Health

Summary

Ms C complained that Ninewells Hospital failed to provide her with reasonable care and treatment when she was admitted for investigations by the gastroenterology (branch of medicine which deals with disorders of the stomach and intestines) team.

We took independent advice from a consultant gastroenterologist. We found that the treatment Ms C received was reasonable and that it was appropriate for a senior gastroenterologist to review her situation before determining what other investigations should be carried out. We did not uphold this aspect of the complaint.

Ms C also complained about a failure to provide her with a reasonable response to her complaint and within a reasonable period of time. We found that communication with Ms C regarding a change to her care management plan was unreasonable; there was a failure to let her know what was happening as she received an appointment for a clinic review rather than a colonoscopy. This was a communication error in the internal referral process. Therefore, we upheld this aspect of the complaint. Wenoted that the board have already taken action to address this failing so madeno further recommendations.

Summary

Mr C complained about the clinical and nursing care and treatment provided to his late wife (Mrs A) during her admission to Ninewells Hospital. Mrs A was admitted with a history of leg swelling and a failing liver.

We took independent advice from a consultant gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines) and from a nurse. In relation to the clinical care and treatment given to Mrs A, we found that the majority of the clinical management of Mrs A had been reasonable. However, we found that Mrs A's infection could have been handled better and that antibiotic therapy should have been started earlier. 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 that the care delivered, documented and communicated was lacking at times. Also the specialist knowledge of nurses managing a patient with decompensated liver disease was lacking and the interventions needed to ensure a clear treatment plan was in place. We upheld this aspect of Mr C's complaint. However, we noted that the board has accepted and apologised for the failings in communication.

Mr C also complained that the board had failed to record an incident on the ward, in a reasonable way. The board accepted that on this occasion the actions of the nursing team fell below the standard they aimed to provide and apologised to Mr C. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C 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:

• Staff need to be aware of the policy around escalation of patients and the board needs an assurance mechanism in place to monitor if this is being followed.
• All staff in the ward should have access to education specific to the speciality and patient condition - including care planning, nutrition and managing encephalopathy.
• Gastroenterology staff should be aware of the indications of antibiotics in liver failure and the ‘liver bundle’ guidance in caring for patients with end stage liver disease.

Summary

Mr C complained that St Johns Hospital did not provide reasonable treatment to his late father (Mr A) during his hospital admission. During admission Mr A received an incorrect dose of paracetamol which the hospital recognised and responded to. The board determined that the medication error was not a contributory factor to Mr A's death.

We took independent advice from a consultant geriatrician (a doctor who specialises inmedicine of the elderly). We found while the general treatment provided to Mr A was reasonable, a significant error occurred, leading to Mr A receiving an overdose of paracetamol. Therefore, we upheld the complaint. Wenoted that the board have already taken action to address this failing so madeno further recommendations.

Summary

Mr C complained about the care which he received from the practice when he reported urinary problems. In particular, he had attended four consultations at the practice to report his symptoms, and despite them carrying out investigations it turned out that he had suffered a prostatic abscess. By the time Mr C was admitted to hospital the abscess had grown to 4cm, and he believed that the GPs involved in his care should have noted the abscess at an earlier stage when it would not have been as large.

We took independent advice from a GP. We found that initially Mr C's symptoms were indicative of a urine infection, and when Mr C attended hospital, a subsequent diagnosis of prostatitis was made. Again, the GPs managed this appropriately. It was only when Mr C's clinical condition deteriorated that it was appropriate to refer him to hospital where the final diagnosis was made. We found no evidence of failings or delays by the treating GPs. We did not uphold the complaint.

Summary

Mr C complained about the treatment which he received at A&E of University Hospital Monklands. Mr C had injured his foot and a doctor diagnosed him as having a sprained ankle. Mr C continued to suffer discomfort and attended his GP several weeks later who referred him back to the hospital. Further investigation revealed he had suffered a ruptured Achilles tendon. Mr C believed that the rupture should have been diagnosed at his initial attendance at A&E.

We took independent advice from an A&E consultant. We found that the records indicated that the doctor had carried out an appropriate examination and reached a reasonable diagnosis of a badly sprained ankle. Although it turned out that Mr C had possibly suffered a partial rupture of the Achilles tendon at the time of the attendance, the actions of the doctor in wrongly diagnosing a sprained ankle was not unreasonable in the circumstances. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment his sister (Miss A) received after she was admitted to Hairmyres Hospital, specifically about the medication prescribed, the standard of communication and the discharge planning. Mr C also complained about the community care, mainly the lack of care plan and the actions of a staff member.

We took independent advice from a consultant psychiatrist and from a mental health nurse. In terms of the hospital care, we found that the medication changes made during Miss A’s hospital admission were both appropriate and consistent, with established and agreed treatment protocols, and that the approach taken was reasonable. We also found that there was evidence to support a reasonable level of communication, and that the discharge planning was appropriate, as Miss A discharged herself voluntarily, and staff had no power to stop this or to detain her. Therefore, we did not uphold this aspect of the complaint.

In terms of the community care, we found that the records did not show that Miss A's risk to herself was underestimated by staff and that the incident which caused her admission to hospital was not predictable. We found that the care planning was reasonable, noting specifically that staff identified Miss A’s health and social-care needs, her goals for care and interventions, and that these were evaluated and updated. Importantly, there was also clear evidence that Miss A was involved in this process. Therefore, we did not uphold this aspect of the complaint.

Summary

Mrs C complained about a decision that was taken by the board to refuse out-of-area funding for a paediatric consultant for her child's (Child A) care. Mrs C said that the process leading up to the decision, how the decision was communicated to her and how the board handled her complaint was unreasonable.

