Health

Summary

Mrs C complained that there was an unreasonable delay in diagnosing her with a breast abscess. Following the birth of her child, Mrs C's GP referred her to Borders General Hospital with a suspected breast abscess after she had been suffering from mastitis (when a woman's breast tissue becomes painful and inflamed). On admission, a surgeon said that there was no evidence of an abscess and Mrs C was discharged. Mrs C was due to return for an ultrasound scan the following day, however, the hospital changed her appointment to a later date. In the interim period, Mrs C experienced a deterioration in her condition and was referred back to the hospital. An ultrasound scan was carried out which confirmed that she had a breast abscess, requiring surgery. Mrs C said the length of time that it took for a scan to be arranged meant that there was an unreasonable delay in diagnosing her with a breast abscess and, as a result, she endured significant distress and her baby did not gain weight appropriately due to difficulties with breastfeeding.

We took independent advice from a medical adviser who specialises in breast surgery. We found that an ultrasound scan should have been carried out to investigate the possibility of a breast abscess during Mrs C's first admission, and that the subsequent delay in arranging the scan was unreasonable. We determined that these failings meant that there was an unreasonable delay in diagnosing Mrs C with a breast abscess. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to arrange an ultrasound scan within a reasonable time and the associated delay in receiving treatment. The apology should meet the standards set out inthe SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• Ensure that ultrasound scans are carried out within a reasonable timeframe in line with the relevant 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.

Summary

Mr C complained about the care and treatment he received at Ayr Hospital. Mr C attended the orthopaedic department (specialising in the treatment of disease and injury of the musculoskeletal system) in relation to knee pain. He had surgery but despite that he continued to experience pain. Mr C was unhappy because he was discharged by the consultant without his pain being fully investigated.

We took independent advice from an orthopaedic consultant. We found that the standard of care that Mr C received for his knee was reasonable and that post-operative follow-up was appropriate. Therefore, we did not uphold this aspect of the complaint.

In addition, Mr C became aware of comments written in his clinical record by the consultant which Mr C described as slanderous. We found that the language used was unreasonable, inappropriate and unfair. However, we noted that the consultant had apologised to Mr C and had reflected on the fact that the language used was open to misinterpretation. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the inappropriate comment written by the consultant in the clinical letter. The apology should meet the standards set out inthe 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

Ms C complained about the care and treatment provided to her by Crosshouse Hospital both during and after her pregnancy. She felt that she was not monitored appropriately during pregnancy and that her concerns had not been taken seriously. She also raised concern that she had requested a caesarean section but this had been denied, and that planning for delivery had not been reasonable.

We took independent advice from a midwife and an obstetrician (a doctor specialising in pregnancy and childbirth). We noted that there was an inappropriate remark recorded in Ms C's records by a midwife and we made a recommendation to the board about this. We found that, whilst many aspects of the care and treatment provided to Ms C were reasonable, there was a failure to take appropriate and timely action when Ms C presented with polyhydramnios (increased fluid) and accelerated foetal growth. Therefore, we upheld this aspect of Ms C's complaint.

In relation to Ms C's concerns about post-pregnancy care, we found that this was appropriate and in line with standard practice. Therefore, we did not uphold this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the inappropriate description in her medical records, and the failure to investigate the cause of polyhydramnios and accelerated fetal growth in a timely manner. 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:

• Notes made in medical records should be appropriate and in line with relevant nursing and midwifery standards.
• Polyhydramnios and accelerated fetal growth should be investigated in a timely manner.

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 clinical and nursing care and treatment given to her late father (Mr A).

We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) and from a nursing adviser.

In relation to the clinical care and treatment, we found that the clinical records evidenced that an appropriate assessment of Mr A was carried out and that reasonable efforts were made by clinical staff to treat Mr A's condition. We found that, overall, the clinical care and treatment given to Mr A was reasonable and we did not uphold this aspect of the complaint.

In relation to the nursing care and treatment given to Mr A, we found that the nursing records were of a reasonable standard and that they demonstrated that there had been a risk-based assessment of Mr A. There was also evidence of care planning related to the level of risk and ongoing documentation around delivery of daily care for Mr A. However, we found that the documentation around the injury to Mr A's foot could have been better and we drew this to the board's attention. On balance, we found that the nursing care and treatment was reasonable and did not uphold this aspect of the complaint.

Lastly, Miss C complained about the communication from the hospital with her and her family. We found that the clinical records demonstrated an appropriate level of communication and we did not uphold the complaint.

