Health

Summary

Miss C, an advocacy worker, complained on behalf of Ms B that the board failed to provide her late mother (Mrs A) with reasonable care and treatment at Aberdeen Royal Infirmary and that staff at the hospital failed to communicate adequately with Mrs A's family about her care and treatment.

Mrs A had been admitted to the hospital's intensive care unit with respiratory failure where she died. Mrs A had suffered from a number of chronic illnesses. We took independent advice from a consultant in emergency medicine. We found that the care Mrs A received was reasonable and in line with current guidelines and good clinical practice. The evidence available showed that, ultimately, Mrs A's failure to respond to the treatment was because of the seriousness of her condition, and not the treatment itself. We did not uphold this aspect of the complaint.

In relation to communication with Mrs A's family, we found that it was clearly recorded in the clinical notes that on Mrs A's admission there had been a discussion with her family. It had been explained that there was a very real risk that Mrs A would not survive the admission and why performing cardiopulmonary resuscitation (CPR, where the heart and/or breathing is restarted if it stops) would not be in her best interest. However, other than this initial conversation, in general, communication with Mrs A's family was very poor. In particular, the decision to extubate Mrs A (to remove a breathing tube) should have been discussed with her family prior to this taking place. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms B and her family for the communication failures 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:

• Patients and their families should be involved in the decision-making process where appropriate and should receive regular updates. This should be recorded in the clinical records.

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 that the board failed to communicate reasonably with him and his wife (Mrs C) about his child's (Child A) care and treatment. Mr C raised concerns about the timeliness and accuracy of medical advice; the failure to engage with Mr and Mrs C in a meaningful way; and a failure to obtain proper consent on a number of occasions.

We took independent advice from a paediatrician, and a paediatric surgeon with an interest in gastroenterology (the branch of medicine that deals with disorders of the stomach and intestines). We found that many aspects of communication had been reasonable, however, there was a lack of documentation regarding information given to Mrs C both prior to and following a endoscopy procedure (a medical procedure where a tube-like instrument is put into the body to look inside) carried out on Child A. The documentation was not in line with General Medical Council guidance on consent and protecting children and young people. We therefore upheld this aspect of Mr C's complaint.

Mr C also complained about the care and treatment provided to Child A. We found that the care and treatment provided was reasonable and did not uphold this aspect of the complaint.

Finally, Mr C complained about the board's handling of his complaints. Whilst we acknowledged that there was a significant volume of correspondence for the board to consider and respond to, we considered it clear that there were multiple occasions on which Mr and Mrs C's complaints were not handled in line with the appropriate complaint handling procedures. We considered that the volume of complaints made by Mr and Mrs C was partially as a result of complaints not being managed and responded to in an effective and timely manner; and that the board's failure to address correspondence correctly contributed to the breakdown in the complaints procedure. We also noted that the board had agreed at one point to issue a formal written apology about Child A being removed from the hospital without consent, but this apology had never been sent. We upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr and Mrs C for the lack of documentation regarding information given to Mrs C both prior to and following the endoscopy procedure; the failure to handle the complaints in a reasonable and timely manner; Child A being removed from the hospital without consent; and the failure to issue an apology for this at the 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:

• Discussions with family members should be documented.

In relation to complaints handling, we recommended:

• Complaints should be handled in a reasonable and timely manner, and in line with the complaint handling procedure.

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 lack of care which his wife (Mrs A) received from the Victoria Hospital Kirkcaldy. Mrs A had suffered from chronic knee pain for a number of years and had undergone episodes of arthroscopy (surgical technique to diagnose and treat problems in the knee joint) in the past. She requested further surgery but the surgeon decided that further surgery would not be of benefit and that she should continue with conservative treatment. Mrs A asked for a second opinion and another consultant discussed Mrs A's condition with the surgeon; it was again decided to continue with conservative treatment. Mr C thought that the decision of the surgeon was unreasonable and that they had influenced the decision from the consultant.

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 the decision by the surgeon not to offer further surgery was reasonable in the circumstances. If a patient still suffers from pain following repeated arthroscopic surgery, it would not be appropriate to continue with the surgical interventions when there is no notable benefit for the patient. We also found that it was not unreasonable for the consultant and the surgeon to have discussed treatment options for Mrs A and that the decision to persevere with conservative treatment was appropriate. We did not uphold the complaint.

Summary

Mr C complained about the care his mother-in-law (Mrs A) received at Victoria Infirmary Hospital. Mrs A has emphysema (a lung condition that causes shortness of breath) and has particular difficulty with her breathing when moving around. Mr C raised concern that when he made enquiries about Mrs A receiving ambulatory oxygen therapy (the use of supplementary oxygen during exercise and activities of daily living) it was unreasonably refused.

We took independent advice from a consultant physician in general and respiratory medicine. We found that it was reasonable for board staff to have reached the view that ambulatory oxygen was not indicated in accordance with guidance issued by the British Thoracic Society. We, therefore, did not uphold the complaint. However, we also considered that board staff should have offered Mrs A a second opinion and so we provided feedback to the board for reflection in this respect.