We took independent advice from a consultant paediatrician (a doctor who specialises in child medicine) and found that the board followed the correct process in reaching a decision regarding the referral and, therefore, did not uphold this part of the complaint.

However, we identified that the board had failed to provide Mrs C with a clear explanation of the process that they followed and the rationale for their decision; to give correct information to Mrs C regarding a third doctor's involvement; to correct their error when communicating with Mrs C; and to provide relevant information to SPSO in this regard in response to our enquiries. We upheld these aspects of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to provide clear explanations, for providing her with erroneous information; failing to correct this error; and for the complaint handling failings. The apology should acknowledge the impact this has had on Mrs C. 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:

• Notifying clinicians and families should receive a full explanation of the outcome of funding requests, including information on the evidence used to reach that decision.
• Complaints should be handled in line with the model complaints handling procedure. The model complaints handling procedure and guidance can be found here: http://www.valuingcomplaints.org.uk/handling-complaints/complaints-procedures/nhs

Summary

Mrs C manages a direct payment (a cash payment paid under self-directed support in order to purchase care at home) on behalf of her disabled son (Mr A). The board contacted Mrs C to progress a review of the direct payment and to review the decision that Mrs C should be permitted to be employed as a Personal Assistant (PA) for Mr A. The direct payment included funding for two carers to provide two-to-one support to Mr A. Following the review, the board decided the funding should be reduced to only pay for one PA until a second PA was recruited to provide the two-to-one support. The board also decided that Mrs C should no longer be employed as a PA,and they advised that a second PA needed to be recruited.

Mrs C complained that the board acted unreasonably in respect of the review of the direct payment. Mrs C felt that the board unfairly blamed her for the failure to complete the review and that their decision to reduce the funding was unreasonable. Mrs C also complained that the board's decision regarding her employment as a PA was not in accordance with self-directed support legislation.

We took independent advice from a social worker. We found that the board acted reasonably in respect of both complaints. We identified that the local authority's decision to reduce the funding until a second PA was recruited was reasonable as the funding should only be used to meet the agreed outcomes detailed in the support plan. We also identified that the board acted reasonably by providing Mrs C adequate notice to recruit an alternative PA. Therefore, we did not uphold the complaints.

Summary

Mr C complained about the care and treatment his relation (Ms A) received at Raigmore Hospital. Ms A suffered from MPO ANCA associated vasculitis (a rare autoimmune disease) and was admitted to hospital with symptoms of diarrhoea and vomiting, headaches and abdominal pain. Ms A experienced episodes of haemoptysis (coughing up blood) while in hospital and died later that day.

We took independent advice from an adviser in acute medicine. We found that, when Ms A was admitted to hospital, a consultant review indicated that a pulmonary haemorrhage (an acute bleeding from the lung, from the upper respiratory tract and the trachea, and the alveoli) was a potential concern along with two other possibilities. We considered it was reasonable at the outset that the board did not proceed to give Ms A a chest x-ray as gastroenteritis (inflammation of the stomach and intestines) was suspected and there was only one episode of haemoptysis. However, we found that there was an unreasonable delay in performing a chest x-ray on Ms A following a second episode of haemoptysis. There was, therefore, a delay in identifying a pulmonary haemorrhage. We noted a member of the nursing staff appeared to identify the possibility of a pulmonary haemorrhage, and whilst this was communicated to the doctor, it was not acted upon. We upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for an unreasonable delay in performing a chest x-ray on your Ms A following a second episode of haemoptysis and a delay in identifying a pulmonary haemorrhage, given a consultant review indicated a pulmonary haemorrhage was a potential concern. 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:

• Raise awareness and understanding of MPO ANCA associated vasculitis and pulmonary haemorrhage. Ensure all staff feel they can raise concerns with a senior member of staff if they consider their concerns are not being addressed. Ensure safety measures are in place to ensure less experienced staff are aware of potential symptoms/problems.

Summary

Mr C visited his dentist due to pain in one of his teeth and agreed to a proposed course of treatment with the dentist. Mr C believed this would be provided under the NHS. Mr C found the communication around the cost of the treatment confusing saying that the dentist had not properly explained the costs or what was required before the procedure, and Mr C was concerned that he was over-charged. Mr C also complained about the standard of treatment he received and that the dentist failed to handle his complaint reasonably.

We took independent advice from a dental adviser. We found that the dentist failed to communicate the treatment plan and options in a reasonable way and that Mr C was not in a position to give informed consent; the breakdown of treatment options (NHS and private/independent) were not in line with relevant regulations; unacceptable materials were used; the findings of x-rays were unreasonably reported on; there was an unreasonable standard of care especially periodontal (gum) care; there was an unreasonable standard of record-keeping; and there were discrepancies in what was charged. We also found that the dentist failed to deal with the complaint in line with the complaints handling procedure. We upheld all aspects of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to communicate with him in a reasonable way about the proposed treatment and costs, failing to provide Mr C with a reasonable standard of treatment and failing to handle his complaint reasonably. The apology should meet the standards set out in theSPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Reimburse Mr C for the costs of the dental treatment he underwent. The payment should be made by the date indicated: if payment is not made by that date, interest should be paid at the standard interest rate applied by the courts from that date to the date of payment.

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

• Ensure the dentist communicates with and obtains consent from patients in line with the relevant regulations and standards.
• Ensure all breakdown of treatment options are delivered in line with the relevant regulations.
• Ensure that only materials deemed acceptable under the regulations are used.
• Ensure x-rays are reported on in line with the relevant regulations.
• Ensure care is delivered to a reasonable standard.
• Ensure record-keeping is in line with the relevant standards and guidance.

In relation to complaints handling, we recommended:

• Ensure all complaints are dealt with in line with the complaints handling procedure.