Health

Summary

Mrs C complained about the treatment which she received at Ninewells Hospital. Mrs C had been receiving iloprost infusions (intravenous medication) for a number of years for her medical conditions which included Raynaud's disease (numbness in fingers or toes). However, the board had changed the criteria for iloprost infusions and advised Mrs C that the infusions would stop. Mrs C felt that this was unfair as the treatment had provided her with relief from her symptoms.

We took independent advice from a consultant physician and rheumatologist (a doctor who specialises in the diagnosis and treatment of rheumatism, arthritis, and other disorders of the joints, muscles, and ligaments). We found that the criteria followed by the board in relation to iloprost infusions was reasonable and that while Mrs C may have benefitted from the treatment, there was no clinical evidence that this was the case. We also found that the board had offered to refer Mrs C to another health board who would offer the treatment as a temporary measure. The board also suggested reasonable alternative treatment options and were continuing to do so. Therefore, we did not uphold the complaint.

Summary

Ms C complained to us about the care and treatment her son (Mr A) had received at Ninewells Hospital. Mr A was admitted to the Intensive Care Unit (ICU) with pneumonia (an infection of the lungs) and died within a month of his admission. In particular, Ms C complained that there was a delay in referring Mr A for surgery to treat his pneumonia.

We took independent advice from a consultant in intensive care medicine. We found that there were no failings in the management of Mr A's pneumonia and that his treatment was reasonable and appropriate.

Ms C also complained that Mr A was kept awake during his time in the ICU, even though he had mental health issues and he was experiencing alcohol and nicotine withdrawal. We found that Mr A's level of sedation was assessed appropriately on a daily basis and that he was given a combination of sedative medication that was appropriate for his individual needs. However, we found that in future, the board may wish to consider the use of nicotine patches for patients withdrawing from nicotine.

Ms C raised concerns that there were delays in treating Mr A's diarrhoea. We found that he was appropriately investigated for any underlying infection and in the meantime, his diarrhoea was managed appropriately through the use of a flexiseal device (a bowel movement management device).

We considered that the care and treatment Mr A received was reasonable and did not uphold Ms C's complaint.

Summary

Ms C complained that her father (Mr A) was inappropriately discharged from the Royal Infirmary of Edinburgh. Mr A had poor balance and mobility and had expressed his concerns about his ability to cope at home. Mr A fell shortly after discharge. After a number of hours, he managed to get help and was taken back to the hospital. Mr A was kept in hospital for another month due to a suspected infection.

We took independent advice from a nurse and a clinical adviser. We found that there had been a lack of discharge planning as to whether or not Mr A could safely cope at home and whether he required the assistance of carers or someone to stay with him. We also found that there were signs in the medical records which may have indicated that Mr A may have had an infection prior to discharge and that the signs were not acted upon. We upheld Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for the failure to accurately determine if he was clinically fit for discharge and that there was a lack of discharge planning into whether he could cope at home. The apology should meet the standards set out in the SPSO guidelines on on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• Clinical and nursing staff should ensure prior to discharge that an appropriate clinical assessment has been carried out. In addition that adequate consideration is given as to whether the patient is able to care for themselves on discharge.

Summary

Mr C, an MSP, complained on behalf of his constituent (Mrs A) about the decision taken by the board not to offer Mrs A surgery to her wrist. Mr C said that the board had not reached the decision based on full information.

We took independent advice from a consultant plastic and hand surgeon (a surgeon who repairs or reconstructs missing or damaged tissue and skin). We found that the decision not to offer surgery was reasonable and had been made by a number of experienced surgeons together in a mutlidisciplinary setting. Therefore, we did not uphold the complaint.

Summary

Mrs C, an advocacy and support worker, complained on behalf of her client (Ms  B) about the care and treatment her elderly mother (Mrs A) received at Wishaw General Hospital and Kello Hospital. Mrs A had been in hospital after being diagnosed with lung cancer. Due to her frail condition, Mrs A was unsuitable for further care and could only be made comfortable. She was discharged home. Mrs A's condition deteriorated further and she was admitted to hospital for pain relief and palliative care. Mrs C complained that Mrs A was not fit for discharge and there was insufficient discussion with the family about this or about the medication Mrs A required to take at home. Mrs C also complained that the support provided by a nurse was unreasonable and on admission to Kello Hospital, staff failed to communicate reasonably with Mrs A family and delayed in providing appropriate pain relief.

We took independent advice from a doctor and from a specialist registered nurse. We found that discharge planning for someone with a terminal illness was complicated and difficult. While it was acknowledged that Mrs A wanted to go home, the arrangements made for her discharge had been hasty with insufficient discussion with the family who were unprepared for the demands of looking after her; they had no clear understanding of the medication prescribed and needed by her. Therefore, we upheld these aspects of Mrs C's complaints.

