Health

Summary

Mr C complained about the care provided to his late mother (Mrs A) by staff at Wishaw General Hospital. Mrs A had attended the emergency department following a fall at home. She was observed for a few hours and discharged home. Mrs A fell again at home that evening and had to be readmitted to hospital where it was established that she had problems with the blood supply to her left leg. Mrs A was told that no further treatment could be given and she was commenced on palliative care. Mr C believed that the seriousness of his mother's condition should have been identified on the first attendance to hospital.

We took independent advice from a consultant in emergency medicine. We found that on the first attendance the staff carried out a thorough assessment, made appropriate investigations and reasonably concluded that Mrs A could be discharged home with follow-up by the hospital at home team. When Mrs A re- attended hospital, her observations were mostly normal and it was only after a further period of review that issues were identified which revealed a lack of blood supply to her left leg. We found that the staff could not reasonably have predicted that Mrs A would go on to have subsequent problems. We did not uphold the complaint.

Summary

Miss C complained about the treatment which her late child (Child A) received at Wishaw General Hospital. Child A had recently had a vaccination and had developed a temperature and a rash. Miss C asked the staff if Child A could have Kawasaki Disease (heart disease) and was told that they did not meet the criteria. Instead Child A was treated for a viral infection and then discharged home after a period of observation. Although Child A showed some signs of improvement, over two weeks later they were admitted to hospital where they died. The post mortem report showed findings in keeping with Kawasaki Disease. Miss C felt that staff should have carried out additional investigations when Child A was originally at the hospital and the disease would have been identified sooner.

We took independent advice from a consultant paediatrician. We found that the staff carried out appropriate assessments when Child A attended the hospital and that it was reasonable to have arrived at a working diagnosis of viral infection based on their reported symptoms. Child A did not meet the criteria for Kawasaki Disease at that time and there was no clinical indication that a hospital admission or referral to other hospital specialist was required. We did not uphold Miss C's complaint.

Summary

Mr C complained about the decision to transfer his wife (Mrs A) from Wishaw General Hospital to a care home and the manner in which this was done. Mr C was concerned that he was not advised in advance about the transfer or that the decision was discussed with him. Mr C was also concerned about the lack of information given to him about the facilities available at the home and the handover provided by the hospital to the home.

During our investigation the board issued an apology to Mr C for the errors made. They confirmed that the transfer took place during a time when there was an extreme pressure on beds and the information provided to Mr C was not adequate. They also accepted that staff on the ward were not aware of the type of services available at the home. They confirmed that there should have been a more adequate handover note. As the board apologised for the errors and confirmed steps they would take to improve the service, the complaint was resolved and we took no further action.

Summary

Mr C complained about the care and treatment his late father (Mr A) received when he attended the emergency department at Monklands Hospital, after having been involved in a minor road traffic accident. The board concluded that Mr A had a soft tissue injury and he was prescribed paracetamol and ibuprofen. Mr A returned to the emergency department one week later reporting worsening symptoms. A further assessment was carried out and it was noted his international normalised ratio (INR - a measurement of how long it takes blood to form a clot) levels were high and fractures to his vertebrae and ribs were identified. Mr A's condition deteriorated significantly and he developed sepsis (a  blood infection) and discitis (inflammation between the discs of the spine). Mr  A died as a result of these complications. Mr C complained that the board failed to note that his father was taking warfarin (a drug used to prevent blood clots) and he should not have been prescribed ibuprofen. Mr C also complained that the fractured vertebrae and ribs were not identified during the first assessment.

We took independent advice from a consultant in emergency medicine. We found that the assessment of Mr A's symptoms was reasonable and an x-ray to inspect for fractures was not warranted. However, we considered that the prescribing of ibuprofen was not reasonable and other forms of pain relief could have been considered. Therefore, we upheld the complaint. We did not make any recommendations as the board had already taken steps to address this failing.

Summary

Mrs C complained about the care which she received from the practice. She said that the practice unreasonably refused to prescribe her pethidine (painkiller) medication and removed it from her list of repeat medications. Mrs C said that she had been on the medication for a number of years and that no alternative painkillers were prescribed and she was at risk of withdrawal symptoms.

We took independent advice from a GP. We found that the clinical records indicated that Mrs C had agreed to stop pethidine, she had also said it was her intention to try ibuprofen (anti-inflammatory pain relief medication) and that she still had a stock of pethidine at home. We found that the GP correctly did not prescribe additional painkilling medication in the meantime and also that Mrs C had not been taking pethidine on a regular basis and as such it was unlikely she would have suffered from withdrawal symptoms. Therefore, we did not uphold Mrs C's complaint.

Summary

Miss C complained about the antenatal care she received from the community midwifery team when she was pregnant. Miss C was informed she was on the "red pathway care" for her pregnancy which meant her antenatal care would be led by a consultant obstetrician (a doctor who specialises in pregnancy and childbirth) and supported by the community midwifery team.

Miss C complained that she was told by her midwife at her first appointment that she would not need to have future appointments with her midwife and would only see her consultant. Miss C also complained that she missed out on vital check ups and she did not receive her relevant maternity forms on time. The board apologised that the consultant did not provide Miss C with the appropriate forms.

