Health

Summary

Ms C, an advocacy and support worker, complained on behalf of her client (Mrs  A) about the medical and nursing care and treatment Mrs A received when she was admitted to Aberdeen Royal Infirmary. Ms C also complained about Mrs  A's discharge, delays in receiving a neuropsychology (the study of the relationship between behaviour, emotion, and cognition on the one hand, and brain function on the other) assessment and neurosurgery (surgery on the nervous system, especially the brain and spinal cord) follow-up and that the board had failed to respond to her complaint in a reasonable way.

We took independent advice from a consultant neurosurgeon and a nursing adviser. We found that both the medical and nursing care and treatment given to Mrs A was reasonable. We did not uphold these aspects of Ms C's complaint.

In relation to Mrs A's discharge, we found that Mrs A had been medically fit for discharge and that nursing staff had reasonably managed the discharge planning. However, the board accepted that there had been a failure to provide appropriate information and literature to Mrs A and her family on discharge and had taken action as a result of these failings. We upheld this aspect of Ms C's complaint.

In relation to Mrs A's neuropsychology assessment, we found that there had been a delay in arranging this. We also found that Mrs A was not advised of the progress of her neurosurgery follow-up appointment when the timescale was not met. Therefore, we upheld these aspect of Ms C's complaint.

Finally, we found that the board had failed to comply with their complaints handling procedure and we upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs A for the delay in providing a neuropsychology assessment, failing to update her on her neurosurgery review appointment and for the failings in complaint handling. 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 should receive a neuropsychology assessment, as part of post head injury follow-up, in a timely manner.
• Patients waiting on review appointments with the neurosurgery department should be updated on the progress of their appointments.

In relation to complaints handling, we recommended:

• Complaints should be dealt with in accordance with the complaints process, including that all issues raised in complaints should be addressed.

Summary

Ms C complained to us about the treatment she received from her dentist. She said that the dentist had damaged the cartilage in her jaw and it was causing her severe pain. When Ms C reported this to the dentist she was advised to stay on a soft diet and that she would be referred to dental consultants should the problem remain.

We took independent advice from a dentist. We found that there was no evidence that the treatment the dentist had provided was inappropriate or that it was the cause of the jaw problems. We found that Ms C had reported problems with her jaw a number of years previously but that no remedial action was required at that time. We found that the advice given by the dentist was reasonable and appropriate. Therefore, we did not uphold the complaint.

Summary

Mr C complained about the treatment he received from a consultant psychiatrist (a medical practitioner who specialises in the diagnosis and treatment of mental illness) at Whyteman's Brae Hospital. Mr C had been on clonazepam (medication to prevent seizures) which the consultant had withdrawn following Mr C taking an overdose of the medication. Mr C believed that the stopping of the medication adversely affected his health as he started suffering from rapid myoclonic jerks (involuntary contraction of muscles) which was the reason the medication had been prescribed in the first instance.

We took independent advice from a consultant psychiatrist. We found that the consultant had appropriately assessed Mr C following the reported overdose and that it was appropriate to stop the medication for some time. The plan was to observe Mr C for a period at the clinic and through his contact with a community psychiatric nurse and when Mr C reported a recurrence of the myoclonic jerks, the clonazepam was reinstated. We did not uphold the complaint.

Summary

Mrs C attended the emergency medicine department at Victoria Hospital with abdominal pain. She was reviewed by medical staff and it was considered that she probably had pain related to possible endometriosis (a condition where the tissue that lines the womb is found outside the womb, such as in the ovaries and fallopian tubes). She was discharged home and advised to see her GP. On the following day, Mrs C was admitted to the surgical admissions ward at the hospital under the care of a general surgery consultant. Blood tests were carried out and she was started on intravenous antibiotics. She was found to be improving and was discharged. Mrs C was readmitted to the hospital just over one month later. An ultrasound scan was carried out and an ovarian cyst was detected. Mrs C subsequently had surgery to remove the cyst.

Mrs C complained that she had not received a reasonable standard of care and treatment when she attended the emergency department. We took independent advice from an emergency medicine consultant. We found that the standard of assessment and treatment she received there had been reasonable. We did not uphold this aspect of Mrs C's complaint.

