Health

Summary

Mrs C complained about the care provided to her late sister (Mrs A) when she attended Raigmore Hospital with gastric symptoms. Investigations were carried out into Mrs A's symptoms over two admissions. During the latter admission, Mrs A was diagnosed with a perforated bowel, thought to be related to cancer. Her condition deteriorated very quickly and she died from her illness.

We took independent advice from a consultant gastroenterologist (a doctor who specialises in the digestive system) and from a registered nurse.

We did not identify any failings in the medical management of Mrs A's condition or in the nursing care provided. We did not uphold this aspect of the complaint. However, we noted that the documentation of her care could have been more detailed and fed this back to the board.

Mrs C was also unhappy that board staff did not contact her regarding Mrs A's discharge from the hospital following her first admission. In response to Mrs C's complaint, the board confirmed that another family member had been told about the discharge and so there was no requirement for duplication of information. We did not uphold this aspect of the complaint.

Summary

Mrs C complained about the treatment which her late husband (Mr A) received at the Queen Elizabeth University Hospital following a fall, in which he sustained a fractured leg. Mr A was admitted for conservative treatment rather than surgery, however, a few days after admission, Mr A's condition deteriorated; he suffered a cardiac arrest and was taken to intensive care.

We took independent advice from an medical adviser. We found that initially Mr A received appropriate medical care in view of his presenting symptoms, but when Mr A's condition began to deteriorate, there was an avoidable delay by junior medical staff in seeking a more senior medical review for Mr A. While this may not have prevented the cardiac arrest or affected the final outcome, it would have allowed for the appropriate medical investigations to be instigated at an earlier time. Therefore, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failure to refer Mr A for a senior medical review at an earlier stage. 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 need to refer patients for a more senior medical review when their medical condition deteriorates.

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 that her partner (Ms A) received at Queen Elizabeth University Hospital while she was recovering from brain surgery. We took independent advice from a nursing adviser. We found that the nursing care provided to Ms A was reasonable and did not uphold this aspect of Ms C's complaint.

Ms C also complained about the medical care and treatment that Ms A received. We took independent advice from a consultant in acute medicine and from a consultant neurosurgeon (specialist in surgery on the nervous system, especially the brain and spinal cord). We found that there was a lack of documented medical assessments regarding Ms A's orientation/confused status, and when confusion was identified, this was not appropriately investigated and documented. We also found that there was no consultant medical review prior to Ms A's transfer from Queen Elizabeth University Hospital to another hospital. Therefore, we upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C and Ms A for the lack of documented medical assessments regarding Ms A's orientation/confusion status and the failure to carry out a consultant medical review prior to Ms A's transfer between hospitals. 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 recovering from neurosurgery should have documented medical assessments of their orientation and where confusion is identified this should be investigated and appropriately documented.
• Where possible, in-patients should receive daily senior clinical review and these reviews should be 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 and Mrs C complained about the care and treatment their children (Child A and Child B) received at Royal Alexandra Hospital following their birth. They also complained about the level of communication with them about Child A and Child B's care and treatment.

We took independent advice from a paediatrician. We found that, overall, the care and treatment Child A and Child B received had been reasonable and we did not uphold these aspect's of Mr and Mrs C's complaint.

However, the board accepted that there had been failings in communication regarding some of the problems Child A and Child B had faced following their birth. We also found that there was a lack of documentation about the communication with Mr and Mrs C about Child A and Child B's care and we raised this with the board. We upheld these aspects of Mr and Mrs C's complaint but noted that the board had already apologised for these failings so made no further recommendations.

Summary

Mr and Mrs C complained on behalf of their child (Child A) about the care and treatment they received from the board's children and adolescent mental health services over several years. The concerns related to the stopping of treatment; the lack of support to aid Child A's understanding of a complex system and consenting to it; and lack of transparency regarding a number of matters. The board did not identify any failings in the care and treatment provided and explained this to the family.

