Health

Summary

Mr C complained about the clinical and nursing care and treatment given to his late mother (Mrs A) while she was a patient at Royal Alexandra Hospital. Mr C also complained that there was a failure to notify him of Mrs A's deteriorating condition.

We took independent advice from a nurse and a consultant physician. We found that falls assessments were not undertaken as they should have been and that Mrs A had not been provided with the walking frame that she required. We also found that Mr C was alerted neither to Mrs A's deteriorating condition nor to her fall and the injuries she suffered as a result. Similarly, Mr C appeared not to have been told of Mrs A's low sodium which was likely to have contributed to her fall and agitation. Therefore, we upheld these aspects of Mr C's complaint.

In relation to clinical treatment, we found the care to be reasonable. We did not uphold this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failure to alert him to Mrs A's deteriorating condition and to her fall and injuries, as well as the failure to advise of her poor prognosis. 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:

• Where a fall occurs, relatives should be alerted in a timely way. Similarly, they should be informed where a poor prognosis is anticipated.
• Medical staff require to communicate effectively with ward staff about the seriousness and risk of common metabolic problems.

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 to us about the care provided to her late husband (Mr A) by the practice prior to him suffering a fatal heart attack. In particular, Mr A had reported chest pains three times over a three month period to his GP. The GP had felt the problems were related to a stomach problem, prescribed Gaviscon (medication for heartburn or indigestion) to Mr A and said they had ruled out a cardiac cause for the chest pain.

We took independent advice from a GP. We found that at the initial consultation it was reasonable that the GP had considered that Mr A's long standing stomach problem was responsible for his reported chest pain, and it was appropriate to prescribe medication. There was a question as to whether Mr A was taking the prescribed medication, which may have resolved the stomach problem, and that it was reasonable to pursue that line of enquiry in an effort to resolve the situation. We found that the GP had carried out an appropriate examination and did not uphold the complaint. We also noted that there was no evidence to suggest that had an earlier diagnosis been made, it would have prevented Mr A's sudden death.

Summary

Mr C complained about the treatment his mother (Mrs A) received at the practice. Mrs A suffered from chest pain and breathlessness and had concerns she had angina (a heart condition). Mr C complained that appropriate treatment and investigations were not carried out in a reasonable time-frame.

We took independent medical advice from a GP. We found that the practice unreasonably failed to carry out appropriate physical assessments during appointments. While the practice did not consider angina was a likely cause for Mrs A's health concerns, at the point where it was agreed to refer her, the practice used the incorrect referral pathway. They arranged for an electrocardiograph (ECG - test that records the electrical activity of the heart) followed by a routine referral to cardiology (the branch of medicine that deals with diseases and abnormalities of the heart), instead of the appropriate action of an urgent exercise tolerance test (or if the patient was not physically capable of doing this test then an urgent cardiology referral). We upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to follow the correct referral pathway for investigation of angina. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/informationleaflets.

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

• The GP should be familiar with the appropriate referral pathway when investigating angina.

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 his mother (Mrs A) received at Aberdeen Royal Infirmary. Mrs A was admitted to hospital to investigate heart concerns and was diagnosed with three vessel disease (a type of heart disease). An operation was carried out, but Mrs A died during the operation. Mr C was concerned about the board's response to Mrs A's reports of discomfort to nursing staff and the subsequent treatment she received. Mr C complained that the delay to take Mrs A's complaint seriously and call a doctor, contributed to her death.

We took independent medical advice from a consultant cardiologist (a doctor who specialises in the heart and blood vessels). We found that Mrs A was regularly assessed by both nursing and medical staff, and with the exception of the lack of ECGs on a particular date, appropriate actions were taken when she reported pain. The triple vessel bypass operation was initially successful, however, due to an uncommon complication which could not have been predicted, she died. We did not uphold this aspect of the complaint.

Mr C also complained that there were discrepancies between what he was told verbally by staff on the day after the operation and the written response to his complaint. We found that the board's response was an accurate account of events as documented in the medical records. However, while the board provided a reasonable explanation of the treatment provided to Mrs A, they did not reasonably reflect that there were two instances where ECGs were not carried out, which was out with normal process. On balance, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for inaccuracies in the complaint response. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/informationleaflets.