In relation to the nursing care, we found the support to be reasonable. We also considered the communication from staff at Kello Hospital to be appropriate and found no concerns with the pain relief given to Mrs A. Therefore, we did not uphold these aspects of Mrs C's complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms B for failing to fully discuss with her the advanced nature of Mrs A's illness and discharge medication. 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:

• Patients and their family/carers should receive appropriate information on discharge arrangements and, where appropriate, have an adequate understanding of the nature and seriousness of the condition. Conversations about this should be recorded.
• Patients should receive the medication prescribed and this should be documented.

Summary

Mr C complained on behalf of his wife (Mrs A) about the care Mrs A received at the practice. Mrs A had previously been diagnosed and treated for breast cancer. Six months after her treatment concluded she began attending the practice complaining of recurrent urinary tract infections and back pain. Six months following that it was found that the cancer had returned and spread to her bones.

We took independent advice from a GP. We found that the practice had carried out reasonable investigations when Mrs A first reported her symptoms. They had appropriately sought to investigate and exclude other possible causes of the symptoms Mrs A was presenting with. However, when Mrs A's symptoms did not resolve and investigations did not reveal a definite cause, the practice should have been alert to the possibility of a more serious underlying condition. We noted that referral guidelines for patients who have previously suffered from breast cancer note that unresolved back pain is a 'red flag' sign, indicating further serious investigation is required. Therefore, we upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs A for the failure 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/leaflets-and-guidance.

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

• The practice should familiarise themselves with red flag signs and should ensure trainees are aware of this also.
• Ensure that the findings of this investigation are shared with the doctors involved in Mrs A's care and discussed at their next appraisal for shared learning and improvement in clinical practice.

Summary

Mrs C complained about the care and treatment given to her elderly mother (Mrs  A) by both the out-of-hours (OOH) service and the Emergency Department (ED) of the Queen Elizabeth University Hospital. She said that Mrs A called the OOH service early in the morning as she feared she had sepsis (a blood infection). A GP attended and decided that she could remain at home. Mrs C believed that Mrs A should have been admitted to hospital. Later the same day, Mrs C took Mrs A to the ED as she said that she was experiencing rigours (episodes of shaking). She was later discharged. Mrs C said that Mrs A had to return to hospital within the week, when she was diagnosed as having sepsis.

We took independent advice from a GP and from a consultant in emergency medicine. We found that both at home and in hospital, Mrs A had been treated reasonably. The GP initially examining her had found her temperature, pulse rate, oxygen saturation and blood pressure all to be in the normal range. She had no 'red flags' in terms of the guidance and she was given clear advice about what to do if her condition worsened. When Mrs A attended the ED, all the tests undertaken were normal and did not indicate further screening. As Mrs C was unhappy with this, further examination was made, but again this did not indicate admission or screening for sepsis. While Mrs C said that Mrs A went on to develop sepsis within a few days, we found that this was not unusual. We did not uphold the complaints.

Summary

Mr C complained about the treatment which he received at Aberdeen Royal Infirmary. He had attended for a regional anaesthetic (nerve block) procedure. During the procedure he suffered a reaction and became unwell with severe breathing difficulties and had to undergo Cardiopulmonary Respiration (CPR) (medical procedure for a patient in cardiac arrest). Mr C wondered if the nerve block procedure had been carried out correctly.

We took independent advice from a consultant anaesthetist and found that the nerve block procedure was performed to an appropriate standard but unfortunately Mr C had an adverse reaction, possibly due to a combination of factors. When it became evident that Mr C was experiencing problems, staff appropriately carried out CPR as a precaution. We did not uphold the complaint.

Summary

Mr C has a complex medical history and made a number of complaints to the board. Mr C complained that the board failed to adequately address repeated errors in the provisions of prescription drugs, failed to inform the prison service of the requirements of his care plan and allowed his medical records to be altered retrospectively. Mr C also complained about the board's handling of his complaint.

We took independent advice from an adviser specialising in general medicine. We found that, on occasion, there had been delays in the provision of prescription drugs. However, these delays did not have a significant impact and it was not unreasonable for the dispensation of medicine to be subject to prison procedures, which limited the hours when medication could be issued. We did not uphold this aspect of Mr C's complaint.

In relation to Mr C's care plan, we found that it had been reviewed and he had been able to participate in those meetings along with prison service staff. We considered that the board communicated reasonably and appropriately with the prison service. We did not uphold this aspect of Mr C's complaint.

In relation to Mr C's medical records, we found that the board said it was impossible to amend records retrospectively. The adviser noted that this statement was inaccurate and we provided feedback to the board in light of this. However, we found no evidence that Mr C's medical records had been altered retrospectively and did not uphold this aspect of Mr C's complaint.

Finally, we found that Mr C had received an explanation from the board for the way his complaint was handled and an apology for any confusion caused. We considered this approach to be reasonable and did not uphold this aspect of Mr  C's complaint.