Health

Summary

Ms C complained about the treatment she received from the dentist. Ms C was referred to the dentist as she required sedation during dental procedures. Ms C said she was told by the referring dentist that the tooth, which had a missing filling, was salvageable and could be crowned, however when the tooth was assessed, the dentist felt it was not salvageable. Ms C complained that the actions of the dentist led to an infection, cutting of the bone and was essentially unreasonable.

We took independent advice from a dentist. We found that Ms C's treatment by the dentist was reasonable and found no failings in the treatment offered. When the planned treatment changed, Ms C was brought back from sedation so she would be in a position to consent to treatment. The treatment was carried out in a reasonable manner. Therefore, we did not uphold the complaint.

Summary

Ms C complained about the treatment she received from the practice in response to her symptoms of oedema (swollen tissue from retained fluid). Ms C said that she had reported symptoms to the practice on numerous occasions. Ms C said there was an unreasonable delay in responding to her symptoms. During an appointment with a GP Ms C was told to stop a certain medication. Ms C said that during the appointment she was not given proper instructions or after care, i.e. to get her blood pressure checked. A few weeks later, after a severe headache, it was found that Ms C's blood pressure was too high and she required hospital admission.

We took independent medical advice from a GP. We found that Ms C's treatment by the practice was reasonable and found no failings in the treatment offered. The practice considered Ms C's symptoms, taking into account her overall medical hisotry and chronic illnesses when considering appropriate action to respond to Ms C's reports of oedema. Therefore, we did not uphold this part of Ms C's complaint.

Ms C also complained that the board failed to provide reasonable after care, specifically that her blood pressure should be checked. There was no written record or evidence to support the practice's view that appropriate information was provided to Ms C regarding having her blood pressure checked. 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 the investigation. The apology should meet the standards set out inthe 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 meets the standard of good record-keeping.

Summary

Mr C complained about the physiotherapy treatment (the treatment of disease, injury or deformity using physical methods such as massage, heat treatment, and exercise) given to his wife (Mrs A) after her hip operation at University Hospital Hairmyres. Mr C also complained that the board had failed to communicate reasonably with himself and Mrs A about Mrs A's rehabilitation potential.

We took independent advice from a senior physiotherapist. We found that Mrs A had been provided with reasonable physiotherapy. The advice we received from the senior physiotherapist was that there were two treating physiotherapists which was excellent practice. We also found that the decision not to provide physiotherapy following discharge had been reasonable and that the communication about Mrs A's rehabilitation potential had been reasonable. Therefore, we did not uphold these aspects of Mr C's complaint.

Mr C also complained about the pressure area care given to Mrs A. We took independent advice from a nursing adviser. We found that the pressure area care given to Mrs A was unreasonable. In particular, that there was a lack of risk prevention strategies implemented when Mrs A was admitted to reduce her risk of developing pressure damage; when the first damage to Mrs A's skin was identified no care plan was put in place to reduce further risk of damage; and when Mrs A's ulcer developed into a grade three pressure ulcer (grade four is the highest form of damage) the relevant guidance was not followed. We also found that the nursing communication with Mr C had been unreasonable and that there was no evidence of a care plan being initiated to address Mrs A's weight loss. We also noted that that the nursing records were unreasonable Therefore, we upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C and Mrs A for the failings identified in pressure area care. The apology should meet the standards set out in the SPSO guidelines on apologyavailable at www.spso.org.uk/leaflets-and-guidance.

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

• Nursing staff should ensure risk assessments for pressure ulcer prevention are accurate. SSKIN care bundles should be followed appropriately to reduce the risk of a patient developing a pressure ulcer.
• Patients with pressure ulcers should have an individualised care plan implemented to further reduce risk of deterioration to the skin.
• Nursing staff should ensure the Healthcare Improvement Scotland standard for prevention and management of pressure ulcers is followed.
• Ensure that there is appropriate communication with patients and/or their families during a patient's stay in hospital.
• Patients with a pressure ulcer should have appropriate nutritional assessments undertaken and receive effective nutritional care, which is in line with relevant guidance.
• Accurate records should be maintained in line with Nursing and Midwifery Council code of record-keeping.

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.