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

• Share the outcome of this investigation with relevant staff to ensure complaint responses are comprehensive and accurate.

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 that his child (Child A) received for jaundice (a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels. Bilirubin is the reddish yellow pigment made during the normal breakdown of red blood cells) in the days following their birth. In particular, Mr C was concerned that Child A did not receive a blood transfusion and received UV phototherapy instead.

We took independent advice from a midwife and a consultant neonatologist (a doctor who specialises in the medical care of newborn infants, especially ill or premature newborns). We found that the care and treatment provided to Child A was reasonable and in accordance with relevant guidelines. We also found that, as Child A's bilirubin level responded well to the phototherapy treatment, it was reasonable that they did not receive a blood transfusion. We did not uphold this aspect of Mr C's complaint.

Mr C also complained about the way in which the board handled his complaint. We found that the board failed to provide a revised timescale for when Mr C could expect to receive a response to his complaint. 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 provide a revised timescale for when he could expect to receive a response to his complaints. 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:

• Complaints should be handled in line with the 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

Mr C complained that the care and treatment given to his late wife (Mrs A) by the board was unreasonable. Mrs A had a history of rheumatoid arthritis (an inflammatory disorder that mainly affects flexible joints) and was later investigated for possible heart disease. The investigations proved negative. However, a year later she was admitted to hospital again and found to have severe problems with the functioning of her heart valves. Heart surgery was considered, but Mrs A developed sepsis and multiple organ failure which increased the risks associated with surgery. However, it was considered that Mrs A would not survive without an operation, which went ahead. After Mrs A was discharged home, she picked up a serious infection and suffered a stoke. She died a few months later.

We took independent advice from a cardiologist (a doctor who specialises in the heart and blood vessels). We found that it was extremely unusual for a patient's heart condition to deteriorate so rapidly and that this could not have been foreseen; there had been no delay in treating Mrs A's symptoms or in diagnosing her heart problems. Mrs A's health was such that surgery was always going to be risky for her, but there had been no delay undertaking it. Afterwards, the serious infection from which Mrs A suffered had a significant associated mortality rate and her health continued to deteriorate despite her treatment. Therefore, we did not uphold the complaint.

Summary

Mrs C complained about the care and treatment her daughter (Miss A) received from the board's out-of-hours GP service on two separate occasions, and from Aberdeen Royal Infirmary during two separate admissions. Mrs C believed that the out-of-hours service had not properly assessed Miss A and should have admitted her to hospital. Miss A underwent an appendectomy (appendix removal surgery) during the first hospital admission and then required to have a further operation for a pelvic abscess which is a recognised complication of appendicitis. Miss A was also found to have Crohn's disease (an inflammatory bowel condition) which further complicated matters. Mrs C believed that it took a long time for staff to decide what to do when Miss A was readmitted to Aberdeen Royal Infirmary, that an unusual antibiotic was administered, and that the medical staff tried too many times to insert cannulas.

We took independent advice from a GP and a consultant in general and colorectal (bowel) surgery. We found that the care in relation to the out-of-hours service was of a reasonable standard, because there were clear records made by both GPs of a detailed history being taken, appropriate examination performed, observations taken and tests carried out, with advice given on what to do if Miss A's condition worsened. We also took into account that appendicitis is not always a straightforward diagnosis to make and that other conditions, such as kidney infection, can mimic this. We did not uphold this aspect of the complaint.

In relation to the first hospital admission, we found that whilst the timing of antibiotic treatment and surgery were slightly outside national guidelines, we did not consider these delays to be unreasonable. Nevertheless, although it was reasonable to discharge Miss A on antibiotic treatment and arrange for blood tests some days later, we were critical that this safety-netting measure was not appropriate. We considered that arrangements should have been made for follow-up review within 48 to 72 hours, given Miss A's c-reactive protein (a marker of inflammation) had risen again and that she had a fever. Therefore, we upheld this aspect of the complaint.

