Health

Summary

Mr C complained about the care and treatment he received from the ear, nose and throat (ENT) service at Inverclyde Royal Hospital. Specifically, that he was not examined thoroughly and that staff were dismissive of his symptoms being related to sinusitis (inflammation of the lining of the sinuses).

We took independent advice from a consultant ENT surgeon experienced in treating cases requiring sinus surgery. We found that Mr C's symptoms had been appropriately investigated, in particular with CT scans (a scan that uses x-rays and a computer to create detailed images of the inside of the body) and endoscopy (direct visualisation by camera). There was no evidence to show that Mr C had bacterial or fungal sinusitis or any evidence of a sinus tumour. We considered that Mr C's care and treatment was reasonable and appropriate and did not uphold his complaint.

Summary

Mr C complained about the medical care and treatment that his wife (Mrs A) received from the board. Mrs A had a diagnosis of cancer and had a number of admissions to Aberdeen Royal Infirmary over a two month period. We took independent advice from a consultant clinical oncologist (a doctor who specialises in the diagnosis and treatment of cancer). We found that:

• Mrs A was discharged from hospital before the results of a stool sample were obtained and while she was experiencing diarrhoea
• there are no written records of the phone calls that the doctor had with Mrs  A or her GP following a positive result for Clostridium difficile (a bacterium that causes diarrhoea and more serious intestinal conditions)
• Mrs A was not readmitted to hospital as soon as the Clostridium difficile result became available.

We considered the medical care and treatment to be unreasonable and upheld this aspect of Mr C's complaint.

Mr C also complained about the nursing care and treatment that Mrs A received. We took independent advice from a nursing adviser. We found that:

• the board's response in relation to hand gels was inaccurate in that hand gels are ineffective when caring for patients with Clostridium difficile
• Mrs A's personal hygiene requirements were not recorded consistently and daily records were not kept to indicate what personal hygiene assistance Mrs A had received or had been offered
• nursing staff did not appear to adhere to the Infection Control Policy.
• nursing staff did not record how they knew about Mrs A's shingles (a viral infection that causes a painful rash) diagnosis or whether this information had been passed on to the admitting doctor.

We considered the nursing care and treatment to be unreasonable and upheld this aspect of Mr C's complaint.

Mr C also complained that the board did not handle his complaint reasonably. We found that the board failed to keep Mr C updated about the reason for the delay in responding to his complaint and to provide a revised timescale for completion. We also found that the board's complaint response did not address all the points that Mr C raised. 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 the failure to provide Mrs A with reasonable medical and nursing care and treatment and for failing to handle his complaint reasonably. 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:

• Nursing staff should be aware that alcohol based hand rubs or hand gels are ineffective in removing Clostridium difficile spores and that hand-washing is an important aspect of preventing the spread of Clostridium difficile.
• Personal hygiene requirements should be recorded clearly and consistently. There should be daily recordings to indicate what personal hygiene assistance patients have received or have been offered.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the model complaints handling procedure. The model complaints handling procedure and guidance can be found here: www.valuingcomplaints.org.uk/handling-complaints/complaints-procedures/nhs.

Summary

Mr C had been in contact with mental health services for a number of years and was informed by his current psychiatrist (a medical practitioner who specialises in the diagnosis and treatment of mental illness) that he had a diagnosis of borderline personality disorder. Mr C complained that his previous psychiatrist had failed unreasonably to diagnose him with this and provide the appropriate treatment.

We took independent advice from a medical adviser. We found that the standard of communication in relation to the diagnosis was unreasonable and that this led to uncertainty and distress for Mr C. While, we did not find this had an adverse effect on his management or treatment, we recognised that not learning of his diagnosis until recently lead to a great deal of uncertainty and distress. On balance, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failings in record-keeping and communication. 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 clinician involved should reflect on this complaint and findings at their next appraisal.
• The board should ensure that clinicians follow the relevant guidance when diagnosing and discussing personality disorders with patients.

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.