Health

Summary

Mrs C's mother (Mrs A) was transferred to hospital by ambulance with low oxygen levels. Mrs C had a power of attorney (POA) in place, enabling her to make decisions on Mrs A's behalf. Mrs A was admitted to hospital and the following day medical professionals spoke with her regarding a 'do not attempt cardiopulmonary resuscitation' (DNACPR) agreement, without first consulting Mrs C. Mrs C complained to the board that it was inappropriate for medical professionals to speak with Mrs A regarding the DNACPR as she had dementia and did not understand what was being said. Mrs C also complained about the lack of knowledge of the POA that was in place. In their response, the board explained that it was a priority to complete a DNACPR given Mrs A's deteriorating condition, and it was appropriate in the circumstances to discuss this with her. The board said that they were aware of the POA and this was appropriately recorded in Mrs A's medical records.

Mrs C complained that the board's actions in implementing a DNACPR were unreasonable, that they unreasonably failed to clearly record in Mrs A's records that a POA was in place and that the handling of the complaint was unreasonable.

We took advice from an independent medical adviser. With respect to the actions in implementing the DNACPR, we found that given Mrs A's state of health on admission to hospital, it was appropriate for medical professionals to consider a DNACPR and discuss this with Mrs A. Whilst there were concerns about Mrs A's capacity, the records indicated that this was considered by medical professionals. It was reasonable for medical staff to decide DNACPR was required and that Mrs A had capacity at the time to be involved in the discussions. We did not uphold this complaint.

With respect to the complaint that the POA was not clearly recorded in the file, we found that at the time of Mrs C's complaint, the board were unable to locate a copy of the POA on file. Whilst the medical notes showed the medical professionals were aware of the POA in place, there was not a record kept on file at all times. On this basis, we concluded that the board failed to clearly record in the file that an active POA was in place. We upheld this complaint.

In relation to Mrs C's complaint, we found that the board failed to respond to the complaint within the 20 working day time-frame and failed to provide any explanation for the delay. Therefore, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failure to keep her updated on the progress of her complaint, the delay in completing the investigation or to provide a revised timescale for response. 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:

• Where the board have been provided with a physical copy of a POA document, a copy should be kept in the relevant patient's medical records, in a prominent position, at all times.

In relation to complaints handling, we recommended:

• Complaints handling staff should be aware of the requirements of the Complaints Handling Procedure with respect to timescales for response and keeping complainants informed about their complaint.

Summary

Mr C complained about the treatment his wife (Mrs A) received from the board for breast cancer. Mrs A attended University Hospital Crosshouse where she was diagnosed with breast cancer and underwent chemotherapy (a treatment where medicine is used to kill cancerous cells), surgery and radiotherapy (a treatment using high-energy radiation). Mrs A was later diagnosed with metastatic breast cancer (cancer that spreads to other parts of the body) and died. Mr C complained that Mrs A did not receive appropriate treatment, that an alternative surgery would have provided a better outcome and that the treatment provided was experimental.

We took independent advice from a consultant clinical oncologist (cancer specialist). We found that Mrs A's treatment by the board was reasonable and found no failings in the treatment offered. Therefore, we did not uphold Mr C's complaint.

However, during the consideration of the complaint we found there were factual errors in the board's complaint response. We made a recommendation under section 16G of the SPSO Act 2002, which requires the Ombudsman to monitor and promote best practice in relation to complaints handling.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the errors identified in the complaint response. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

Summary

Mrs C complained on behalf of her daughter (Miss A) about the care and treatment she received for ongoing ear problems. Miss A had received care and treatment at Crosshouse Hospital over a number of years. Mrs C complained about information that was shared with her about Miss A at an Ear Nose and Throat (ENT) clinic consultation, specifically that Miss A might be putting fake blood in her ear; the decision to cancel another opinion; and the decision to discharge Miss A from the ENT service and refer her to mental health services. Mrs C also complained about the length of time it took the board to respond to her complaint.

We took independent advice from a consultant ENT surgeon. We considered that it was reasonable to consider the possibility of a psychological factor, cancel the third opinion, and refer Miss A to mental health services, on the basis that extensive investigations and treatments had not identified a physiological disorder. We also noted that Miss A had not been discharged from the ENT service but had been referred to mental health services. However, we found that there was no definitive evidence to clearly show that a fluid sample taken was in fact fake blood. In addition, we considered that the way in which the matter was approached with the family could have been more appropriately dealt with by mental health staff or at the very least their opinion should have been sought in the first instance. We considered that elements of Miss A's care and treatment were not handled reasonably and we upheld this aspect of Mrs C's complaint.

