Health

Summary

Mrs C's complaint concerned the care and treatment given to her late husband (Mr A) by his GP practice. Mr A first attended the practice with lower back pain but later attended with testicular pain. After an examination he was informed that there was suspicion of prostate cancer. An urgent referral was subsequently made by his GP and he was advised that there was a high risk that he had prostate cancer which had spread. Mr A later died. Mrs C complained that the practice had failed to properly investigate Mr A's testicular and back pain, and that their referral letter misrepresented the situation. Mrs C also complained that Mr A had been prescribed morphine which caused hallucinations and that no palliative care plan had been made for him.

We took independent advice from a GP. We found that Mr A was treated reasonably and appropriately; there had been no delay in his diagnosis and an urgent referral had been made in a timely way. There was no evidence of misleading information in the referral letter and it was in line with General Medical Council Good Medical Practice. We also found that morphine could cause side-effects, particularly towards the end of life and that Mr A had been referred to the community palliative care team. We did not uphold the complaint.

Summary

Mr C complained about the dental treatment which his wife (Mrs A) received from her dentist. The dentist that examined Mrs A had said that there was decay in one of her teeth and that the existing crown should be removed; the decay treated; and a new crown fitted. An estimate was given for the potential costs of the treatment and/or crown, either on the NHS or as a private patient. Mrs A decided to take time to think about the matter and in the interim she increased her dental insurance cover should she have to pay a higher cost for the replacement crown. Mrs A then attended another dentist who said that there was no decay and that remedial work was not required. Mr C felt that the dentist was wrong to state that the tooth had decay and needed treatment, and as a result Mrs A had incurred extra costs.

We took independent advice from a dentist. We found that the dental treatment Mrs A received was reasonable and in line with accepted practice. Dental radiographs confirmed that there was decay in the tooth and that the existing crown did require to be removed to allow the decay to be treated. A new crown would then be required. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment which she received at the Royal Alexandra Hospital. She was in the hospital when her waters broke and there was a delay in transferring her to the labour ward. Mrs C underwent a caesarean section (surgical operation for delivering a child) and then went on to develop an infection which required antibiotics. Mrs C felt that the delay in transferring her to the labour ward was the cause of her infection.

We took independent advice from a consultant obstetrician (medical specialist in care of women before, during and after pregnancy) and gynaecologist (medical specialism in disorders of the female productive system) and found that Mrs C had received appropriate care and treatment. While there was a delay in transferring Mrs C to the labour ward, as it was busy at the time, Mrs C was kept under observation and there was no indication of problems with either her or her baby. Following the caesarean section Mrs C developed a temperature and appropriate blood tests were requested along with a medical review. Intravenous (into a vain) antibiotics (for possible infection) were started until the blood results were available. We did not uphold the complaint.

Summary

Mrs C complained on behalf of her daughter (Miss A) about the care and treatment that Miss A received at the Royal Hospital for Sick Children (Yorkhill) for a cyst on her kidney. Mrs C said that there was no transition management to help Miss A prepare for moving from children to adult services; about the decision to move Miss A to adult services; that she was discharged from the board's care prior to being successfully treated for a cyst; and that there was a delay in Miss A receiving a second operation to remove the cyst as a result of the move to adult services.

We took independent advice from a paediatric and adolescent (branch of medicine dealing with children and their diseases) consultant. We found that it was reasonable for the board to have discharged and transitioned Miss A to adult services at the time that they did. However, we also found that there were failings in the care provided to Miss A, specifically that there was a failure to have a coordinated plan and process in place to support Miss A's transfer from paediatric to adult services which led to a delay in treatment of the cyst. We upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss A for failing to transition her appropriately from paediatric to adult services. 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:

• There should be guidance in place for staff which sets out a clear pathway for transition from paediatric to adult services, including the age range and the degree of flexibility possible.
• Patients transitioning between paediatric to adult services should have a coordinated plan in place and this should be documented.
• A process should be in place for the transition from paediatric to adult services for clinicians to use to guide transition management.