Summary

Mr C complained about the time taken for the board to refer him to specialist care for pain in his hip following a hip replacement.

We found that for several years the board's actions were reasonable. However, at one point, the board recognised the possibility of infection but chose not to aspirate (drain fluid from) Mr C's hip. We considered this to be unreasonable and that Mr C should have been refererred for specialist care. We upheld this aspect of the complaint.

Mr C also complained about the boards handling of his complaint. We found that the board complaint handling was reasonable and, therefore, we did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to provide reasonable treatment in relation to pain in his hip. The apology should meet thestandards 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 board should develop a written policy for the investigation of painful hip replacements that takes into consideration the content of the European Consensus Document on Periprosthetic Infection (https://www.efort.org/wp-content/uploads/2013/10/philadelphia_consensus.pdf).

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 actions of the prison health care service. Following a medication spot check, Mr C was found to be short of antidepressant tablets, and as a result his medications were stopped with immediate effect. Mr C explained that his medication count was short as his medication safe was broken into recently and everything was taken. In response to his complaint, the board explained they would not reinstate Mr C's medication. They also stated they had made enquiries with the Scottish Prison Service (SPS) and were informed that Mr C had not reported his safe being broken into.

Mr C complained to us about his medication being stopped and about the enquiries the board made into whether or not he had reported his safe being broken into.

In respect of the complaint about Mr C's medication being stopped, we took independent advice from an GP adviser. We noted that, ideally, a GP would not withdraw anti-depressant medication suddenly. However, we found that this may not be the case if there is poor compliance with the requirements of the medication. We also highlighted guidance about prescribing medication in a prison setting and noted that Mr C had signed a medical agreement treatment form that acknowledged his medication may be stopped if not appropriately managed. After reviewing Mr C's medical records, we noted that an early entry had suggested potential drug misuse. Based on the review of the information available, we concluded that healthcare staff's decision to stop Mr C's medication was appropriate and their actions reasonable. Therefore, we did not uphold this complaint.

In respect of the second complaint, the board acknowledged that they had not appropriately described their enquiries in their responses to Mr C. The board had spoken with SPS staff and stated that SPS had confirmed Mr C had not reported his safe being broken into. However, Mr C had, in fact, reported his safe as being broken into to SPS staff. The board accepted this error had caused Mr C further concern and apologised for this. We considered this likely to be a case of miscommunication rather than any attempt by the board or SPS staff to mislead. However, although we considered the enquiries made by the board to be in good faith, we concluded that they could have been clearer and taken into account the content of Mr C's complaint more closely. Furthermore, the outcome of the enquiries could have been relayed to Mr C more accurately. On this basis, we 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 make reasonable enquiries to the SPS about what happened to his medication and whether his safe had been broken into. 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.

Summary

Ms C complained about the care and treatment her late child (Child A) received from the board before their death. Child A had been diagnosed with a rare disorder that affected their development. Child A had a CT scan (a scan which creates detailed images of the inside of the body) of their brain, which identified cerebellar tonsillar descent (the lower part of the brain pushes down into the spinal canal). Ms C found out about this after Child A died. She said that Child A's behaviour had changed around that time, and she complained that the board had failed to tell her about this.

We took independent advice from a consultant neuroradiologist (a specialist who uses scans to diagnose and characterise abnormalities of the central and peripheral nervous system, spine, and head and neck). We found that it had been unreasonable not to discuss the findings and the clinical implications with Ms C and, therefore, upheld this aspect of the complaint.

Ms C also complained that the board had failed to provide reasonable care and treatment to Child A in relation to this. We found that it had been unreasonable not to carry out further investigations, and specifically an MRI scan, to evaluate this. We upheld this aspect of the complaint. However, the evidence suggests that it would not have been possible to prevent Child A's death at that time.

Finally, Ms C complained that the board delayed in responding to her complaint. The board had acknowledged that there were delays in responding to Ms C's complaint and that she was not kept updated on the delays. We also upheld this aspect of the complaint, although we noted that the board had apologised to Ms C for this.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to discuss the findings and implications of the CT scan and for failing to carry out further investigations to evaluate Child A's condition. 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 of this nature, the imaging findings should be shared with patients and their carers.
• Radiology staff reporting head CT scans should be aware of the clinical implications of cerebellar tonsillar descent (congenital or acquired) and appropriate imaging confirmation and evaluation should be undertaken where clinically relevant.

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.

Amendment

When originally published (18/9/2019), this summary included the line: "However, the evidence suggests that it would not have been possible to prevent Child A's death."

