Health

Summary

Mr C complained that the board's neurology (the branch of medicine concerned with the diagnosis and treatment of disorders of the nervous system) department had unreasonably delayed in diagnosing his epilepsy (a neurological disorder). Mr C was initially diagnosed with chronic fatigue syndrome (a medical condition of unknown cause, with fever, aching, and prolonged tiredness and depression) and said that he was referred to the neurology department on many occasions over a number of years but stayed with this diagnosis. Several years later, Mr C's diagnosis was changed to functional weakness and, several years after this, it was identified that he had epilepsy. Mr C considered that his epilepsy should have been identified earlier.

We took independent advice from a consultant neurologist. We found that it was unlikely that the symptoms Mr C initially had were due to epilepsy. He subsequently did develop symptoms that fitted epilepsy, but it was reasonable that it took some time to make a diagnosis, as his symptoms were relatively infrequent. We found that the sequence of investigations undertaken were reasonable and that there were no failings in Mr C's care and treatment. Therefore, we did not uphold this complaint.

Summary

Ms C attended Perth Royal Infirmary where she was treated for a suspected stroke. Her condition improved but she was found to have sustained brain damage, leaving her with ongoing communication difficulties. Ms C complained that her symptoms were misread, and that she was misdiagnosed and mistreated for a stroke. She considered that the treatment (thrombolysis injection to dissolve a suspected clot) contributed to her brain injury and resulting speech difficulties.

We took independent advice from a consultant geriatrician (a specialist in medicine of the elderly). We considered that Ms C's symptoms, together with CT scan findings, supported the diagnosis of a stroke. We found that the treatment given was appropriate to the findings, and did not cause any direct side effects. Therefore, we did not uphold this aspect of Ms C's complaint.

Ms C also complained about a delay in responding to her complaint, and errors and inconsistencies in the response. The board had acknowledged that the response was delayed and apologised to Ms C. They told us that they had reminded staff of the need to ensure complainants are provided with updates if deadlines are not going to be met. We recognised the complexity of the complaint contributed to the delay and, on balance, considered that the response was reasonable and proportionate. However, we did not consider that the board fully explained the reasons for the delay to Ms C and found that they did not agree a revised target timescale as they are required to do. For this reason, we upheld this aspect of Ms C's complaint but made no further recommendations.

Summary

Mr C attended the Western General Hospital after he experienced seizures. They carried out scans, which showed a lesion (an abnormal growth) in his brain. Mr C complained that there was a delay in diagnosing that it was brain cancer, as medical staff initially thought that the lesion was an abscess (a collection of infected fluid). We took independent advice from a consultant oncologist (cancer specialist). We found it was reasonable that Mr C's lesion was thought to be an abscess, given the results of the scans and his medical history. We found that it was good practice that they also tested the lesion for cancer. We did not uphold this aspect of the complaint.

Mr C also complained that when cancer treatment options were discussed with him, he was not given appropriate support. In addition, he complained that there was a delay in telling him about fertility options before he started his cancer treatment. We found that Mr C had appropriate support from the multidisciplinary team and his family when treatment options were discussed with him. We also found that he was given appropriate written information about fertility options. Therefore, we did not uphold these aspects of the complaint.

Summary

Mrs C complained about the treatment provided to her husband (Mr A). Mrs C said that the board unreasonably removed Mr A's right kidney and ureter (the duct by which urine passes from the kidney to the bladder) on the basis of a diagnosis of cancer.

We took independent advice from consultants in urology (the medical specialism that deals with the male and female urinary tract, and the male reproductive organs) and pathology (the study of disease). We found that there were failings in relation to record-keeping which we drew to the board's attention. We also found that there had been a delay in the surgery being carried out which the board had apologised for. However, we found the investigations carried out which led to the diagnosis of cancer were reasonable. We also found that the biopsies (tissue samples) taken in this case were appropriately interpreted at the time and that a mistake had not been made. Therefore, we did not uphold the complaint.