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 his partner (Ms A) received from Glasgow Royal Infirmary for pain in her stomach. He said that the board failed to appropriately diagnose and treat Ms A's health issues within a reasonable time. Mr C's concerns included that for years, Ms A had been passed from one consultant at the hospital to another, without a diagnosis being made for her health condition and appropriate treatment being provided. He was also concerned that the board was now only offering Ms A treatment at the chronic pain clinic.

We obtained independent medical advice from a consultant gastroenterologist (specialism of treatment of the stomach and intestines). We found that Ms A's management had involved numerous specialities and, that all the referrals and the sequence of investigations appeared appropriate and consistent with the clinical guidance referred to in national guidance. We also found that Ms A's regular clinic reviews, and the explanations provided to her at these appointments, seemed appropriate. In terms of the care now being offered to Ms A, we considered that it was appropriate and reasonable. Therefore, we did not uphold the complaint.

Summary

Mr C complained on behalf of his mother (Mrs A) that the board did not reasonably respond to his complaint or his request for compensation.

Mrs A's belongings went missing whilst she was in hospital and searches did not locate them. Mr C complained to the board about the loss of Mrs A's belongings. The board accepted that there had been unreasonable delays in responding to the complaint and apologised for this. After contact from our office, the board accepted that they should have made much more of an effort to explain the reasons for these delays and that there was a missed opportunity to confirm to Mr C how to make a request for compensation for missing items. Therefore, we upheld Mr C's complaint that the board had not responded reasonably to his complaints.

Mr C also submitted a request for compensation for the missing items. The board made Mr C an offer of a sum that they told him had been reached after making an appropriate reduction for wear and tear from his estimated valuation of the missing items. The board's internal communication indicated that the offer had been made as a good will gesture as they did not accept any responsibility for the loss of the items. We found that the board's communication with Mr C was confusing because it did not make clear that the offer was a good will gesture. Therefore, we upheld Mr C's complaint that the board had not responded reasonably to his request for compensation.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for causing confusion when responding to his request for compensation. 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 mother (Mrs A) received when Mrs A was admitted to Queen Elizabeth University Hospital. Ms C considered that her mother's death could have been avoided if she had been provided with better care and treatment. Ms C complained that the board:

failed to provide reasonable care and treatment;

failed to advise the family regarding the correct procedure to follow when requesting clinical records;

failed to provide a reasonable response to the complaint; and

failed to respond to the complaint within a reasonable time.

We took independent advice from a clinical adviser. We found that Mrs A should have been seen by a more senior doctor during the four day period she was in hospital. We considered that a more senior doctor may have identified that the use of diclofenac (pain relief) in an elderly patient with renal impairment may affect the kidney function. They may also have identified a need to increase the use of steroids. Therefore, we upheld this aspect of Ms C's complaint. However, we noted that even if Mrs A had seen a more senior doctor this may not have changed the outcome for her.

In relation to procedure information, we found that the board had apologised for giving out incorrect information to the family which meant there was a delay in receiving clinical records.

In relation to complaints handling, we found that the complaint was made beyond the timescale for making complaints set by the board. However, the board decided to accept the complaint for investigation and they were therefore required to follow their complaint handling procedure. When the board responded to the complaint they failed to identify and advise the family that Mrs A had not seen a senior doctor more than once during her stay in hospital. We also found that correspondence on the complaint was ongoing for a period of almost nine months before a meeting was held. We considered that as many issues were being raised and the family were expressing concerns over a course of correspondence, there would have been merit in holding a meeting at an early stage to discuss concerns. Ms C could therefore have been signposted to this office sooner if the board considered they could do nothing further. We upheld these aspects of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to ensure Mrs A was seen by a more senior doctor on more than one occasion when she was in hospital and for failing to identify this during the board's own investigation of the complaint. 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 review the process they have in place for regular review of patients by senior doctors and confirm the outcomes.
• The board should ensure they have a protocol on pain relief in elderly patients.

