Health

Summary

Ms C complained on behalf of her child (Child A). After being assessed at a gender identity clinic, Child A was diagnosed with transsexualism and it was recommended that they be prescribed Sustanon (a hormone injection). The gender identity clinic wrote to Child A's GP to ask for arrangements to be made for Sustanon to be prescribed and administered. However, the practice advised that they would not prescribe or administer the medication for an initial period. Instead, they considered it appropriate for the gender identity clinic to prescribe the medication and make arrangements for it to be administered until Child A was stabilised, at which point the practice would take over. The practice stated that this decision was due to a lack of professional knowledge in this area and concerns about the GP's indemnity cover as Sustanon is classed as an unlicensed medication for this purpose. Ms C complained that the practice unreasonably declined to prescribe the medication and that they failed to communicate reasonably. Ms C stated that no GPs had been in contact to discuss the situation and there had been a lack of clarity about the practice's decision-making.

We took independent advice from an adviser with a background in general practice. We found that General Medical Council guidance supported the practice's position that they should not prescribe medication or initiate treatment if they do not consider themselves professionally competent to do so. We considered it appropriate, and in line with relevant guidance, for the practice to refer the matter back to the gender identity clinic for them to arrange treatment. In addition to this, we were satisfied that the reasons provided by the practice to Ms C were valid considerations for the practice to take into account. Therefore, we did not uphold this aspect of Ms C's complaint.

In relation to communication, we considered that it would have been helpful if a GP from the practice contacted Ms C or Child A to discuss their concerns. However, we noted that the practice's position was accurately conveyed by the practice manager. On balance, we considered the practice's communication to be reasonable. Therefore, we did not uphold this aspect of Ms C's complaint.

Summary

Mrs C complained on behalf of her husband (Mr A). Mrs C said Mr A had undergone an operation on his heart, which they had believed would be routine and uncomplicated. Mr A suffered serious complications during the surgery, resulting in a long period of recuperation and life altering consequences. Mrs C said they accepted that what had happened was a recognised risk of the surgery, however, she complained that Mr A had not been provided with adequate information during the consent process. Mrs C felt her complaint had been poorly handled, and although the board had apologised to Mr A, Mrs C was unhappy with this response.

We took independent medical advice. We found that Mr A was not provided with sufficient information during the complaints process. The advice also stated that the board needed to ensure that consent was taken early enough to allow patients to consider properly the potential complications and risks associate with their surgery. We found that the board's response to the complaint was reasonable in terms of practical solutions to the failings identified, but that they had not fully accepted responsibility for the failings, which devalued the apologies they offered. We upheld both aspects of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for failing to obtain his informed consent. 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:

• Ensure the boards consent process allows (where practical) for a reasonable period of time between consent being given and a surgical procedure being undertaken.

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 that the Scottish Ambulance Service (SAS) delayed in sending an ambulance for her husband (Mr A). Mr A's GP requested an ambulance within two hours as Mr A was experiencing vomiting and diarrhoea and was delirious. The ambulance did not arrive until almost eight hours later. SAS explained that there was an unexpected increase in the volume of calls that day, and that there was no missed opportunity to allocate an ambulance. SAS acknowledged that their delay in sending an ambulance was unreasonable.

We took independent advice from a consultant paramedic. We found that there was no missed opportunity to send an ambulance. However, we found that on one occasion the SAS call handler failed to use the correct interrogation system. We also found that SAS failed to carry out a clinical triage which would have involved Mrs C receiving a call from a clinical adviser who would have assessed Mr A's symptoms in more detail. This failing was acknowledged by SAS and was due to the high demand on the service. We upheld Mrs C's complaint and made a recommendation for learning and improvement.

Recommendations

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

• SAS should ensure that call handlers have absolute clarity on 999 call made by/on behalf of urgent patients to ensure correct interrogation system is used consistently.

Summary

Miss C complained to us that the medical practice had failed to provide her with appropriate care and treatment. She had attended the practice for a medical certificate following her recent attendance at A&E where she was diagnosed with a fractured finger and had her fingers strapped. Miss C said that the practice failed to manage her care appropriately in liaising with hospital staff and delayed making a referral to the hand clinic.

Summary

Mr C complained that his stoma reversal surgery (a surgery to reconnect the bowel) was delayed because of his mental health.

We took independent advice from a consultant colorectal (bowel) surgeon. We found that the surgeon acted unreasonably in failing to seek specialist advice from the mental health team when initally considering Mr C for surgery. In addition, we found that the surgeon did not respond when advice from the mental health team was offered. Mr C's maximum waiting time for treatment under the requirements of the Patients Rights (Scotland) Act 2011 was exceeded by ten months. There was no evidence that consideration was given by the board to arranging treatment by another provider or if any decision was made that this would not be an efficient and effective use of healthcare resources. We concluded that there was an unreasonable delay in the stoma reversal surgery going ahead, and upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failings this investigation has identified. 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 work together with other members of the healthcare team in a professional and supportive manner to maintain continuity of patient care.
• The board should take all reasonably practicable steps to ensure that it complies with the Treatment Time Guarantee.
• Where the board is not able to meet the Treatment Time Guarantee, they should consider arranging treatment by an alternative provider (as required by the Patient Rights Act and Regulations).

