Health

Summary

Ms C, an advice and support worker, complained on behalf of her client (Mr A) regarding the treatment which he had received from the practice, prior to him being diagnosed with prostate cancer. Mr A had attended frequent consultations with right hip pain and had been referred to physiotherapy (treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery) on a number of occasions. He was also sent for an orthopaedic (treatment of diseases and injuries of the musculoskeletal system) referral which had not helped. Mr A stopped attending physiotherapy as he received no benefit from the exercises or the painkillers which the practice had prescribed.

We took independent medical advice from a GP. We found that initially it was felt that Mr A had a musculoskeletal problem (injuries or pain in the joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back) which was reasonable in view of the presenting symptoms. The practice provided appropriate pain relief and made appropriate referrals for specialist opinions in orthopaedics and physiotherapy. It was only when Mr A presented with pain in his upper spine, which triggered a red flag sign, that blood tests were arranged which indicated possible prostatic cancer. This resulted in an urgent referral to the cancer specialists. We had no concerns about the way the GPs at the practice managed Mr A's reported symptoms over the period and there was no delay in making a specialist referral when he reported a new symptom of spine pain. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment provided to his late daughter (Miss A) by unscheduled care practitioners (UCPs) at A&E at Campbeltown Hospital. Miss A had attended the hospital on a number of occasions within a short period of time and reported symptoms of severe pain and sickness. Miss A then attended another hospital outwith the board area and a diagnosis of pancreatic cancer was made. Mr C said that Miss A felt that the UCPs had not listened to her and that had led to a delay in the diagnosis.

We took independent medical advice from a GP. We found that there was no evidence that the UCPs had failed to provide Miss A with a reasonable standard of treatment. She had been attending hospital specialists who were treating her for other medical conditions and that her reported symptoms could reasonably have been connected with the other medical conditions or side effects of the medication she was taking. There was nothing to suggest that Miss A was suffering from the effects of pancreatic cancer when she saw the UCPs. There are usually no symptoms in the early stages of the disease and those symptoms which do develop do so when the disease has reached an advanced stage; by the time of diagnosis, pancreatic cancer has often spread to other parts of the body. We did not uphold the complaint.

Summary

Miss C complained on behalf of her brother (Mr A) about the care and treatment he received while he was a day patient at a psychiatric hospital. Miss C complained that the hospital wrongly decided to not detain Mr A under the Mental Health (Care and Treatment) Act (Scotland) 2003 (MHA) and that they failed to appropriately supervise him. Miss C also complained that the board unreasonably delayed in responding to her complaint.

As part of their investigation of Miss C's complaint, the board carried out a Significant Adverse Event Review (SAER). The SAER concluded that Mr A did not meet the legal criteria for detention under the MHA as he was capable of making decisions, he consented to treatment, and they were satisfied that Mr A was under the usual levels of supervision. The board acknowledged there was a delay in completing the SAER and subsequently in providing the final response to the complaint. Miss C was unhappy with this response and brought her complaint to us.

We took independent psychiatric advice. We found that it was appropriate that Mr A was not detained under the MHA as he did not meet the legal criteria. We also found that appropriate assessments were carried out on Mr A's mental health and that he received an appropriate level of supervision. We did not uphold this aspect of Miss C's complaint.

In relation to complaint handling, we concluded that the board unreasonably delayed in responding to Miss C's complaint due to the delay in completing the SAER. Therefore we upheld this aspect of Miss C's complaint. The board have acknowledged this failing and have taken action to address this.

Summary

Mr C complained about the care he received from the practice prior to his diagnosis of hereditary haemochromatosis (a medical condition caused by an overload of iron in the body). Mr C experienced various symptoms that he said increased in number and severity over six years until his diagnosis. Mr C raised concerns that the practice should have carried out relevant tests, referred him to relevant specialists and reviewed his ongoing symptoms.

We took independent advice from a GP. We found that appropriate tests were arranged and appropriate and timely referrals were made to various specialities. We considered that a slightly raised blood test result was not diagnostic of haemochromatosis and relates to different conditions. We concluded that the care provided by the practice was of a reasonable standard. We did not uphold Mr C's complaint.

Summary

Mr C complained about a delay in the board diagnosing hereditary haemochromatosis (a medical condition caused by an overload of iron in the body). Mr C experienced various symptoms that he said increased in number and severity over six years until his diagnosis. Mr C raised concerns that the doctors should have investigated further rather than repeating the same tests, and that they missed a condition that would have been easily diagnosed by a simple blood test.

We took independent advice from a consultant in general medicine with a clinical interest in haemochromatosis. We noted that it is quite rare and diagnosis can be delayed in many cases for over five years. Mr C was seen by different clinicians in various different specialities before the diagnosis emerged following a random blood test for ferritin (iron storage protein). There was no family history of the condition and we considered that the symptoms Mr C experienced prior to the diagnosis were non-specific rather than being classical symptoms of haemochromatosis. We also considered that a blood test done a year before the diagnosis would not prompt consideration of hereditary haemochromatosis as a likely explanation. We concluded that staff did not unreasonably delay in considering the diagnosis at an earlier stage. We did not uphold Mr C's complaint.

