Health

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.

Summary

Mrs C complained about the nursing care provided to her cousin (Mr A) during an admission to Forth Valley Royal Hospital. Mrs C raised concerns about various aspects of the nursing care provided to Mr A in respect of his hygiene and whether he was being provided with appropriate support to eat and drink properly.

We took independent advice from nursing adviser. We found that there were daily entries in the nursing notes to indicate Mr A's needs were met. We noted that the care plan documentation had not been completed until some time after admission. However, while it would be good practice to do so earlier, this does not necessarily mean the nursing care provided was not of a reasonable standard. We acknowledged that the account provided in the nursing records was not Mrs C's experience. However, we did not consider there to be independent evidence that could verify her view. Therefore, based on the available evidence, we did not uphold this complaint.

Mrs C also complained about communication issues she experienced as Mr A's power of attorney. The board had previously provided an apology for Mrs C's experience but there were still a number of areas Mrs C was unhappy about. On balance, we concluded that staff's communication with Mrs C was reasonable in the context of a busy hospital environment. We acknowledged that communication was not as good as it could have been, but we did not consider it to be unreasonable. We provided some feedback to the board but, on balance, did not uphold the complaint.

Summary

Mrs C complained about the care and treatment her late mother (Mrs A) received at the Victoria Hospital. Mrs A had been deemed appropriate for discharge home but Mrs C and her family were concerned that Mrs A had lost weight and that her pain was not under control at the date of discharge. Mrs A had to be readmitted to hospital the day after discharge and passed away a number of hours later.

We took independent advice from a consultant geriatrician (a doctor specialising in medical care of the elderly). We found that initially Mrs A had received an appropriate medical review which had determined that Mrs A would be fit for discharge. Mrs A had reported pain while in hospital and additional pain relief had been prescribed to supplement her usual pain relief which she received at home. However, between the period of making the decision that Mrs A was fit for discharge and the actual date of discharge, Mrs A required additional pain relief which had not been resolved at the point of discharge. We found that the staff involved should either have allowed Mrs A to remain in hospital until her pain issues had resolved or discharged her home with additional pain relief. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failure to ensure that Mrs A's pain relief was under control at time of discharge. 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 ensure that a patient's pain relief is under control or addressed at point of discharge from hospital

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, an advocate, complained on behalf of her client (Ms A) about the treatment which Ms A received at the practice. Ms A had reported concerns about hip pain on a number of consultations, but the GPs wrongly diagnosed a soft tissue injury when Ms A had actually suffered a fracture of the hip.

We took independent advice from a GP. We found that Ms A had an extensive medical history of hip problems and was under the care of the orthopaedic (conditions involving the musculoskeletal system) team. When Ms A reported hip pain following a fall it was not unreasonable for the GPs to conclude that Ms A had suffered a soft tissue injury as she was able to weight bear. Although it would appear that the fracture had occurred by the time Ms A was seen by the GPs, this was not an indication that the care and treatment was unreasonable. We did not uphold the complaint.

Summary

Ms C attended hospital for minor surgery under anaesthetic. She said that she made it very clear in advance of attending for the surgery that she did not want to have any opioid drugs (common pain relief) administered. However, despite communicating that prior to and on the day of surgery, an opioid was administered whilst Ms C was under anaesthetic. Ms C also had concerns about the staff present in the anaesthetic room. She said no one introduced themselves or explained their role to her; she did not know who one individual was even though they squeezed her arm as a method of tourniquet (device for stopping the flow of blood through a vein or artery) during the insertion of the cannula; and she questioned the appropriateness of the method of tourniquet used.

We took independent advice from a clinical adviser. It was noted that staff denied not having introduced themselves to Ms C. They said they had acknowledged Ms C's anxieties and to help with that she was moved to first on the theatre list. We also reviewed a patient leaflet produced by the Faculty of Pain Medicine which indicated that squeezing a patient's arm was an acceptable method of tourniquet.

In turning to Ms C's concern that she was administered an opioid against her expressed wishes, the board confirmed the anaesthetist was aware of Ms C's previous unpleasant experience with morphine and recalled reassuring her that they would not use that drug or any long acting opiates. They were not aware that Ms C wished to avoid all opioids. We found that it would have been unreasonable not to administer pain relieving drugs to Ms C during her surgery, because she could have suffered acute pain and distress.

Finally, we were satisfied that the board had taken reasonable steps to identify the staff present in the anaesthetic room. In light of the information we saw in Ms C's case, we did not uphold the complaints.

Summary

Mr C had a modified Brunelli procedure to his wrist (a surgical procedure that can be used to correct instability in the wrist). Mr C complained that the board failed to inform him of the risks of the anaesthetic, particularly of phrenic nerve palsy (loss of the ability to move the diaphragm and to feel the sensations of the chest and upper abdomen).

We took independent advice from a consultant anaesthetist. We found that there was a failure to discuss the common possibility of temporary phrenic nerve injury with Mr C and that Mr C was not provided with any written information about the procedure. We upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to discuss the possibility of temporary phrenic nerve injury with him and for failing to provide any written information in accordance with the Association of Anaesthetists of Great Britain and Ireland guidance (AAGBI). 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 undergoing this type of procedure should be informed of the common risks such as possible temporary phrenic nerve injury. Information leaflets should be provided as per guidance from the AAGBI.

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 underwent a hip replacement at Victoria Hospital. Mr C complained that the board failed to ensure they had obtained informed consent from him and that they failed to provide him with a reasonable standard of care and treatment.

We took independent advice from a consultant orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that the consent process was reasonably documented and that Mr C did provide informed consent. Therefore, we did not uphold this aspect of Mr C's complaint.

We found, however, that Mr C had not received proper post-operative care, with delays in his review appointments There was a failure to discuss in full the nature of the nerve injury he had suffered, as well as the possible treatment options. 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 reasonable standard of care and treatment. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Review the x-rays taken and document their findings in detail, as well as providing Mr C the opportunity to discuss the findings should he wish to.

In relation to complaints handling, we recommended:

• The surgeon should reflect on the case as part of their appraisal process, in particular the delays in post-operative contact and the failure to review Mr C's x-rays timeously.

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 which her daughter (Miss C) received at Borders General Hospital. Miss C had injured her hand, and nerve conduction studies showed there was evidence of nerve damage. Mrs C felt that there was a delay by the consultant in treating the injury and that the option of surgery should have been considered.

We took independent advice from a consultant orthopaedic surgeon (a specialist in the treatmentof diseases and injuries of the musculoskeletal system). We found that the consultant had reached a diagnosis of brachial neuritis (pain or loss of function in a nerve) which was reasonable and that it was appropriate to treat the condition conservatively rather than with surgery. It was also noted that there was an improvement in Miss C's condition. We did not uphold the complaint.