Health

Summary

C's parent-in-law (A) suffered from symptoms that they later learned were caused by having a stroke, and was taken by emergency ambulance to University Hospital Monklands. A CT scan carried out that day was reported as normal, but A's condition continued to deteriorate and they were admitted to the intensive care unit and put on life support. The following day, a repeat CT scan was performed which showed evidence of A having had a severe stroke and, following discussions with family, their life support was switched off and they died. C was concerned about the time it took staff to diagnose A with a stroke.

We took independent advice from a medical adviser. We found that the management of A including investigations and treatment decisions were appropriate and carried out within a reasonable time. Clinicians considered the possibility that A had a stroke and took appropriate action by arranging a CT scan, and then a further CT scan the following day. We did not uphold the complaint.

Summary

C complained about the care and treatment their relative (A) received at Wishaw General Hospital. A had been admitted to hospital in relation to an infection. They developed hospital acquired pneumonia and died days later. C was concerned that the Hospital Emergency Care Team (HECT) did not respond appropriately to A's deteriorating condition, and that that there had been a failure to contact the family when A's condition deteriorated.

In response to the complaint the board acknowledged, in hindsight, that HECT should have reviewed A in person rather than a telephone discussion having taken place between HECT staff and ward staff. The board said that they were unable to say whether or not A's management would have changed, had they been seen by HECT. The board accepted that the family should have been contacted and they apologised for this. Action was also taken to remind staff of the importance of contacting relatives.

We took independent advice from a consultant in geriatric (elderly) and general medicine. We found that when A deteriorated overnight, they should have been seen by HECT. We also considered that A should also have been examined the following morning. A had delayed recognition and treatment of the infection as a result. This reduced A's chances of surviving the infection, but we could not say with certainty that this would have significantly improved the chance of survival. We were also critical that the record-keeping by HECT was not in line with the Nursing and Midwifery Code.

We agreed that the family should have been contacted and recommended further action to be taken by the board for further learning and improvement. We concluded that A did not receive a reasonable level of care in keeping with local and national standards and, therefore, upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings by HECT and for not examining A within a reasonable 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:

• Deteriorating patients should be reviewed in accordance with local and national guidance and this should be appropriately recorded in line with the Nursing and Midwifery Code.

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 of her late son (Mr A). Mr A had a history of mental health and addiction problems. Mrs C complained about the role of the board's addictions service in Mr A's treatment. Mrs C said that Mr A was prescribed drugs that had a damaging effect on his mental state. She considered that the drugs should not have been prescribed in combination, and without appropriate supervision. She raised concerns that she was unable to support Mr A as she was excluded from discussions about his care. While it was on record that Mr A did not wish for information about his care to be shared with his mother, Mrs C did not consider that Mr A had capacity to make that decision. In any event she considered that the clinicians' duty of care and Mr A's right to life should have overridden any obligations to protect his right to confidentiality.

We took independent medical advice from a consultant psychiatrist. We found that the drugs prescribed to Mr A are commonly prescribed alongside one another and were appropriate for the treatment of his problems. We considered that there was appropriate monitoring of Mr A's clinical state, and that it was appropriate for clinicians to act in line with Mr A's expressed wish for information not to be shared with Mrs C. We noted that the assessment of Mr A's capacity appeared reasonable and that Mr A's recorded clinical presentation was reasonably not viewed as meeting exceptional circumstances that would have permitted breaching his confidentiality.

We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment of her late son (Mr A). Mrs C complained that Mr A was prescribed drugs that had a damaging effect on his mental state. She considered that the drugs should not have been prescribed in combination, and without appropriate supervision. She raised concerns that she was unable to support Mr A as she was excluded from discussions about his care. It was on record that Mr A did not wish for information about his care to be shared with Mrs C. Mrs C did not consider that Mr A had capacity to make that decision, and felt that the clinicians' duty of care and Mr A's right to life should have overridden any obligations to protect his right to confidentiality.

We took independent medical advice from a GP and a consultant psychiatrist. We found that the drugs prescribed to Mr A are commonly prescribed alongside one another and were an appropriate treatment option. We considered that the monitoring of Mr A's clinical state was reasonable, and that it was appropriate for clinicians to act in line with Mr A's expressed wish for information not to be shared with Mrs C. We found that the assessment of Mr A's capacity appeared reasonable and that Mr A's recorded clinical presentation was not viewed as meeting exceptional circumstances that would have permitted breaching confidentiality.

We did not uphold the complaint.

Summary

Mrs C complained to us on behalf of her late son (Mr A). Mr A was admitted to University Hospital Monklands for surgery to treat perianal abscesses (a collection of pus or infected fluid near the anus). Mr A was discharged home and received visits from district nurses to check his surgical wounds. Mr A began to feel unwell and he died a few days after his discharge home.

Mrs C complained that Mr A did not receive reasonable care and treatment in the hospital and that district nurses failed to recognise Mr A was seriously unwell.

We took independent advice from a colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus) and a nurse. We found that the care and treatment Mr A received in the hospital was reasonable and there was no indication Mr A should not be discharged home. We found no evidence that district nurses were aware that Mr A was feeling unwell. Therefore, we did not uphold the complaint.