Mrs C also complained about the surgical care and treatment she received when she was admitted to the hospital. We took independent advice from a general surgery consultant. We found that Mrs C should have had a magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan during or shortly after her initial admission. The delay in carrying this out delayed her subsequent surgery. Therefore, we upheld this aspect of Mrs C's complaint.

Mrs C also complained about the medical care and treatment she had received during her admissions. We found that she should have had early medical investigation to establish an underlying cause for her symptoms during or shortly after the initial admission. In addition, although antibiotics were prescribed and given, there was no evidence that the sepsis pathway plan was implemented. Although it had been reasonable to discharge Mrs C from hospital after her first admission, additional investigations should had been carried out whilst she was an in-patient or shortly after her discharge. In particular, she should have had a repeat test to ensure her blood tests were returning to normal. We also upheld this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the delay in carrying out a scan and in diagnosing that she had an ovarian cyst and for the failure to carry out repeat blood tests during or shortly after her first admission to hospital. 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 board should ensure that patients receive the appropriate tests.

Summary

Mr C complained about the care and treatment provided to him in relation to surgery he underwent at Dumfries and Galloway Royal Infirmary. Mr C felt that the board had failed to provide reasonable care and treatment to him leading up to the surgery and action was not taken to prevent the deterioration which led to surgery. Mr C also felt that when he was in hospital he was not provided with reasonable nursing care and treatment, and that the care and treatment provided to him after surgery in relation to 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) was unreasonable.

We took independent advice from a diabetologist (a doctor who specialises in the treatment of diabetes), a nurse, and an occupational therapist. We found that the care and treatment leading up to Mr C's surgery was reasonable as all appropriate investigations were undertaken and he was provided with treatment in line with the relevant national guidance. We did not uphold this aspect of Mr  C's complaint.

In relation to the nursing care provided to Mr C, we found that Mr C had been provided with the wrong dose of medication for four days during an admission, which we considered unreasonable. We also found that the communication from nursing staff to Mr C was unreasonable as they did not appear to have taken into account his mood or mental wellbeing. We upheld this aspect of Mr C's complaint.

Finally, in relation to the occupational therapy input for Mr C after his surgery, we found that there was no evidence that Mr C's ability to use his wheelchair in restricted spaces was explored, there was little evidence that Mr C was given sufficient opportunity to practice functional tasks prior to discharge and there was no evidence that Mr C's mental health and wellbeing was considered by the occupational therapy team. 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 for failing to provide reasonable nursing care, and failing to provide reasonable care and treatment to Mr C after his amputation. 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 perform medicines reconciliation appropriately to avoid incorrect dosages being given.
• Occupational therapy assessments should be full and thorough, and in particular take into account the mental health needs of patients.

Summary

Ms C underwent abdominal surgery at Dumfries and Galloway Royal Infirmary and complained about the way in which it was carried out. Ms C also complained that the follow-up care and treatment was unreasonable.

We took independent advice from a consultant surgeon. We found that the board failed to explain all the recognised risks and complications of the surgery to Ms  C prior to the surgery. We considered that this was not in line with the General Medical Council guidance on consent. We also found that the board were unable to confirm the operating consultant surgeon's experience in this type of surgery. We concluded that there was a lack of evidence to demonstrate that the operating consultant surgeon was appropriately trained, experienced and had conducted a sufficient number of cases to perform the surgery without the direct involvement of a plastic surgeon. Therefore, we upheld this aspect of Ms C's complaint.

In relation to follow-up care and treatment, the board acknowledged and apologised for failings highlighted in their own complaint investigation. They found that Ms C's symptoms and pain were not fully considered in order to identify and prompt the removal of stitches sooner and that communication around this had been unreasonable. Following our investigation, we also found that an urgent GP referral and ultrasound scan should have prompted urgent surgical review. We also noted that there was no planned review following earlier treatment and that there were no post-operative instructions on operation records. Therefore, we upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to inform her of all the recognised risks of the surgery and for not involving the appropriate clinicians in her surgery. 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:

• Operation records should be legible and give sufficient detail to enable continuity of care by another doctor as set out in Good Surgical Practice.
• Surgeons should obtain the patient's consent in the pre-operative clinic in accordance with the Royal College of Surgeons' guidance.
• Surgeons should be appropriately trained, experienced and have conducted a sufficient number of cases to perform this type of surgery.