Mrs C also raised concerns about the Significant Adverse Event Review (SAER) which had been carried out. We found that the SAER carried out was reasonable. We found that a comprehensive review of the case was carried out, and failings in the consenting process were recognised. We also found that there had been a thorough external review of the pathology slides and recommendations made for improvements. We did not uphold the complaint.

Summary

Mr C complained that the board failed to provide reasonable care and treatment for his foot, and that the board did not respond to his complaint appropriately.

Mr C underwent surgery to address a bunion (a type of bony lump that forms on the side of the foot) at St John's Hospital. Mr C experienced problems after his operation, and had further surgery on the same area approximately four years later. At this time, Mr C was noted to have septic arthritis (inflammation of a joint caused by a bacterial infection) and a procedure was performed to wash out the joint and remove infected tissue. Mr C's problems continued to persist, and he required further surgery the following year.

We took independent advice from a consultant podiatric surgeon (a clinician who diagnoses and treats abnormalities of the foot). We noted that Mr C had presented with a foot that was difficult to correct surgically. While there was a lack of correction after the initial surgery, we did not conclude that this was an unreasonable failing by the board. Mr C also had concerns about the second procedure. We concluded that this had been performed reasonably. However, we noted that Mr C's foot wound had been slow to heal following the procedure and he had received extensive antibiotic treatment. In these circumstances, a post-operative x-ray should have been performed to determine whether there was evidence of spreading infection. An x-ray was not performed and we concluded that this was unreasonable. On balance, we upheld this aspect of the complaint.

Finally, Mr C raised concerns about the board's handling of his complaint, stating he had anticipated a more compassionate response. We found that the board's complaint response acknowledged the problems Mr C experienced appropriately. We also noted the board had not complied with the timescale under their Complaints Handling Procedure. Therefore, we upheld this aspect of the complaint. We noted that the board had acknowledged this failing and we made no further recommendations.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to perform an x-ray following the second surgical procedure. 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 patient receives joint washout and debridement treatment, an x-ray should be considered to establish if the infection has spread.

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 that her mother (Ms A) received at University Hospital Hairmyres. Ms A attended the hospital with back and chest pain, and her blood count was found to be low. The cause of Ms A's low blood count was suspected to be an internal bleed. Ms C was concerned about the investigations carried out to identify the cause of Ms A's low blood count and that Ms A was discharged home without a final diagnosis.

We took independent advice from a consultant hepatologist (specialist treating the liver, gallbladder and pancreas) & gastroenterologist (treatment of the stomach and intestines). We found that the clinical approach used to identify the source of Ms A's bleeding was reasonable. In particular, plans were made for Ms A to have an endoscopy (procedure using an instrument to give a view of the body's internal parts) and a colonoscopy (procedure where a flexible fibre-optic instrument is inserted through the anus in order to examine the colon) on an

out-patient basis. We found that it was reasonable for the board to discharge Ms A and that it would not have been possible for the board to make a final diagnosis during Ms A's admission. We did not uphold Ms C's complaint.

Summary

Mr C complained about the care and treatment provided to him by the board in relation to a pacemaker implantation (a device that generates electrical impulses delivered by electrodes to contract the heart muscles and regulate the heart). After Mr C had his pacemaker implanted, he attended hospital on several occasions as he was aware of having palpitations (noticeably rapid, strong or irregular heartbeat). Some months after implantation, it was found that Mr C had a heart failure as a result of the pacemaker. Mr C raised concern that it took several months to detect the heart failure and take action on this.

We took independent advice from a cardiologist (a medical specialist who diagnoses and treats disorders of the heart). We found that the monitoring of Mr C's pacemaker was reasonable, and that no problems were identified during this monitoring. We found that Mr C was not experiencing any symptoms of heart failure and therefore there would have been no reason for the board to suspect this. We determined that the finding of heart failure was incidental, and when identified it was acted upon in a timely and appropriate manner.

