Health

Summary

Mrs C complained on behalf of her adult son (Mr A) about the care he received when he presented to the emergency department at St John's Hospital. Mr A has autism (a developmental disability that affects how a person communicates with, and relates to, other people) and a learning disability and attended A&E after suffering a dissociative episode (disruption in aspects of consciousness).

We took independent advice from an emergency medicine consultant. The adviser noted that the board failed to meet contemporary best practice when taking the decision to perform a sternal rub (rubbing knuckles on the sternum as an act of stimulation); however, we did not conclude that this action was unreasonable. We found that, in one instance, staff did not communicate reasonably with Mr A. We also noted that the emergency department team did not meet with Mrs C after she made a complaint, which showed a lack of supportive partnership working. Therefore, we upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for not responding to her concerns in a way that reflected partnership working. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance . Reconsider their decision not to meet with Mrs C and Mr A. The board should inform Mrs C of whether they are prepared to offer a meeting or if an alternative arrangement to effect partnership working would be more suitable.

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

• Staff should recognise that patients with autism and learning disabilities might find the emergency department distressing and this may result in challenging 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

Ms C attended an antenatal screening which tested for Down's syndrome before the birth of her child (Child A) and it was determined that she was at low risk to have a child with this condition. Following the birth, Child A was diagnosed with Down's syndrome. Ms C said that the board's communication with her about Down's syndrome, before and after the birth was unreasonable.

During the pregnancy, an ultrasound scan confirmed Child A had a hole in their heart. Child A died a few months after birth and Ms C complained that the board had unreasonably failed to diagnose, discuss and treat Child A's heart condition and breathing problems.

We took independent advice from a midwife and consultants in cardiology, emergency medicine and neonatology. We found that, before the birth of Child A, Ms C was given reasonable information about the Down's symdrome screening process but after their diagnosis there was little evidence of what had been said and discussed. There was no record of the conversation telling Ms C about Child A's diagnosis and the immediate plan for them. We upheld this aspect of Ms C's complaint.

In relation to Child A's heart condition and breathing problems, we confirmed that there are limitations in the antenatal screening process, with screening identifying only half the number of heart defects. We found that Child A's heart and breathing problems had been reasonably diagnosed and treated but that there were also lung problems which could have not been predicted. We did not uphold this aspect of Ms C's complaint.

Recommendations

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

• Full records require to be maintained and available for a clinical audit trail and scrutiny.

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 to us about the care and treatment her sister-in-law (Mrs A) received at the Royal Infirmary of Edinburgh after taking two overdoses of medication within a few days. On the first occasion, Mrs A was assessed in the emergency department for risk of liver damage and then admitted to the acute medical unit. She had a psychiatric assessment the following morning and it was decided that she did not need any further in-patient psychiatric care. Mrs A discharged herself from the hospital later that day against medical advice. Mrs A was brought back to the emergency department on the following day after taking a further overdose and was then admitted to the toxicology unit. On the following day, she was transferred to a specialist liver transplant unit, although it was decided that she was not a candidate for a liver transplant. She was subsequently moved to intensive care after it was recorded that her kidneys were failing. Mrs A died there several days later. Mrs C complained about the care and treatment provided to Mrs A during each admission to the hospital.

We took independent advice from an emergency medicine consultant, a psychiatric consultant, a general medical adviser and a consultant in anaesthesia and intensive care medicine. We found that the care and treatment provided to Mrs A in the hospital throughout all admissions had been reasonable and appropriate. We did not uphold Mrs C’s complaints.

Summary

Ms C complained to us on behalf of her sister (Ms A). Ms A had sustained a head injury after a climbing accident. She attended hospital and was kept in overnight. After being discharged, Ms A became unwell, was visited at home by an out-of-hours GP and was then taken by ambulance to the emergency department at another hospital, St John's Hospital. She was diagnosed with post-concussion syndrome (when concussion symptoms last for weeks or even months after the injury which caused the concussion) and was discharged home. Ms A still felt unwell and was subsequently admitted to a third hospital and where she was diagnosed as having had a series of mini-strokes. Ms C complained that the board failed to provide Ms A with appropriate care and treatment when she attended St John's Hospital and unreasonably discharged Ms A from St John's hospital.

We took independent advice from a consultant in emergency medicine, a general medicine consultant with experience in stroke medicine and a radiologist (a doctor who uses medical imaging such as x-rays, ultrasounds and scans). We found that there were two documented symptoms that should have prompted the emergency staff to consider a diagnosis of stroke for Ms A. We also found failings in the board’s handling of the radiology aspects of Ms C’s complaint and her concerns about the out-of-hours GP’s notes on their assessment of Ms A. We upheld this aspect of Ms C's complaint.

In terms of Ms A’s discharge, we found that Ms A was not well enough to have been sent home and should not have been discharged from hospital. We considered that her working diagnosis should have been stroke, not post-concussion syndrome, and she should have been referred to the hospital’s stroke team. We, therefore, upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C and Ms A for the failings in Ms A’s care and treatment, her discharge from hospital and the investigation of Ms C's complaint. 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:

• Emergency department staff should note key symptoms and reach an appropriate diagnosis, in a case such as this.
• Patients should not be discharged in circumstances such as this.

In relation to complaints handling, we recommended:

• Issues set out by patients in their complaints should be raised with relevant staff in a timeous manner.
• Complaints should be fully and appropriately investigated.