For clarification, this has since been changed to: "However, the evidence suggests that it would not have been possible to prevent Child A's death at that time."  We apologise for any confusion caused.

Summary

Ms C complained about the care provided to her by the Scottish Ambulance Service (SAS) when she experienced an episode of cellulitis (a potentially serious skin infection). She said that SAS failed to identify that she was suffering from sepsis (a serious complication of infection) and take the appropriate action.

We took independent advice from an adviser who is experienced in pre-hospital, emergency and unscheduled care. We found that the care and treatment provided by SAS to Ms C was reasonable and in line with relevant guidance. We did not uphold Ms C's complaint.

However, during our investigation we identified that SAS had failed to respond to Ms C's complaint within the appropriate timescales and had not kept her updated on the delay. We therefore made a recommendation under section 16G of the SPSO Act 2002, which requires the Ombudsman to monitor and promote best practice in relation to complaints handling.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C that her complaint was responded to outwith 20 working days and she was not provided with an explanation for the delay or a revised timetable for sending the response. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

In relation to complaints handling, we recommended:

• Complaints should be responded to within 20 working days, and if the investigation will take longer, SAS should discuss this with the complainant and agree revised time limits.

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 husband (Mr A) that the Royal Infirmary of Edinburgh Hospital failed to call Mr A to a follow-up review appointment with the cardiology department.

Mr A had been diagnosed with heart disease. He attended an out-patient appointment and saw a consultant cardiologist. During that appointment, it was agreed that Mr A should be reviewed two years from then. Some years later, Mr A collapsed. An ambulance took Mr A to hospital, but he died on arrival. On becoming aware that Mr A had not attended his follow-up appointment with cardiology, Mrs C wrote to the board to ask why he had not been called back to the follow-up appointment as agreed. The board said that Mr A had been asked to make a follow-up appointment but nothing was noted in the system, and they were unable to explain this conclusively. Mrs C complained about the board's failure to call Mr A in for his review appointment. She said that the appointment system seemed flawed and there needed to be a backup system in place so no one else missed an important appointment.

We found that at the time when Mr A was advised to make a review appointment, all patients were advised during their consultation if and when a follow-up appointment was required. The patient would be asked to book an appointment accordingly at the reception desk. Once the appointment was booked, a letter was sent out confirming the date and time of the appointment. No further letters or reminders were sent. It was the patient's responsibility to remember to attend the appointment.

The board told us that having reflected on Mr A's case, they acknowledged that there were failings in the appointment process. They told us that going forward, when staff typed the clinic outcome letter, they would now check that any requested follow-up appointments had been made. If an appointment had not been made, staff would contact the out-patient department requesting that the appointment be made and confirmation sent to the patient.

We took independent advice from a consultant cardiologist. We found that the appointment process described by the board was not common practice and it was susceptible to problems. We found that the boards process placed undue responsibility on the patient.

We considered that the appointment process was open to weaknesses and because of that, the board had been unable to say whether Mr C's review appointment was in fact scheduled. We noted that the most common appointment process would be for each patient to be given a routing card at the end of their consultation which they would return to the clinic reception desk; this would be a record of the discussion held with the patient and the next steps agreed. Even though the board's proposed change would be an improvement to the current process, it did not go far enough as it relied only on verbal communication between clinical staff, the patient and staff at the reception desk. Therefore, we upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to arrange an appropriate review appointment for Mr A. 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 board should reflect on these findings, particularly the view of the adviser and the feedback provided by Mrs C, and consider what further improvements can be made to the appointment process.

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 that she and her family were unreasonably removed from the practice list of patients. Mrs C said that she had no trust in the service provided by the practice and that she had never received explanations about what diagnoses had been reached about her numerous medical conditions.

We took independent advice from a GP. We found that prior to removing Mrs C and her family from the patient list, the practice had repeatedly made an offer of a meeting with Mrs C to discuss her concerns. When Mrs C failed to accept the offers, the practice viewed the doctor/patient relationship had irretrievably broken down and that it was in Mrs C's best interests to register with another medical practice. The hope was that she could build up a good doctor/patient relationship with her new practice. We did not uphold the complaint.

Mrs C also complained that it was unreasonable to have her family removed from the patient list as well. Guidance suggests that members of a patient's family should not be removed automatically from the practice list where there is a breakdown in the doctor/patient relationship. However, in instances where children and/or carers are involved, it is appropriate to remove the whole family, as this will allow better communication and the sharing of information where all family members are registered with the same practice. Therefore, we did not uphold this complaint.