Summary

Miss C complained about the treatment which she received from a dentist. She said that she had attended the dentist over a five month period complaining of a sore tooth and that the dentist told her she required eight fillings. Miss C said that following the treatment she still suffered sensitivity and discomfort from the treated teeth and that when she attended another dentist she was told that the fillings were not required.

We took independent advice on Miss C's complaint from a dentist. We found that there was evidence from Miss C's x-rays that decay was present in her teeth and that treatment was required. Although Miss C had not reported problems with some teeth, it did not mean that there was no decay present and that, if the decay was not too deep, it is not uncommon for dentists not to record the depth of the decay. There was no evidence to substantiate the complaint that the dentist failed to provide Miss C with a reasonable standard of treatment. We did not uphold the complaint.

Summary

Ms C complained to us about the care and treatment she received at University Hospital Ayr. Ms C underwent total hip replacement surgery (a surgical procedure where a damaged hip joint is replaced with an artificial one) on both hips. Ms C raised concerns that the risks of each surgery were not communicated appropriately to her; there were failings in carrying them out, which caused her to experience pain and mobility issues; and her post-surgical care was unreasonable.

We took independent advice from a medical adviser who is a consultant orthopaedic and trauma surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). For both surgeries, we found no evidence of failings in carrying them out. We found that Ms C experienced recognised complications of total hip replacement surgery. We also found that Ms C's post-surgical care was reasonable. However, we found that there was no evidence Ms C was appropriately informed of the risks involved in each surgery during the consent process. Therefore, we upheld Ms C's complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failings identified in the surgical consent process for both hip surgeries. 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 consent process should follow national guidelines. Consent should be taken, where possible, prior to the day of surgery. As part of the consent process, there should be a clear discussion of the risks and benefits (of having the surgery and not having the surgery) and of any alternative treatment options; and those discussions should be clearly 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

Mr C complained about the aftercare and treatment provided to him following his knee surgery. Mr C underwent a full knee replacement and following the surgery he experienced difficulty with bending and positioning his knee, as well as extreme pain. Despite completing physiotherapy, hydrotherapy and intense exercises, the problem did not resolve.

The board acknowledged a rare complication had occurred following Mr C's surgery, however, they consider that there was no undue delay in addressing the stiffness in Mr C's knee and that it was dealt with in a reasonable timescale.

We took independent advice from a consultant orthopaedic surgeon (a medical expert who treats patients with problems in their muscles, bones, joints and other related structures). We found that the aftercare was provided promptly and that there was no unreasonable delay. The board were not provided the opportunity to carry out further investigations or treatment as Mr C chose to seek private treatment. The board acted reasonably by offering a second opinion, however the offer was declined. We did not uphold the complaint.

Summary

Mr C complained about a dentist's failed attempts to restore his broken tooth with a white composite filling. The filling fell out a week later and was replaced but unfortunately it failed again and fell out two days later. The option of fitting a crown was discussed but Mr C did not consider that he should have to contribute to the cost of this. He subsequently changed dentist and requested that the cost of subsequent treatment under the new dentist was reimbursed. We took independent advice from a dentist. We found that the treatment provided in attempting to restore Mr C's broken tooth was reasonable and in line with standard clinical practice. The dentist had no obligation to contribute to the cost of any treatment Mr C received from his new dentist. Therefore, we did not uphold the complaint.

Mr C also complained about concurrent root canal treatment he was undergoing on a different tooth. This was carried out over several visits and, at the second visit, the dentist temporarily restored the tooth and booked Mr C a further appointment. However, Mr C reported that the tooth broke around four hours later when he was eating soft food. We found that the treatment provided was reasonable and in line with normal clinical practice. There was no evidence to support Mr C's concerns that failings in his treatment contributed to the tooth breaking a few hours later, and did not consider that the quality of this treatment should be associated with the subsequent extraction of the tooth by the new dentist. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment he received from Ayr Hospital in relation to surgery he underwent for penile deviation (curvature of the penis). Mr C was dissatisfied with aspects of the medical and nursing care. Following surgery, he developed a haematoma and infection. In addition, the end result of the surgery was unsatisfactory for him.

We took independent advice from a consultant urological surgeon (a doctor who specialises in the male and female urinary tract, and the male reproductive organs) and a registered nurse.

We found no evidence that the surgery was of an unreasonable standard. However, we found that informed consent for the surgery undertaken was not properly obtained from Mr C, in line with the General Medical Council's (GMC) guidance on consent. We considered that the medical care Mr C received was unreasonable and upheld this aspect of his complaint.

In terms of the nursing care, we identified failings in that there was a lack of record-keeping to show that Mr C's wound was regularly checked and assessed with the appropriate dressings applied. In addition, in terms of his discharge from hospital, there was no evidence to show that Mr C was given information about caring for his wound at home or that he was supplied with sufficient dressings. We considered that these aspects were unreasonable and upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to obtain informed consent from him and for the nursing care failings in relation to wound care, record-keeping, and discharge information. 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 consent process should follow GMC guidelines.
• Patients should be provided with appropriate information as part of discharge planning and document that this should be documented.
• Patients should receive appropriate wound dressings in line with the wound dressing formulary.
• Post-operative patients should have their wound checked and this should be recorded on each occasion.

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.