We took independent advice from a midwife. We found that when Miss C contacted the community midwifery team, the midwife acted appropriately and offered to meet with Miss C to provide her with the necessary forms and information, however, Miss C refused this offer and did not engage in the service. We found at this point, Miss C was still within the required timescale for submitting her forms, therefore, she did not suffer any significant injustice as a result. We did not find any evidence that Miss C was advised at her first appointment that she was not required to see her midwife again. We did not uphold Miss C's complaint.

Summary

Ms C has complex Post-Traumatic Stress Disorder (a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma) and had been receiving Comprehensive Resource Model (CRM - a holistic therapeutic approach to help people re-process and release the effects of traumatic events) treatment under the care of her psychiatrist. Ms C heard that her psychiatrist had left the practice and that she was to be offered a six week course of Cognitive Behavioural Therapy (CBT - a talking therapy aiming to help manage problems by changing the way people think and behave) in place of CRM treatment. Ms C had tried this before and found it of little benefit. Ms C complained that the board had failed to consult her on the decision to withdraw CRM treatment, and had failed to put in place an appropriate support plan for her.

The board explained that the removal of this treatment was a result of a review of all adult psychiatry services, stating that there was no evidence base for CRM and it did not appear on the Matrix for Psychotherapy Treatments (a guide to planning and delivering evidence-based psychological therapies within NHS boards in Scotland).

We took independent advice from a consultant psychiatrist. We found that Ms C had been discharged from the service on clinical grounds and would only have been informed of the decision to withdraw the treatment when she requested a new appointment. We were satisfied that the board did not have a specific duty to consult with Ms C before deciding to withdraw from providing CRM treatment and we, therefore, did not uphold this complaint.

In relation to the support plan put in place following the board's decision to withdraw CRM treatment, the board said that the psychiatrist had wanted to find out the wishes of their patients in care provision. They had discussed the future care of all their patients and had agreed to refer them to their Community Health Team for an assessment of their needs. We found that the board's approach in offering individual appointments to assess ongoing needs for future treatment was reasonable. Therefore, we did not uphold this complaint. However, we did find shortcomings in the board's communication with Ms C in relation to the matters she complained about and fed this back to the board.

Summary

Mrs C made a complaint on behalf of Mrs B about the care and treatment her late husband (Mr A) received at his GP practice. Mr A had a number of health issues including epilepsy for which he had been prescribed medication for many years. Mr A had attended the surgery for worsening upper abdominal pain following a two day history of vomiting. Mr A was admitted to hospital where he died several days later. Pancreatitis (inflammation of the pancreas) was recorded as one of the causes of Mr A's death. Mrs C complained that the practice had failed to provide Mr A with reasonable care and treatment. In particular, that Mr A's GP had failed to recognise that Mr A's epilepsy medication could cause pancreatitis.

We took independent advice from a GP. We found that the care and treatment provided to Mr A by the practice was reasonable. Mr A's health concerns were appropriately investigated and blood tests and referrals were made as appropriate and in a timely manner. We also noted that pancreatitis is a very rare side effect of the medication Mr A was taking for his epilepsy. We considered that the care provided to Mr A by the practice was of a reasonable standard and in line with good medical practice. Therefore, we did not uphold Mrs C's complaint.

Summary

Ms C, an advice worker, complained on behalf of her client (Mr A) about the care provided to him by the practice. Mr A had repeatedly reported his concerns about stomach problems and when he was referred to hospital specialists they diagnosed that he had a stomach ulcer. Mr A felt that there was a delay in referring him to the hospital specialists.

We took independent medical advice from a GP. We found that the practice had appropriately assessed Mr A's reported stomach problems over a period of years, provided appropriate medication and referred Mr A to hospital specialists when his symptoms failed to resolve. There was no delay in the referral to the hospital specialists, and while initially the hospital specialists had diagnosed a stomach ulcer, there were also thoughts that Mr A's symptoms were related to his other health conditions. We did not uphold the complaint.

Summary

Mrs C complained about the nursing care and treatment provided to her late brother (Mr A) at Queen Elizabeth University Hospital. Mrs C raised a wide range of issues including a failure to provide Mr A with adequate personal care and to properly identify and treat a pressure ulcer. Mrs C also said her mother had been required to provide Mr A with personal care, even though she was elderly and unfit to do so. The board said Mr A had requested nursing staff allow his family to provide personal care, and that staff had discussed this with Mr A and his mother. Mr A had suffered skin damage, but not a pressure ulcer and this had been treated appropriately.

We took independent advice from a nurse. We noted that staff should have ensured that discussions about patient care were properly recorded and we provided feedback to the board. However, we found that the care provided to Mr  A was reasonable and we did not uphold this aspect of Mrs C's complaint.

Mrs C also complained that the board failed to handle her complaint reasonably. We found that there had been an excessive delay in responding to Mrs C's complaint correspondence, due to human error on the part of a member of staff. We upheld this aspect of Mrs C's complaint and provided feedback to the board.