon and a consultant in emergency medicine. In her complaint, Mrs C said that the consent process followed by the board did not include reasonable information about the consequences of gallbladder removal. We found that the symptoms Mrs C experienced were not recognised as complications directly related to her gallbladder surgery and were, therefore, not discussed with her prior to her surgery. We found that efforts were made to ensure that reasonable explanations were given to Mrs C on the risks and benefits of her surgery and her consent form listed the risks of the surgery. We did not uphold this aspect of the complaint.

Mrs C said that the care and treatment provided to her in the emergency department was unreasonable. We found that the treatment Mrs C received was reasonable and there was no reason to admit her to hospital at that time. While we note that the time that Mrs C waited to be seen was slightly outwith the triage timescales, we did not identify this as a failing or evidence of unreasonable care. Therefore, we did not uphold this aspect of the complaint.

Mrs C also complained that the follow-up surgical care and treatment was unreasonable. We found that once Mrs C made the board aware that she was experiencing significant symptoms following her surgery, and given her anxiety issues, they should have offered her an early out-patient appointment within a few weeks. It would also have been reasonable to have arranged to see her in clinic to discuss her endoscopy and biopsy results and options open to her at that time. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to offer her an early out-patient appointment after she reported she was experiencing significant symptoms following her surgery; and failing to arrange to see her in clinic to discuss her endoscopy and biopsy results and options open to her at that time. 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:

• In cases such as this, the board should arrange to see patients in clinic to discuss their test results.
• In cases such as this, the board should offer patients out-patient appointments within a reasonable time.

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 treatment her husband (Mr A) received during his admission to Wishaw General Hospital. Mr A was admitted with abdominal pain and a temperature and was discharged the same day with a principal diagnosis of gastritis (inflammation of the lining of the stomach). Mr A latter suffered a ruptured appendix and damaged bowel which required emergency surgery. Mrs C complained that if Mr A had received the correct diagnosis in his initial admission, with reasonable investigations carried out, the rupture could have been avoided.

We took independent advice from a general and colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We found that the treatment provided to Mr A was unreasonable. Insufficient notice was taken of Mr A's raised temperature, white cell count and CRP (inflammatory marker) as objective evidence together with lower abdominal pain. We considered that appendicitis should have been considered as a possible diagnosis. We also found that Mr A was discharged too early without a second examination and on discharge the wrong diagnosis was recorded and advice on what to do next was unclear. We upheld this aspect of Mrs C's complaint.

Mrs C also complained about the board's response to her complaint. Mrs C raised a number of questions about the treatment Mr A received. The board explained the actions taken and why they considered this was reasonable.

We sought advice about the accuracy of the board's response in terms of Mr A's presentation and treatment. We found that the board failed to provide a reasonable response to Mrs C's complaint. While the board responded to the questions Mrs C raised, the medical records did not evidence the board's outline of the treatment provided, including that appendicitis was considered in Mr A's initial admission and the advice provided when discharging Mr A. We also upheld this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to provide a reasonable complaint response.
• Apologise to Mr A for failing to provide reasonable treatment to him. The apologies should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/information-leaflets .

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

• Documentation, including discharge summaries, needs to be clear, including who saw, when and what.
• Formal discharge summaries should be completed in a timely manner.
• Learning should be taken from the complaint and reflected upon in a morbidity review to highlight the importance of high index of suspicion of appendicitis in young adults with abnormal tests and atypical history.
• Relevant staff should be reminded of the importance of difficult cases being re-assessed by more senior clinicians.

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 care and treatment provided to her by the board for a number of symptoms over a period of several months. We took independent advice from a GP, from a consultant in acute medicine, from a gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines) and from a neurologist (a doctor who specialises in the brain and nervous system). We found that whilst much of the care and treatment provided to Ms C was reasonable, the possibility of Ms C's symptoms being caused by other disorders should have been discussed with her. Therefore, on balance, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failure to recognise and discuss the possibility of her symptoms being caused by a functional disorder or chronic fatigue syndrome. The apology should meet the standard set out in the SPSO guidelines on apology available at: www.spso.org.uk/leaflets-and-guidance .
• Consider carrying out a further review of Ms C's symptoms (should she still wish to have this done) if she is referred to the board via her GP in light of the findings of this investigation.