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 to us that the medical practice had failed to provide appropriate care and treatment to her mother (Mrs A) at a home visit. She said that her mother had been dizzy, light-headed and off her feet and that she suffered from high blood pressure. Mrs C said that the GP recognised her mother's high blood pressure but did not take any further action and told her to wait for the district nurses, who were scheduled to visit in three days time, and that they would take further blood pressure readings, which Mrs C considered to be unreasonable. Mrs C called out the out-of-hours GP later that evening as her mother's blood pressure was still high. The offer of a hospital referral was made but Mrs A declined the offer. Mrs A was admitted to hospital two days later for a suspected heart attack and remained a patient for nearly two weeks.

We took independent advice from a GP adviser and concluded that the practice had provided a reasonable level of care. We found that the GP had carried out a reasonable examination and had concluded that there was no indication of an acute illness. The GP felt that the cause of the high blood pressure was caused by Mrs A's anxiety. It was appropriate to check the blood pressure readings and we considered that, as the district nurses were scheduled to visit a couple of days later, the matter would receive appropriate follow-up at that time. We did not uphold the complaint.

Summary

Mrs C complained to us about the care and treatment she received at Wishaw General Hospital following a fall at her home. Mrs C had hit her face and suffered deep cuts to her head which required stitches. Mrs C also sustained a fracture to her wrist. Mrs C was concerned that she was not admitted to hospital for observation and that no x-ray or scan was taken of her head.

We took independent advice from an adviser in emergency department medicine. We concluded that Mrs C received a thorough assessment when she attended the Minor Injuries Unit and that appropriate follow-up at the Fracture Clinic and Ear, Nose and Throat deparment were made. We found that there was no clinical justification for staff to arrange a head x-ray or a scan when Mrs C attended the hospital and that there was no requirement for her to be admitted to hospital for further observations. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment provide to his late father (Mr A) by the practice. Mr A was referred to a cardiology consultant (a doctor who specialises in the heart and blood vessels) by his GP following complaints of breathlessness. The consultant gave the practice some guidance about future treatment, and Mr A visited the practice a number of times over the next few weeks. Some changes to his medication were made and he was again referred to cardiology. Following this, Mr A was diagnosed with pulmonary fibrosis (a rare condition causing scarring of the lungs) and he died a few weeks later. Mr C complained that the practice had not followed the guidance of the consultant.

We took independent advice from a GP adviser. We found that the practice did follow the advice of the consultant, and that the eventual diagnosis of pulmonary fibrosis could not have been foreseen during the period when the practice was responsible for Mr A's care. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment provided to his late mother (Mrs A) at Monklands Hospital. In particular, he complained that Mrs A had been inappropriately discharged. He also complained that the board's communication about Mrs A's positive Methicillin-resistant Staphylococcus aureus (MRSA, a strain of antibiotic-resistant bacteria) result was unreasonable.

We took independent advice from a consultant in acute medicine and a nurse. Regarding Mrs A's discharge, we found that she had been fit for discharge and that the discharge planning for her had been reasonable. We also found that Mrs A's nutritional care had been reasonable. Therefore, we did not uphold this aspect of Mr C's complaint.

In relation to the communication about the positive MRSA result, we found that the level of communication with Mr C and his family had been unreasonable and that the board had failed to follow their policy for the control and management of patients colonised or infected with MRSA. We also noted that the board had accepted and apologised for the breakdown in communication in relation to the MRSA result. We upheld this aspect of Mr C's complaint.

Recommendations

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

• The policy for the control and management of patients colonised or infected with MRSA should be adhered to. In particular, the patient/relative should be informed about a positive result, given a copy of a MRSA patient information leaflet and that this should be documented in the medical records.

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, who works for an advocacy and support service, complained on behalf of her client (Mr A) about the care and treatment provided to him by his GP. Mr A had suffered a tick bite which had left him with a red rash. Mr A said that the GP dismissed his concerns, and that, following the bite, he had a number of symptoms such as flu like issues, stomach pains, joint and bone pain and neck stiffness. Mr A believed that the GP should have completed further blood tests and carried out investigations to determine if he had Lyme disease (a bacterial disease caused by tick bites).

We took independent advice from a GP adviser. We found there was no corroboration that Mr A had suffered a rash following the bite. The GP had recorded that there was a red lump at the site of the bite, but no rash, and had noted that they thought this was more likely to be a skin infection than a rash associated with Lyme disease. We found that the GP had prescribed antibiotics for a skin infection, and had advised Mr A to look out for symptoms of Lyme disease and what to do should he develop symptoms. We found that the GP had acted reasonably and we did not uphold the complaint.

Summary

Mrs C has power of attorney for her son (Mr A) who has a learning difficulty and lives independently. Mr A was awarded an Individual Service Fund (ISF) under self-directed support by the board to support him to achieve his personal outcomes.

Mrs C complained that the board did not act reasonably in relation to the ISF. She said that the board unreasonably refused certain funding requests, that they failed to follow procedure and to provide clear information about their policies and procedures. The board acknowledged that their communication regarding their processes was poor, however they did not consider the funding requests sustainably supported Mr A to meet his personal outcomes.

We took independent advice from a social worker. We found that it was reasonable for the board to refuse some of the funding requests, but not all. We found the board failed to ensure the ISF agreement was completed and signed and this was not done until more than 12 months after the ISF started. We concluded that the board did not properly follow procedure and that there were failings in their communication with Mrs C. Therefore, we upheld the complaint. We noted the board had made some significant improvements since Mrs C raised her complaint, therefore we did not make any further recommendations. However, we did ask the board to provide us with evidence of these changes.