We took independent advice from a consultant child and adolescent psychiatrist. We considered that there had been a reasonable amount of input at an appropriate level of seniority in place to make decisions in a complex case. We found that it was a reasonable course of action to stop a type of therapy and not carry out a risk assessment as there was evidence of engagement and future planning and no evidence of a high risk situation at this time. In addition, whilst the therapy was stopped, Child A continued to receive care from psychiatric and psychology services. In terms of consent, there was evidence in the clinical records to support that attempts were made by staff to tailor their approach towards Child A and we did not identify unreasonable practice. However, we did provide feedback to the board regarding ensuring that patients receive relevant information about their clinical condition. We also considered that further opinions were appropriately sought when the family questioned the clinical diagnosis in line with national guidelines. We did not identify any concerns regarding transparency in the clinical records or with the family. We did not uphold the complaint.

Summary

Mr C complained that the care and treatment given to his late wife (Mrs A) by her GP practice were unreasonable.

Mrs A had a history of rheumatoid arthritis (an inflammatory disorder that mainly affects the flexible joints). Her health began to deteriorate further, but Mr C said that it took time to establish that Mrs A had heart problems for which she needed an operation. After surgery Mrs A was discharged home, but months later she required to be admitted to hospital again. Mrs A had developed a serious infection in her heart and died shortly afterwards. Mr C complained that it took too long to diagnose his wife's infection.

We took independent advice from a GP. We found that in the early stages of her illness, Mrs A had been investigated and treated appropriately and it had been very unusual for a patient to have developed such severe heart disease in a short space of time. After her operation and return home, Mrs A became increasingly unwell and was regularly seen by members of the GP practice who treated her for a urinary tract infection. However, we found that the severe heart infection (endocarditis) had not been considered as a possible diagnosis, as it should have been, particularly as it was known that Mrs A had an artificial heart valve and persistent signs of infection. Her pre-existing heart condition could have predisposed Mrs A to developing endocarditis, and it was unreasonable not to consider this. This led to a delay in diagnosis and a delay in admitting Mrs A to hospital. Therefore, we upheld the complaint.

During the course of our investigation, we also found the complaint handling to be unreasonable.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failure to properly consider Mrs A's presenting symptoms and for failing to consider and discount the possibility that she had endocarditis. As a consequence there was a delay in admitting her to hospital.
• Apologise to Mr C for the failure to deal with their complaint as required by NHS Scotland's Model Complaints Handling Procedure.

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

• Patients' symptoms should be considered holistically.
• Clinicians should be aware of National Institute for Health and Care Excellence (NICE) guidance (s64) in relation to the symptoms that may indicate infective endocarditis.

In relation to complaints handling, we recommended:

• Complaints should be addressed and responded to in terms of the NHS Scotland's Model Complaints 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

Mrs C complained on behalf of her late son (Mr A) about the care and treatment he received from his GP practice. Mr A phoned the practice as he was coughing and felt unwell. Mr A was considered to have symptoms of a cold and he was prescribed a cough suppressant. Around a week later, Mr A died from pneumonia (an infection of the lungs).

Mrs C complained that the practice unreasonably diagnosed Mr A over the phone, even though he had asthma and learning difficulties. We took independent advice from a GP. We found that as Mr A was noted to have symptoms of a cold, it was reasonable that he was diagnosed over the phone, even though he was a vulnerable adult. We did not uphold this aspect of the complaint.

Mrs C also complained that when she was admitted to hospital shortly afterwards, the practice did not contact her son to check on his condition. We found that the practice had not been informed of Mrs C's hospital admission or advised of any concerns about Mr A. Therefore, we found that the practice had no cause to check on Mr A's condition. We did not uphold this aspect of the complaint.

Lastly, Mrs C complained about the practice's handling of her complaint. We found that there were failings in their complaints handling, which the practice had already acknowledged and apologised for. We noted that Mrs C's complaint was not acknowledged within the relevant timescale and her request for a phone call was not followed up. Therefore, we upheld this aspect of the complaint.