Summary

Mrs C complained about the treatment she received from the practice for an infection in her leg. Mrs C attended an out-of-hours surgery over the weekend prior to attending her local practice on the Monday. The practice adjusted Mrs C's medications and arranged a follow-up appointment with a nurse for wound dressing. Mrs C's leg grew worse and a GP was called to her home. The GP arranged for Mrs C's admission and further assessment at a hospital.

We took independent medical advice from a GP. We found that Mrs C's treatment by the practice was reasonable and found no failings in the treatment offered. Therefore, we did not uphold Mrs C's complaint.

Summary

Mr C complained about the care and treatment he received at the Royal Infirmary of Edinburgh. He attended A&E after experiencing pain in his back and leg. Mr C was assessed by the on-call orthopaedic (conditions involving the muscoskeletal system) doctor and an x-ray was performed. Following this, Mr C was admitted to an orthopaedic ward. He was then discharged four days following admission. Weeks later, Mr C returned to hospital and a hip x-ray was performed. Investigations over the following days identified that Mr C had a pathological hip fracture and advanced prostate cancer. Mr C underwent a hip replacement procedure and was referred to the uro-oncology (the diagnosis and treatments of tumors of urinary systems) service.

Mr C complained about the delay in accurately diagnosing his condition and that he was unreasonably discharged from hospital during the first admission. We took independent advice from a consultant orthopaedic surgeon. We were critical that the board were unable to provide the in-patient orthopaedic notes for Mr C's first admission, other than the summary of ward rounds.

We found that the investigations performed following Mr C's initial presentation to the board were inadequate. We found that a hip examination and hip x-ray should have been performed given the examination findings. We considered it was likely that the failings in this case led to a delay for hip replacement surgery, during which time Mr C continued to suffer pain from the condition. We upheld this aspect of Mr C's complaint.

In the absence of the orthopaedic records for the first in-patient admission, we noted that the board were unable to demonstrate that Mr C had been safely discharged. We concluded that the decision to discharge Mr C was unreasonable and we upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failure to examine and investigate Mr C's hip during the admission and for the poor record-keeping. 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:

• An individual with thigh pain and an inability to weight bear should have a hip examination performed. An individual who is unable to do an active straight leg raise and is unable to weight bear should have a hip x-ray performed.
• Ensure clinical records are appropriately managed.

Summary

Mr C complained that the board had not provided him with appropriate care and treatment for pain in his knee and thigh.

We took independant advice from a GP. We found that appropriate investigations had been carried out into both issues, appropriate referrals to other services had been made, and pain had been managed in line with guidance. We did not uphold Mr C's complaint.

Summary

Mrs C attended hospital to undergo colonoscopy (a procedure to look at the lining of the large bowel) and gastroscopy (a procedure to look at the inside of the oesophagus and first part of the small intestine). The information booklet she had been given in advance indicated that she would be sedated. However, Mrs C said she was persuaded to go ahead without sedation which she found extremely painful. She said that she felt traumatised and violated. She complained to the board who said that the matter of sedation had been discussed with her and it was her decision to go ahead without it; staff had no recollection of her complaining of pain.

We took independent advice from a gastroenterologist and from a registered nurse. We found that the procedures concerned were ones where sedation would normally be given as the information booklet indicated. There was no evidence that medical staff had discussed the procedures with Mrs C and the associated consent forms had not been properly completed. Similarly, we found concerns about the nursing records and although at one point Mrs C was recorded as having a pain score of 2-3 (out of 4) she was not monitored or assessed further. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failings identified. 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:

• Medical staff should fully discuss risks and record the risk and benefits of any medical procedures.
• Nursing staff should follow the Nursing and Midwifery Council (NMC) guidelines when completing records.
• Nursing staff should respond appropriately to pain score data.

Summary

Mr C complained about the nursing care and treatment his father (Mr A), who had dementia, received when he was admitted to University Hospital Monklands. He also complained that Mr A had been unfit for discharge on the day of his planned discharge. In addition, Mr C complained about the level of communication with Mr A's family from the board.

We took independent advice from a nursing adviser and a consultant geriatrician (a doctor who specialises in medicine of the elderly). We found that the nursing care Mr A received had been reasonable and we did not uphold this aspect of Mr C's complaint.

Mr A's planned date for discharge was modified due to his deteriorating health. We found that there had been a failure to assess Mr A's mental health and the possible presence for delirium prior to the original date for discharge, and as a result, the consultant geriatrician advised that staff could not be confident, or show, that Mr A had improved to a level where it was safe to consider discharge. We were particulary concerned that a dementia test was not carried out. We found that the board had unreasonably considered Mr A fit for discharge on the date of the planned discharge and upheld this aspect of Mr C's complaint.

In relation to communication, we found that the nursing communication was reasonable but the board had identified some failings. We also found failings in the medical communication in the initial part of Mr A's admission to the hospital. 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 the family for the failings this investigation has identified. 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:

• Ensure older people in hospital have their cognitive status assessed and documented. Older people in hospital experiencing an episode of delirium should be assessed, treated, and managed appropriately.