Health

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.

Summary

Mrs C complained about the care of her child (Child A) in Ayrshire Central Hospital. In particular, she complained that Child A was prescribed antihistamine medication as a sleep aid, without proper instruction or explanation of potential side effects. A meeting was held but Mrs C did not consider that the board's subsequent written response reflected the detail of what was discussed. The full findings and decision outcome were not detailed or explained in the response. Neither was the action plan that the board had put in place. The response did not comply with the requirements of the NHS Complaint Handling Procedure and we referred the matter back to the board for further work.

Following the board's further response we investigated whether the actions in prescribing medication were reasonable and whether the board's handling of the complaint was unreasonable or not.

We took independent advice from a consultant paediatrician (consultant specialising in the medical care of children) and concluded that clinicians acted reasonably in assessing Child A for prescription medication. We did not uphold this aspect of the complaint, however, we provided feedback to the board that medical records should reflect all discussions regarding a patient's care and that those records should be legible.

With respect to the handling of the complaint, we found that the board unreasonably failed to respond to Mrs C's initial complaint, and also failed to provide adequate detail in their response following the involvement of our office. We identified that the board had failed to produce a report of their investigations, communicate whether the complaint was upheld or not, and did not keep Mrs C adequately updated as to their progress. We upheld the complaint and made recommendations with respect to ensuring that the board take actions to implement recommendations from a previous case we investigated.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to adequately respond to the points of complaint originally raised, or those outlined in the complaint to our office, and for not updating Mrs C regarding the delays in responding. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/informationleaflets .

In relation to complaints handling, we recommended:

• The board should ensure the recommendations with respect to a previous complaint to our office, have been properly implemented and complaints handling is now compliant with their statutory responsibilities.

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 called an ambulance after finding his wife (Mrs A) in a concerning condition. The ambulance took longer to arrive than Mr C felt was reasonable, and he made further calls to the Scottish Ambulance Service (SAS) before it arrived.

When Mr C complained to SAS about this, their investigation concluded that the call had not been handled in line with their protocol and that, had protocol been correctly followed, a higher acuity may have been given to the call and an ambulance diverted from another call to respond. SAS apologised for the delay in the ambulance arriving and took steps to prevent a similar situation recurring. Mr C was dissatisfied and raised his complaints with us.

We found that there was an unreasonable delay in the ambulance arriving but found no evidence to determine whether a higher acuity would have been given or an ambulance diverted if the protocol had been followed correctly. We upheld the complaint but made no further recommendations.

Summary

Mrs C complained about the care and treatment provided to her father (Mr A) during two admissions to Ninewells Hospital. Mrs C complained about nursing care, medical treatment, surgical treatment, communication, and complaint handling.

During our investigation we took advice from a nurse, a consultant in acute medicine, a dermatologist (a specialist in diseases of the skin, hair and nails), a plastic surgeon, and a vascular surgeon (a clinician who treats disorders of the circulatory system).

In relation to nursing care, we found that there had been failings in relation to wound assessment and management; pressure ulcer prevention and management; mouth care; medication administration; adhering to fluid balance; and involving palliative care specialists. We were also concerned that the board's own investigation had not identified these failings. We upheld Mrs C's complaint about nursing care.

In relation to medical treatment, we found that many aspects of this were reasonable and that dermatology care was of a very good standard. However, we identified that there was a delay of around 12 hours in Mr A receiving antibiotics at one point and on this basis, we upheld this aspect of Mrs C's complaint.

We found that the surgical treatment provided to Mr A by both plastic and vascular surgery was reasonable and did not uphold this aspect of Mrs C's complaint.

With regard to communication, we found that the communication between the different teams and clinicians had been of a good standard. We also found that in general, there was good communication with Mr A and his family. However, at a point when Mr A's condition was deteriorating and it was unclear how much information he could understand and retain, there was a gap in communication with his family and we considered this to be unreasonable. We therefore upheld this aspect of Mrs C's complaint.

We considered the board's handling of Mrs C's complaint. We found that there were significant and unacceptable delays throughout the complaints process, and that communication from the board was reactive rather than proactive. We also found that there were a number of failures or delays in answering Mrs C and her family's questions. We considered the handling of Mrs C's complaints to have been unreasonable and we upheld this aspect of her complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to provide reasonable nursing care to Mr A; failing to provide reasonable medical treatment to Mr A; failing to reasonably communicate in relation to Mr A's care and treatment; and failing to handle Mrs C's complaint in a reasonable and timely manner. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• Wounds should be assessed and managed appropriately and timeously, and in line with relevant guidance.
• Pressure ulcer prevention and management should meet the Healthcare Improvement Standards for Pressure Ulcer Prevention 2016.
• Mouth care should be carried out frequently, especially in patients who are not eating or drinking well, and if problems develop they should be addressed in a timely manner.
• Medication should be administered in accordance with the Nursing and Midwifery Code and the board's own local policy on prescribing and administration of medication. Where medications are not administered reasons for this should be documented.
• Accurate fluid balance and adherence to fluid restriction should be a priority in patients who have renal failure.
• Patients such as Mr A should be reviewed by palliative care staff in a timely manner, and efforts should be made to make patients comfortable during the end of life period.
• Action should be taken in a timely manner when a patient develops a new fever, and antibiotics should be commenced promptly.
• It should be documented if a patient is able to understand and retain information, and if not, communication with relevant family members should take place and be documented.

In relation to complaints handling, we recommended:

• Complaints should be handled in a reasonable and timely manner, and in line with complaint handling guidance.
• The board's complaints handling system should ensure that failings (and good practice) are identified, and enable learning from complaints to inform service development and improvement.

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'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.