Summary

Mrs C complained about the treatment which she received at A&E of Raigmore Hospital following a fall where she bumped her head and suffered hearing problems. The staff believed the hearing loss would be temporary and discharged her home. However, Mrs C's hearing loss continued over a number of months and she attended her GP on a number of occasions. A referral was made to the ear, nose and throat department (ENT) where a hearing aid was fitted. Mrs C believed that she should have been referred to ENT specialists at the time of the A&E attendance.

We took independent advice from a consultant in emergency medicine. We found that staff at A&E carried out appropriate investigations at the time of Mrs C's attendance and that it was reasonable to suspect the hearing loss would be temporary. There was no clinical indication for an immediate referral to ENT and advice was given to attend her GP should the symptoms not resolve. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment her child (Child A) received from a practice managed by the health board. Child A had initially attended the practice for treatment of tonsillitis. However, they continued to be unwell and Mrs C took them back to the practice a number of times over the subsequent months.

Mrs C complained that, despite raising concerns about Child A's symptoms with the GPs, her suspicion that Child A may have glandular fever was not properly investigated. Based on Child A's presentation, the practice concluded that they were suffering from post-viral symptoms. However, Mrs C stated that this was never communicated to her. Mrs C complained that the practice did not provide reasonable care and treatment to Child A in respect of their presenting symptoms.

We took independent advice from a GP. We found that the clinical decision-making and management in respect of Child A's presenting symptoms was reasonable. From the review of the consultation notes, it was likely that post-viral symptoms were discussed with Mrs C. However, we concluded that it was not possible to categorically confirm this from the medical records kept by the practice. While we did not consider this to mean that the practice failed to provide reasonable care and treatment to Child A, we did provide feedback about the fact that Mrs C was not left with a clear understanding of the diagnosis that had been made. However, on the basis of reasonable care and treatment being provided to Child A, we did not uphold this complaint.

Summary

Mr C complained about the treatment which he had received at A&E of Caithness General Hospital. He had initially contacted NHS 24 and arrangements were made for him to be taken to hospital. Caithness Hospital does not have an ear, nose and throat (ENT) department and Mr C said that he expected to be transferred to another hospital to see the specialists there, but instead he was discharged home. Mr C's GP made a subsequent referral to ENT at Raigmore Hospital. Mr C felt it had inappropriately been downgraded and that he was not provided with appropriate treatment for his reported symptoms.

We took independent advice from an A&E consultant and from an ENT consultant. We found that Mr C had been appropriately assessed and treated at A&E on his initial attendance, and when he was subsequently referred to the ENT department, his symptoms were appropriately assessed and reasonable investigations were carried out in an effort to reach a diagnosis. We did not uphold the complaint.

Summary

C complained about their detention under an emergency detention order under the Mental Health (Care and Treatment) (Scotland) Act 2003. C stated that the detention was unnecessary and that the board failed to inform them about it. C also complained that there was a failure to offer support and signposting to advocacy services.

We took independent advice from a consultant psychiatrist (a medical practitioner who specialises in the diagnosis and treatment of mental illness). We found that the detention was appropriate from both a clinical and legal perspective under the Mental Health (Care and Treatment) (Scotland) Act 2003. We found that it was considered to be in C's best interests to detain them because of legitimate concerns about their mental health. The documentation was signed by a medical practitioner with full General Medical Council (GMC) registration and with the consent of a mental health officer, in accordance with the requirements of the act. We did not uphold this aspect of C's complaint.

We also found that C was informed of their detention within a reasonable period of time. We noted that prioritisation was given to addressing C's mental and physical health. The clinical team sought the views of C's relatives to inform their ongoing clinical management of C. Under the circumstances, this was an appropriate and reasonable action which then resulted in C's detention being revoked early. We did not uphold this aspect of the complaints.

Summary

Ms C complained on behalf of her child (Child A) that the care and treatment Child A received from the board was unreasonable. Ms C complained that there was an unreasonable delay in diagnosing Child A's hip dysplasia (when the hip socket doesn't fully cover the ball portion of the upper thighbone) and dislocated hip.

We took independent advice from a consultant orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that it was unreasonable that Child A's legs and hips were not examined during a consultation. We considered that had Child A's hips and legs been examined and concerns noted, this should have prompted further investigations to be arranged, such as x-rays, and there was a high likelihood of an x-ray at this time indicating hip dysplasia. Therefore, we upheld this aspect of Ms C's complaint.

Ms C also complained that the board's handling of her complaint was unreasonable. We found that there were delays in the board's response to Ms C's complaint and the board did not provide proactive updates about the status of Ms C's complaint. We found that the board's handling of the complaint was not in line with the NHS Model Complaints Handling Procedure (MCHP) and, therefore, upheld this aspect of Ms C's complaint.

We noted that the board had already taken action to improve their complaints handling. We made no further recommendations but did provide feedback on this point.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failings identified in the care and treatment provided to Child A and for the failures identified in the board's complaints handling. 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:

• Patients should be fully examined when presenting at an orthopaedic clinic and further investigations organised as appropriate.

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.