Recommendations

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the NHS Scotland Model Complaints Handling Procedure. The model complaints handling procedure and guidance can be found here: www.valuingcomplaints.org.uk/handling-complaints/complaints-procedures/nhs

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 she received from Victoria Hospital. She said that there were delays in receiving appointments and treatment; that she was not properly consented for surgery; that a stent was removed without anaesthetic; and that after surgery she was left with a bulge/hernia that did not receive timely treatment. In responding to the complaint, the board acknowledged that Ms C had incorrectly been sent a letter saying that she was no longer on the waiting list for surgery and incorrectly advising that she would require another GP referral. The board also found that the bulge she was concerned about had not been examined as it should have been; that there were some communication failures; and that an appointment had to be rescheduled twice. The board apologised for these errors.

We took independent advice from a consultant urological surgeon (a specialist in diseases of the urinary organs in females and the urinary tract and sex organs in males). We found a number of failings in terms of it being unclear about; what treatment options had been discussed with Ms C; the implications and risks of the change in surgery; poor record-keeping; the removal of the stent was not clearly explained; and no written advice leaflet provided. Therefore, we concluded that Ms C's care and treatment was of an unreasonable standard and upheld her complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the 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:

• The consent process (and evidence of it) should start earlier than the day of surgery and General Medical Council guidance should be followed.
• Clinicians should keep clear, accurate, and legible records which report the relevant clinical findings, the decisions made, the information given to patients, any drugs or other treatment prescribed and who is making the record and when.
• When available, explanatory leaflets should be used to assist patients in their understanding and decision-making.

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, a solicitor, complained on behalf of his client (Mr B) about the care and treatment Mr B's mother (Mrs A) received at Stratheden Hospital after she broke her hip. Mr C complained that Mrs A did not get appropriate treatment for her physical health issues; in particular, that her condition was not appropriately monitored, which led to her becoming dehydrated. Mr C also complained about the nursing care, particularly that Mrs A did not receive appropriate nutritional care and that there was a lack of action in response to her weight loss. Additionally, Mr C raised concerns about the board's complaints handling.

We took independent advice from a consultant psychiatrist and from a mental health nurse. We found that Mrs A's treatment plan was reasonable and that she received appropriate treatment for her physical health issues, which led to an improvement in her condition. However, we found that her fluid balance was not recorded appropriately during that time, as the board had acknowledged. We found that after Mrs A's condition improved, the board decided to take a more limited approach to her treatment. We considered that the reasons for that decision were not properly recorded, and Mrs A's condition was not monitored appropriately afterwards. Therefore, we upheld this aspect of Mr C's complaint.

In relation to the nursing care provided to Mrs A, we found that insufficient action was taken in relation to her nutrition and weight loss. The board identified these failings and apologised to Mr B. We upheld this aspect of Mr C's complaint.

Finally, we found that the board did not clearly respond to all aspects of Mr B's complaint. We upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr B for the failures to appropriately monitor Mrs A's condition, to record relevant information about her care and treatment, and for not providing a clear response to aspects of his complaint. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• In similar cases, fluid balance sheets should be completed appropriately and in accordance with the board's procedure.
• If a decision is made to change the treatment plan for a complex patient, the clinical reasons should be clearly recorded, along with the parameters of what that means for managing their condition.
• Nutritional screening should be carried out promptly and patients should receive effective nutritional care, which is in line with the relevant national nutritional guidance.

In relation to complaints handling, we recommended:

• Complaint responses should be clear to avoid any misunderstandings and the issues should be thoroughly investigated.

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 psychiatric treatment she received for anxiety. She complained that there were unnecessary delays and a lack of communication regarding her treatment which added to her anxiety. Ms C complained that her psychiatrist did not assess her properly and proceeded with options for therapy without first carrying out an appropriate assessment.

We took independent advice from a consultant psychiatrist. We found that Ms C's assessment had been appropriate and reasonable, and that medical staff tried to work constructively with Ms C and to tailor treatment to her specific needs and wishes for treatment. We considered that the board had taken Ms C's social anxiety into consideration when arranging appointments. Therefore, we did not uphold this aspect of the complaint.

Ms C also complained about the board's complaints handling. We considered that the board could have clarified aspects of the complaint at the outset, with a view to agreeing a reduced number of complaints. This may have provided for a more manageable complaint from the point of view of investigation. We noted there had been significant delay in providing complaint responses, which had added to Ms C's stress. We considered that the delays were unreasonable and we therefore upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the delay in providing a response to her complaints. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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.