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

• Staff should be aware of how to recognise and manage functional disorders, including chronic fatigue syndrome.

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 about the treatment provided to his late father (Mr A). Mr A had complained about poor memory and poor balance over a number of weeks. The board carried out a number of investigations, however, due to the wait for follow-up appointments, Mr A decided to seek private treatment and he was subsequently diagnosed with Creutzfeldt-Jakob Disease (CJD - a rare degenerative brain disorder). Mr C complained that the board failed to carry out the appropriate investigations, and that the board inappropriately discharged Mr A when his condition was getting progressively worse.

The board confirmed they were satisfied that the appropriate investigations were undertaken. They acknowledged that they could not offer Mr A an earlier appointment and explained that this was due to the service being understaffed.

We took independent advice from a consultant neurologist (a doctor who specialises in the brain and nervous system). We found that the appropriate investigations were carried out. Due to the nature of Mr A's condition, a number of conditions had to be ruled out first and there is no single test that can be performed in order to reach a diagnosis. The board subsequently informed us that the staffing issues have since been resolved. We also considered that it was appropriate to discharge Mr A as the risks of complications was much lower at home than in hospital. We did not uphold Mr C's complaints, however, feedback was provided regarding the board's communication with the patient and his family and the manner in which Mr A was prioritised.

Summary

Ms C complained about the care and treatment provided to her by the practice for a number of symptoms over period of several months. We took independent advice from a GP. We found that the assessments, investigations, referrals and treatment provided to Ms C were reasonable. We did not uphold the complaint.

Summary

Mr C was admitted to A&E following a road traffic accident. He was concerned that inadequate investigations were carried out to determine the extent of his injuries. Following an MRI scan, it was found that Mr C had a neck injury which required surgery. Mr C also felt his complaints of pain were minimised and often ignored by staff.

We took independent advice from an emergency medicine consultant. We found that proper assessments and investigations were carried out in light of the injuries Mr C presented with. We had no concerns about the way staff managed Mr C's reports of pain and that he was given appropriate pain relief. We found that there was no indication that an MRI of Mr C's neck should have been carried out sooner. MRI scans are required to identify injuries to the soft tissues in the neck or the spinal cord and are normally only carried out when patients have symptoms consistent with spinal cord injury or when, in the presence of a normal CT scan, there is a significant suspicion of a ligamentous injury. In Mr C's case, it was noted that when he displayed a foot drop and weakness in his hand, the decision was taken to obtain an MRI scan.

We found that the board provided reasonable care and treatment for Mr C's neck injury and, therefore, we did not uphold the complaint.

Summary

Mrs C complained that the care and treatment provided to her late mother (Mrs A) at Royal Alexandra Hospital was unreasonable. Mrs C also complained that the board's communication with Mrs A's family was unreasonable.

Mrs C said that staff had acted unprofessionally when asked for help changing Mrs A's position. Mrs C also told us she had frequently observed nursing staff inaccurately recording information on Mrs A's care plan, food and fluid charts. During our investigation we found that Mrs C had made amendments on the nursing records where she perceived them to be wrong. It was unclear though where Mrs C had made amendments so we were unable to assess the quality of the records. It also meant we were unable to clearly identify failings in the board's care and treatment of Mrs A. We therefore discontinued our investigation of this aspect of the complaint.

Mrs C told us the board's communication with Mrs A's family was unreasonable because staff did not provide them with updates about Mrs A's condition. She also said that on a couple of occasions staff told Mrs A that she would be going home and a care package would be organised, only for her later to be told the care package had been cancelled due to lack of carers. We found that although the medical records demonstrated that staff spoke to Mrs A's family about her condition throughout her stay in hospital, it was clear that Mrs A's family did not feel they knew enough about what was happening and, in particular, when Mrs A could be discharged. In response to Mrs C's complaint to them, the board apologised for their communication with Mrs A's family and the distress caused by the uncertainty about Mrs A's discharge date. They agreed this should have been communicated more effectively. We upheld this aspect of the complaint but made no recommendations as the board had already taken appropriate action.