In relation to the second hospital admission, we found that the choice of antibiotic treatment was reasonable. In addition, we considered that the problems with cannulation, whilst distressing for Miss A, was not because of sub-standard care, and that the time taken to perform another operation was reasonable given the fact that re-operating is a major undertaking; and there had been an outbreak of flu at Aberdeen Royal Infirmary, which resulted in Miss A being transferred to another hospital. Therefore, we did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C and Miss A for failing to put in place an appropriate safety netting measure at the time of the first discharge from hospital. 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:

• Surgical staff should arrange appropriate follow-up review post-discharge where relevant to ensure robust safety measures are in place.

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 provided to her father (Mr A) while he was a patient at the Golden Jubilee National Hospital. Mr A had been admitted for planned surgery and subsequently his health deteriorated. Mrs C said that Mr A reported problems with his leg/foot and that these were ignored by staff. Mrs C felt that Mr A should have been sent to the high dependency ward after the surgery so that he would have been better observed by staff and that his outcome would have improved. Mr A was then housebound, had limited mobility, and a poorer quality of life.

We took independent advice from a cardiothoracic consultant (doctor specialising in operations of the heart, lungs and other chest organs). We found that the planned surgery was carried out without complications and that it was appropriate to transfer Mr A back to a ward rather than a high dependency ward as there were no concerns noted. When Mr A did deteriorate, he developed respiratory failure (a condition in which the blood does not have enough oxygen or has too much carbon dioxide) which was identified by staff and he was then taken to the high dependency ward. Mr A also had other long-standing medical conditions, which were more likely to have contributed to Mr A's deterioration rather than as a result of the surgery he underwent. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late husband (Mr A). Following surgery to remove a tumour on this lung, Mr A was treated for atrial fibrillation (AF - an irregular and usually rapid heart rhythm) with amiodarone (an antiarrhythmic drug). Mrs C complained that the board unreasonably prescribed amiodarone as a first line treatment for Mr A's AF. Mrs C noted that patients prescribed with amiodarone after thoracic (chest) surgery are vulnerable to side effects, and she considered Mr A would have survived had a less dangerous drug been used to treat him.

We took independent clinical advice from an adviser. We found that guidance supported the use of amiodarone at the time of Mr A's treatment as it is the drug most likely to restore normal heart rhythm and thereby avoid the consequences of low blood pressure, heart failure or stroke, and its use remains common. We acknowledged that amiodarone may not always be the most appropriate first line treatment option in all cases of AF, however, we were satisfied that it was reasonable for medical staff to reach the view that the benefits of treatment with amiodarone outweighed the risks in Mr A's case. Therefore, we did not uphold Mrs C's complaint.

However, we provided some feedback to the board that, despite referring to it on a number of occasions in their response to Mrs C's complaint, they did not have a written protocol on treating post-operative AF following lung surgery. We suggested the board may wish to review their practice on the routine use of amiodarone as a first line therapy in all cases of post-operative AF, and consider producing a protocol on the management of AF after thoracic surgery. We also provided feedback with respect to the content and lack of accuracy of the board's response to Mrs C's complaint and invited the board to make a further apology to Mrs C having reflected on the findings of our investigation and feedback with respect to their complaints handling.

Summary

Mr C complained about the treatment which his child (Child A) received at Forth Valley Royal Hospital. Mr C said that Child A had been unwell for many months following a viral diagnosis and that they had continued to experience symptoms which had affected their life, including missing school for multiple periods. Although Child A had been referred to otorhinolaryngology (medical treatment of ear, nose and throat) and paediatrics (medical care of children), Mr C felt that a diagnosis should have been reached after such a long time.

We took independent advice from a consultant paediatrician. While there was a lack of advice and support provided to Mr C on how to manage Child A's symptoms in the interim, which would have helped to allay their fears, we found that appropriate investigations and assessments had been carried out in an effort to arrive at a diagnosis, including referrals to specialist services. We did not uphold the complaint.