Summary

Miss C complained about the care and treatment provided to her by the GP practice. Ms C has complex medical conditions and was concerned about a medication being stopped, a decision to refer her to a specialist and the way in which a blood sample was taken.

We took independent advice from a GP. In relation to the medication being stopped, we found that it was reasonable and safe for the practice to do this whilst waiting for a referral to a specialist. The GP had also asked Miss C to arrange an appointment with them if she wanted to discuss this.

In relation to the referral to a specialist, Miss C felt that this was unnecessary. We considered the referral to be reasonable in order to establish the medical reason for Miss C's symptoms.

Miss C was concerned about her vein being 'blown' when blood was taken, however, she did not raise this with the practice at the time. The GP subsequently apologised and said they were unaware of this as they were able to continue to draw blood.

Miss C also raised concerns about communication from the practice regarding her medication being stopped. The practice accepted that this was the case, apologised and altered the way in which this would be communicated in future. We considered that the care and treatment Miss C received was reasonable and we did not uphold this complaint.

Summary

Ms C, an advocate, complained on behalf of her client (Mrs A) about a delay in diagnosing gastric diverticulum (a pouch protruding from the gastric wall) and subsequent treatment. Ms C raised concerns that Mrs A underwent unnecessary repeat tests because the initial investigations had not been interpreted properly.

We took independent advice from a consultant general and colorectal surgeon (a physician who specialises in the medical and surgical treatment of conditions that affect the lower digestive tract). We found it was reasonable that the gastric diverticulum had not been picked up on the initial tests, given it is a rare condition, and that there had been other reasonable explanations for Mrs A's abdominal pain and weight loss. We considered it was appropriate to repeat Mrs A's tests, at which time the gastric diverticulum was identified. We concluded that the delay in diagnosis was not unreasonable and treatment was carried out thereafter within a timely manner. We, therefore, did not uphold the complaint.

Summary

Mrs C complained about the care and treatment her late mother (Mrs A) had received in Raigmore Hospital before her death. Mrs A had been referred to the hospital by her GP. The referral letter said she had fallen at home and referred to acute kidney injury. Mrs A fell on two occasions after being admitted to hospital. It was then identified nearly three weeks later that she had fractured her hip. Mrs A later died in the hospital.

We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) and a nursing adviser. We found that the care and treatment provided to Mrs A in relation to her kidney function was reasonable and appropriate. In addition, she had not displayed sufficient pain or deformity that meant a hip fracture should have been considered. However, the nursing records indicated that Mrs A was at risk of falling, but there was inadequate information about what action would be taken to prevent any falls. We found that it was reasonable for staff to try to reduce Mrs A's agitation after her first fall by allowing her to walk with a member of staff, but it would have been more appropriate to have had two members of staff with her. Staff should also have told the family about the first fall when they contacted them about the second fall.

In view of these failings, we upheld Mrs C's complaint, although we noted that the board had already apologised to Mrs C and had taken a number of actions to try to prevent similar failings in the future.

Recommendations

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

• Nursing staff should ensure that the relevant nursing documentation is completed appropriately.

Summary

Mrs C complained about the standard of aftercare she received at Raigmore Hospital following hip surgery, both in terms of the orthopaedic care (treatment of diseases and injuries of the musculoskeletal system) and physiotherapy care (treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise). Mrs C said that her thigh should have been physically examined by the surgeon as she found out later that she had weakness in her thigh muscle and that physiotherapy staff did not provide treatment at two appointments she attended.

We took independent advice from a consultant orthopaedic surgeon and a physiotherapist. In terms of the orthopaedic care, we found that an x-ray was appropriately carried out which confirmed Mrs C's fracture was healing. We considered that there was no requirement to perform a physical examination of Mrs C's thigh and it would be accepted that she would have weakness with this type of injury and associated surgery. We noted that Mrs C also received support by way of a referral to the hip fracture service.

In terms of the physiotherapy care, we established that no specific referral had been made to the service in relation to Mrs C's hip. We considered that appropriate treatment was provided in response to the GP referral for carpal tunnel (a medical condition where there is pressure on a nerve in the wrist). Furthermore, reasonable action was taken by physiotherapy staff to refer Mrs C to the orthotic clinic (the branch of medicine that deals with the provision and use of artificial devices such as splints and braces) regarding her leg length discrepancy following hip surgery. We concluded that the aftercare was of a reasonable standard and did not uphold Mrs C's complaint.

Summary

Ms C, an MSP, complained on behalf of her constituent (Mr B). Mr B had concerns that his late mother (Mrs A) who suffered from COPD (a chronic inflammatory lung disease) had been discharged from Vale Of Leven Hospital. Mrs A was readmitted to hospital the day following discharge with pneumonia and died a few days later. Mr B felt that Mrs A should not have been discharged from hospital while she still had an infection.

We took independent advice from a consultant physician. We found that Mrs A was prone to suffering chest infections in view of her COPD. Prior to the hospital discharge there was evidence that Mrs A's health had improved and that there was no clinical need for her to remain in hospital. Arrangements were made for an appropriate care package to be in place at home and Mrs A was in agreement with this. Mrs A then quickly went on to develop a new infection, which could not be predicted, and she did not recover from it during her readmission to hospital. We did not uphold the complaint.