In relation to complaint handling, we found that the board had not responded to Mrs C's complaints correspondence within the 20 working day timescale. Mrs C was advised on two occasions that this may not be possible. We considered that this was reasonable given the board would have needed to review a number of years of care and treatment. However, we were critical that there were many occasions where Mrs C had to contact the board for updates after the 20 working day timescale had passed. On a number of occasions, the board did not proactively update Mrs C, as they should have done, with an expected timescale for the completion of their investigation. In addition, when they had suggested a revised timescale, this was not met. Therefore, we upheld this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss A and the family for matters related to the fluid sample. 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:

• Staff should obtain speciality advice where appropriate and ensure that accurate information is shared with patients and their families.

In relation to complaints handling, we recommended:

• The board should have in place the necessary systems to ensure that complaints are handled in line with the NHS Scotland Model Complaints Handling Procedure, and that all staff responsible for dealing with complaints are aware of their responsibilities in this respect.

Summary

Mr C, an advocate, complained on behalf of his client (Miss A) about the post-operative care Miss A received at Golden Jubilee National Hospital. Miss A underwent a total hip replacement and was discharged under a week later. Miss A complained that she did not feel ready to return home so soon after surgery and wished to be admitted to a community hospital to recuperate. She was advised that she did not meet the criteria for admission to a community hospital, so she arranged to be transferred to a nursing home. Miss A said that, prior to her discharge, no one had explained to her she would have to pay to stay in the nursing home. She also complained that no referrals had been made for physiotherapy (the treatment of disease, injury or deformity using physical methods such as massage, heat treatment, and exercise) or occupational therapy (a method of helping people who have been ill or injured to develop skills or get skills back by giving them certain activities to do), and said that her recovery time was longer as a result.

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 Miss A's discharge and arrangements for follow-up care were reasonable. We noted that Miss A's concerns had been discussed with her and extra help for when she returned home was offered but declined. Miss A had been assessed as having achieved her rehab goals while an in-patient and was assessed as being safe for discharge home. We did not find any evidence why Miss A would have expected to receive respite care following her surgery. Therefore, we did not uphold Mr C's complaint.

Summary

Mr C complained about the information which a GP entered on a form for Employment Support Allowance (ESA). The GP had included historical information in Mr C's medical records, which Mr C felt was not relevant.

We took independent medical advice from a GP. We found that although the information was contained in Mr C's medical records, it was not relevant to the reasons why Mr C was unable to work at that time. The form does not ask for a summary of a patient's past medical history but rather about the patient's current medical conditions which may be a barrier to them being fit for employment. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for including information which was not relevant to his current medical condition. 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:

• The GP concerned should ensure that in future only relevant information regarding the patient's current medical condition is entered in the ESA form.

Summary

Ms C complained about the care provided to her late mother (Mrs A) by the practice. Mrs A had attended the practice on a number of occasions with chest pains, confusion, arm weakness and sight problems. Mrs A also had a history of high cholesterol (a fatty substance found in the body that can increase risk of health conditions) and a family history of heart problems. Mrs A later died at home and Ms C felt that the GPs involved in her care should have made earlier referrals to hospital specialists.

We took independent medical advice from a GP. We found that although Mrs A had attended the practice on a number of occasions before her death, she had not reported chest pain for a period of six months and it was felt reasonable that the staff had assumed her previously reported symptoms had resolved. During previous consultations with GPs they had considered a number of diagnoses and prescribed appropriate medication for the symptoms which were reported. There were also attendances at hospital where scan results were reported as being normal. Therefore, we did not uphold Ms C's complaint. However, we provided feedback to the practice that on one occasion, there was a need to make a referral to cardiology for further investigation and to provide Mrs A with safety netting advice. While there was no evidence that this would have prevented Mrs A's death, it may have led to an earlier diagnosis of heart problems and allowed treatment options if required.

Summary

Mrs C complained on behalf of her husband (Mr A) regarding the delay in reaching a diagnosis of prostate cancer during consultations at Perth Royal Infirmary. In response to Mrs C's complaint, the board explained that a number of factors had contributed to the time taken to diagnose Mr A. The board said that Mr A's symptom pattern was unusual, and investigations were initially performed to rule out bladder and kidney cancer. Mrs C was unhappy with this response and brought her complaint to us.