Summary

Mrs C complained about the standard of medical care and treatment provided to her late husband (Mr A) at Dumfries and Galloway Royal Infirmary. Mr A had a complex medical history and his condition deteriorated soon after admission. He was first transferred to the high dependency unit and then the intensive care unit. Mr A died a few weeks after he was admitted. Mrs C was concerned that medical staff failed to recognise the significance of his deterioration, diagnose him and refer him to the intensive care unit within a reasonable time. Mrs C was also concerned about treatment decisions and management, and lack of communication from medical staff.

We took independent advice from an adviser who specialises in general medicine. We were satisfied that the overall standard of medical care and treatment provided was reasonable and we did not uphold Mrs C's complaint. However, we found failures in communication and that Mr A and Mrs C were not kept updated about his condition as they should have been. We made recommendations to the board in light of these findings.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the shortcomings in communication. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

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

• Staff should ensure they keep patients and/or their families/carers regularly updated.

Summary

Miss C complained about the care provided to her late mother (Mrs A) at University Hospital Ayr. Mrs A was receiving dialysis (a treatment which mimics many of the kidney's functions). Miss C complained about the care provided to her mother in relation to an arteriovenous fistula (a blood vessel created in the arm for transferring blood into the dialysis machine and back again) following a dialysis session. Miss C considered that the interruption in her mother's normal dialysis routine as a result of the fistula problems impacted on her renal (relating to the kidneys) care and her overall deterioration.

We took independent advice from a consultant physician with experience in dialysis. We found that the care provided in relation to the insertion of the needles at the fistula was reasonable. We found that the most likely cause of extensive bruising to Mrs A's arm was caused by a pseudoaneurysm (a collection of blood that forms behind the two outer layers of an artery) behind the fistula and that the cause of the bleed was difficult to determine.

We also found that, given the condition of Mrs A's arm, the decision to the continue with dialysis using a permcath (a type of venous catheter) was the most appropriate treatment option and that there was no unreasonable delay in changing to this option. We found that the interruption to Mrs A's normal dialysis routine as a result of the fistula problems did not impact on her renal care and her overall deterioration.

We did not uphold Miss C's complaint.

Summary

Mr C complained that the practice unreasonably removed him from the patient list. Mr C had been in correspondence with the practice about matters not connected with his NHS treatment. Mr C received a letter from the practice in which the suggestion was made that perhaps it would be for the benefit of all concerned that he should move to another GP practice. Mr C was dissatisfied with the practice letter and wrote back to them asking for more clarification. He then received a further letter from the practice advising him that they had requested that the health board remove him from their patient list due to a breakdown in the relationship between himself and the practice. Mr C complained about his removal from the list and the fact that he was not given any specific information about why he was removed.

We took into account the contractual regulations and relevant guidance regarding the removal of patients from the practice list. This sets out that, other than in cases involving violence or aggression, a patient whose behaviour is giving cause for concern should be given a written warning informing them that they will be removed from the practice list if they do not alter their behaviour. The warning should last for 12 months. While the practice did have concerns about Mr C's correspondence, staff did not formally bring them to Mr C's attention in line with the regulations and guidance and, therefore, he was unaware of the practice's concerns. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for unreasonably removing him from the patient list. The apology should comply with the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-guidance.

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

• Staff should be aware of and comply with the guidance and regulations where there are concerns about patient behaviour.

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 she received at an appointment with a gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines) at Ninewells Hospital and the response to her subsequent complaint. Mrs C said the doctor failed to properly investigate her condition given her symptoms/medical history and that there were failings in communication.

We took independent advice from a specialist in gastroenterology. We found that there were failings in relation to documenting Mrs C's medical history and this meant she was left with the impression that the doctor did not take her symptoms seriously, especially her neurological symptoms. While we note not everything that would have been discussed was in the consultation records, we determined that the standard of medical care was not reasonable and this led to a breakdown in the relationship with Mrs C. We upheld this part of the complaint.

In relation to complaints handling, we found that the board's response to the clinical issues raised was reasonable based on Mrs C's medical records. Therefore, we did not uphold this part of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failings in the way the consultation was conducted. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

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

• The doctor involved should reflect on the complaint and our findings in their next appraisal.
• The board should consider a neurology referral in light of our findings.
• Sufficient time/input from experienced clinicians should be accomodated for consultations anticipated to be complex.