In relation to complaints handling, we recommended:

• A response to a complaint should be transparent.

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 board failed to appropriately assess and treat his chronic back pain. Mr C had received a recommendation for spinal cord stimulation (a pain management technique that involves the surgical implantation of an electrotherapeutic device onto the spinal cord) by a pain consultant from another area. The board explained to Mr C that they can only offer traditional spinal cord stimulation and not the high frequency type that was recommended for him as it was not available within Scotland. The board also said that Mr C did not meet the criteria for traditional spinal cord stimulation, which they do offer. In any case, any referral for further treatment would need to come from Mr C's local pain clinic which was not in Greater Glasgow and Clyde. Mr C was referred for a second opinion which confirmed agreement with the initial assessment and recommended a pain management programme. Mr C was dissatisfied with the board's decision and brought his complaint to us.

We took independent advice from a consultant in pain medicine. We confirmed that the treatment Mr C was seeking is not available in Scotland. We also confirmed it was correct to advise Mr C that any referral for further treatment would need to come from Mr C's local pain clinic. We concluded that the assessment of Mr C's pain was appropriate and the recommendation of a pain management programme was reasonable. Therefore, we did not uphold the complaint.

Summary

Mr C complained about the treatment his late wife (Mrs A) received at A&E of Aberdeen Royal Infirmary. Mrs A had collapsed at home, and had suffered a fatal heart attack. Despite attempts at cardiopulmonary resuscitation (CPR), Mrs A died. The board maintained that appropriate tests and investigations were carried out when Mrs A suddenly deteriorated and that the cardiac arrest could not have been predicted.

We took independent advice from an emergency department consultant. We found that the staff involved had carried out appropriate assessments and investigations into a possible cause for Mrs A's collapse at home and that she was being monitored appropriately. While the results of investigations were being waited on, Mrs A suddenly deteriorated and staff were unable to save her life. We did not uphold the complaint.

Summary

Ms C complained about the care and treatment her late sister (Ms A) received in Dr Gray's Hospital before her death. Ms A attended the emergency department in the hospital after striking her head. She had suffered a laceration (cut in the skin), which was glued shut, and she was then discharged. On the following day, she was admitted to the hospital with a high heart rate and shortness of breath. It was subsequently noted that Ms A was suffering from acute chronic kidney injury and chronic atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate). She became unresponsive and was taken for a CT scan to check if her head injury was contributing to her loss of consciousness. Ms A died in the radiology department.

We took independent advice from an emergency medicine adviser and a consultant in acute medicine. We found that the standard of documentation for Ms A's presentation to the emergency department was poor. It was also unreasonable that she was not scanned in the emergency department before she was discharged, given her reduced level of consciousness and confusion; her headache; and the fact that she was on anticoagulant medication (medication to prevent blood clots). Further tests should have been carried out and her discharge from the emergency department was contrary to guidance. In addition, the advice given to her when she was discharged from the emergency department would have been challenging for Ms A to understand and retain. It was also surprising that, when she was admitted to hospital, Ms A was given increasing doses of beta-blockers given that she had an allergy to. Therefore, we upheld this aspect of the complaint. The board said that they have taken action to address these failings and we have asked them to provide evidence of this.

Ms C also complained that the board had failed to provide an accurate account of Ms A's death. We found that the board's response on this matter had been accurate. We did not uphold this aspect of the complaint.

Ms C complained that the board failed to communicate appropriately with her family. We found that it had been unreasonable for the board not to contact the next of kin when Ms A deteriorated. We upheld this aspect of the complaint. However, we noted that the board had acknowledged and apologised for this failure and we made no further recommendations in relation to this.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failure to provide reasonable care and treatment to Ms A in the hospital's 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.