We took independent advice from a consultant urologist (a specialist in the study or treatment of the function and disorders of the urinary system). We found that it was reasonable of the board to first exclude the possibility of bladder or kidney cancer before investigating the possibility of prostate cancer. We also found that the department had carried out appropriate tests prior to Mr A being reviewed by the consultant. We considered that the board had met the waiting time targets and did not uphold Mrs C's complaint. Although we did not consider that the delay in diagnosis was unreasonable in this case, we gave detailed feedback to the board regarding areas for potential improvements in practice.

Summary

Ms C complained that the board unreasonably failed to discover an object left in her nasal tissue after surgery at St. John's Hospital. Ms C said that on removal of stents (splints placed temporarily inside a duct, canal, or blood vessel to aid healing or relieve an obstruction), one stent came away in two pieces. Ms C was alerted at the time that a piece of silicone stent may have been retained. Ms C continued to attend the hospital for treatment of chronic rhinosinusitis (a condition where the cavities around nasal passages (sinuses) become inflamed and swollen for a prolonged period). Sixteen months after the surgery, a scan was carried out which identified that a titanium clip had been retained in the nasal tissue. The silicone stent and titanium clip were removed at the same time Ms C was undergoing another surgery, approximately 12 months after the retained titanium clip was discovered.

We took independent medical advice from a consultant rhinologist (a specialist in conditions affecting the nose). We found that the board unreasonably failed to discover and report on all elements retained in Ms C's nasal tissue after surgery. No investigations were carried out until the scan 16 months after the stents were removed, where it was found that the titanium clip was still in place. After it was discovered, it was over a year before it was removed. We found that there was an unreasonable delay in identifying the retained titanium clip. Therefore, we upheld this part of Ms C's complaint.

Ms C also complained that the board failed to provide a reasonable explanation as to how an object was left in her nasal tissue after surgery. The board accepted that they had not provided a reasonable explanation. The communication regarding this issue was poor. When it was found that a titanium clip had been retained as well as the silicone stent, it was over four months before Ms C was informed of this. No explanation was provided as to why the clip was retained or why Ms C was not informed that this was a possibility. We considered that the board could have been more open and detailed about what happened and why. Therefore, we upheld this part of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failings identified by this investigation. 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:

• A review of practice to consider best practice to secure silicone tubes for dacryocystorhinostomy (DCR) surgeries.
• A review of the process for selecting patients for DCR surgery.
• Clinicians should review their diagnosis when patients do not respond to treatment.
• Learning from this investigation is fed back to relevant staff in a supportive way.
• The process of discussing options and consent to treatment should be clear in its documentation.

Summary

Mrs C complained about the care and treatment provided to her late mother (Ms A) at the Royal Infirmary of Edinburgh. Ms A had undergone treatment for early stage lung cancer, and was followed up at six-monthly intervals. Mrs C complained that at a follow-up appointment, Ms A had been told there were no signs of cancer, but a few weeks later was found to have liver cancer. Mrs C said that there was a failure to identify the spread of lung cancer and that Ms A had been given false hope.

We took independent advice from a radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans) and an oncologist (a doctor who specialises in the diagnosis and treatment of cancer). We found that there had been a failure to identify a mass near Ms A's spine on a scan, and that this was unreasonable. However, we noted that it was unlikely that earlier identification of this would have altered Ms A's outcome. We also found that at a follow-up appointment, the clinical examination done was incomplete as it did not include examination of the abdomen. We upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failure to identify a mass and the failure to carry out a full clinical examination at the oncology appointment. 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:

• Radiological findings should be accurately reported.
• Full clinical examination should be performed and documented during oncology follow-up appointments in cases of radical lung cancer treatment.

Summary

Mr C complained about the care and treatment his daughter (Ms A) received from the practice. Ms A contacted the practice about severe abdominal pain and was given advice over the phone. Four days later Ms A was admitted to hospital where she had her appendix and part of her bowel removed. Mr C felt that it was unreasonable that the practice did not examine Ms A in person when she called them and that this failure could have led to a potentially serious situation.

We took independent advice from a medical adviser. We found that the practice failed unreasonably to adequately assess and examine Ms A. Therefore, we upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failings in assessment and examination. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leafletsand-guidance.

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

• The doctor involved should reflect on the complaint and findings in their next appraisal.
• The doctor involved should follow the relevant guidance on assessment and management of abdominal pain in women of childbearing age.