We noted that the risk of heart failure was not outlined on the consent form for Mr C's pacemaker implantation and that this was technically a failing. However, we found that national practice does not currently reflect that this risk is not routinely included anywhere on consent forms in the NHS at this point. Therefore, while we considered that it may be good practice to raise the risk of heart failure when taking consent for pacemaker implantation, as the risk is not one that is nationally recognised or currently reflected in practice and guidance, we did not consider this to be a failing of the board with regards to required actions and reasonableness. We did not uphold this aspect of Mr C's complaint.

Mr C also complained about the board's communication with him regarding his pacemaker and heart failure. We found that communication was prompt and covered all issues reasonably. We did not uphold this aspect of Mr C's complaint.

Summary

Mrs C complained about the care and treatment that her late mother-in-law (Mrs A) received when she attended the emergency department at University Hospital Monklands on two separate occasions. Mrs A was also under the care of a consultant surgeon at the time.

We took independent advice from a consultant in emergency medicine and a general surgeon. We found that the majority of the care and treatment provided in the emergency department was reasonable. However, we also found that the on-call surgical doctors did not make Mrs A's consultant surgeon aware of her attendances to the emergency department. Therefore, we upheld this aspect of Mrs C's complaint. The board said that they had already taken action to address this issue so we asked them to provide evidence of this.

Mrs C also complained that the board failed to handle her complaint reasonably and in particular that the board did not respond to all the points of her complaint. We found that the board provided a response to the majority of the concerns Mrs C raised and, therefore, we did not uphold this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to make Mrs A's consultant surgeon aware of her attendances to the emergency department. The apology should meet the standards set out in the 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

Mrs C, a support and advocacy worker, raised a complaint on behalf of her client (Mr B) about the clinical and nursing care and treatment his late wife (Mrs A) received when she was admitted to University Hospital Monklands.

We took independent advice from a consultant physician and a nursing adviser. In relation to the clinical care and treatment given to Mrs A, we found that the physiotherapy support had been reasonable. We also found that the administration of medicines and the clinical input at the time of Mrs A's death had been reasonable. However, we found that she should have been referred to the diabetes in-patient team early in her admission to the hospital and, had this happened, it was likely that insulin would have been started which may have avoided the development of a necrotic heel. We also found that there should have been better control of Mrs A's blood sugar which might have reduced her propensity to infection. We noted that communication or documentation of communication with the family could have been better. Given the failings identified, we upheld this aspect of the complaint.

In relation to the nursing care and treatment given to Mrs A, we found a number of failings. In particular, that Mrs A did not receive the required interventions to prevent pressure damage and that there had been a delay in obtaining equipment to help prevent pressure damage. We also found there had been confusion over the diagnosis of a sacral wound and that Mrs A's food, fluid and nutrition needs were not met. Furthermore, we found that there was a failure to refer Mrs A to podiatry (medical treatment of the feet and their ailments) and that there were omissions in patient-centred care planning and incomplete documentation. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr B and his family for the failings this investigation has 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:

• Ensure that there is appropriate and documented communication with patients and/or their families during a patient's stay in hospital.
• Where a diabetic patient has consistent elevation of blood sugars there should be a thorough evaluation of their diabetes medication and an early referral to the diabetes review team.
• Nursing staff should ensure Healthcare Improvement Scotland (HIS) standards for prevention and management of pressure ulcers is followed.
• When a patient with diabetes shows a decreased appetite, a patient-centred care plan should be developed in line with HIS Standards for Food, Fluid and Nutrition and HIS Standards for Care of Older People in Hospital.
• Accurate records should be maintained in line with the Nursing and Midwifery Council Code of record-keeping and the HIS Scottish Wound Assessment and Action Guide.

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 that the board failed to recognise and treat problems with her nose. Miss C was seen by consultants at both Wishaw General Hospital and Monklands Hospital but felt that her problems were ignored.

We took independent advice from an ear, nose and throat surgeon. We found that the assessments and conclusions reached by the consultants who reviewed Miss C were reasonable, and took into account her concerns. We considered that the treatment provided was in line with the findings of the assessments carried out. Therefore, we did not uphold the complaint.