Health

Summary

Miss C complained to us about the standard of dental treatment provided to her adult son (Mr A) by the dentist over a number of years. In particular, she raised concern that there were delays in referring Mr A to hospital for specialist treatment and that the dentist had failed to listen to her concerns that Mr A should have been provided with braces.

We took independent advice from an adviser in general dentistry. Whilst we did note some failings in record-keeping, we found that there was no delay in referring Mr A to hospital. We also found that there was no evidence that Mr A needed braces. We did not uphold the complaint, however, we highlighted our concerns about record-keeping to the dentist to use as a learning opportunity.

Summary

Ms C, who is an advocacy and support worker, complained on behalf of her client (Mr A) about the care and treatment Mr A had received at Raigmore Hospital. Mr A had been diagnosed with terminal cancer. Ms C complained that a consultant oncologist (a doctor who specialises in cancer treatment) unreasonably told Mr A that radiotherapy (a treatment using high-energy radiation) he had received for his cancer had not worked and that he should take pazopanib (a drug used to treat kidney cancer). Mr A considered that the radiotherapy had been effective and that he should be given further radiotherapy treatment.

We took independent advice from a consultant uro oncologist (a doctor who specialises in treating cancers of the urinary system and male reproduction system). We found that it had been reasonable for the board to consider that the radiotherapy had not been effective and that Mr A should take pazopanib. We found that there had not been any failings in Mr A’s management by the board. His decision not to take pazopanib was also respected by the clinicians and he was given further radiotherapy. We did not uphold Ms C's complaint.

Summary

Ms C complained that the physiotherapy treatment she had received at Lorn and Islands Hospital had been unreasonable, inappropriate and had caused her injury.

We took independent advice from a physiotherapist. We found that there was no evidence that the assessment or physiotherapy treatment Ms C received had been unreasonable or inappropriate. Ms C had given consent to all of the treatments she received. We were also satisfied that the board had tried to address her concerns and to explain the reasons for the treatment she had received. In addition, they had produced an information leaflet for patients about the nature and range of treatment options available. Therefore, we did not uphold Ms C’s complaint.

Summary

Mrs C, an advocacy worker, complained on behalf of her client (Ms A) that the board failed to provide Ms A with a reasonable standard of mental health care and treatment. Ms A suffered from long term anxiety and depression and was referred for assessment at New Craigs Psychiatric Hospital. She was diagnosed with hypomania (a less severe form of the manic phase of bipolar affective disorder) and was started on the appropriate medication for this diagnosis. Three months later, Ms A was informed that she had been misdiagnosed and was advised to slowly come off the medication. The board apologised to Ms A for this error in diagnosis and acknowledged the distress the consequences had caused her. Ms A was unhappy with this response and Mrs C brought her complaint to us.

We took independent advice from a consultant in forensic psychiatry. They noted that Ms A's medical records did not detail what, if any, action was taken to explore other options to carry out a second opinion following a request from Ms A. We also found that the board unreasonably prescribed Ms A third level medication (medication prescribed if the first two are insufficient) in the first instance. Although this decision may not have been unreasonable itself, we found that the reasoning for this prescription was not clearly recorded. Therefore, we upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms A for failing to record the justification for her prescription and for failing to document whether all reasonable options were explored in response to her request for a second opinion. 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:

• Prescribing clinicians should be mindful of current clinical guidelines and ensure that they document decisions with sufficient detail to support the rationale for treatment options.
• Processes should be in place to ensure reasonable requests for second opinions are met.
• Clinical staff should keep accurate and sufficiently detailed clinical 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

Ms C complained about the care and treatment provided to her late partner (Mr A) during his time as an in-patient at New Craigs Psychiatric Hospital and after his discharge. Ms C was concerned that the potential physical causes of Mr A's psychosis (a mental health problem that causes people to perceive or interpret things differently from those around them) were not appropriately investigated, and that the approach taken to his anti-psychotic medication was unreasonable.

We took independent advice from a psychiatrist. We found that the potential physical causes of Mr A's psychosis were reasonably investigated. We also found that the anti-psychotic medication Mr A was given was appropriate and necessary for his recovery, and that it was appropriate to continue Mr A on this medication after his discharge. We did not uphold Ms C's complaints.

Summary

We closed this complaint before concluding our investigation. The complainant had asked for the investigation to be put on hold while she made a subject access request, but more than six months later had not asked for our investigation to be continued. At the time of closing, more than a year had passed since she brought her complaint to us and her circumstances had changed, meaning the outcome she was seeking was no longer achievable.

Summary

Mr C complained about the treatment he had received at the Accident and Emergency Department at the Queen Elizabeth University Hospital. He had experienced leg pain for a number of months and was shortly going to go for planned surgery at a private hospital. A few days before the private surgery was due, his condition deteriorated and his leg felt numb. He was referred to the Accident and Emergency Department by his GP for a review and, after a few checks, was told to return home. Mr C's condition continued to deteriorate and he contacted the private hospital for advice and was told to return to Accident and Emergency. Following a scan it was diagnosed that Mr C had cauda equina syndrome (a spinal cord nerve disorder which can cause bladder and bowel disturbance as well as altered sensation in the saddle area). Mr C felt that there had been a failure in his treatment at the initial presentation to Accident and Emergency and that the diagnosis of cauda equina syndrome could have been made earlier.

We took independent advice from an emergency medicine adviser and an orthopaedic adviser (a specialist concerned with the musculoskeletal system). We found that, although the GP referral letter mentioned that Mr C had altered sensation in the saddle area (which is a red flag sign for cauda equina syndrome), observations in hospital had recorded that there was no numbness present around the anal area. We could not account for the conflict in information between the GP and the hospital. We did, however, note that a comprehensive examination and medical history had been taken in the Accident and Emergency Department and that Mr C had been advised to return to the Accident and Emergency Department or to contact the private hospital if his symptoms deteriorated. On balance we considered that Mr C had received a thorough assessment on initial attendance at the Accident and Emergency Department and that appropriate advice was given to seek further medical review should his condition deteriorate. We did not uphold the complaint.

Summary

Mrs C complained that the board did not adequately investigate and treat the cause of her back pain.

We took independent advice from an orthopaedic surgeon (a surgeon who specialises in the musculoskeltal system). We found that the board did not evidence that a full history and examination of Mrs C was carried out at her out-patient appointment, and that the discharge letter to Mrs C’s GP did not detail any treatment plan. We considered this to be unreasonable. We also found that, following Mrs C’s assessment and examination, her case was not discussed with a consultant prior to any decisions being made about her care and treatment. There was delay in Mrs C receiving treatment at the pain clinic which was partly due to a delay in the board dictating the referral letter. We found that this delay was unreasonable and exceeded the national waiting time standards. We upheld Mrs C’s complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failure to take an adequate history and examination and for the delay in treatment.

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

• Orthopaedic Registrars should be reminded about the importance of good record-keeping, which should include a detailed history and examination and the treatment plan.
• Decisions about patient care within the Orthopaedic Spinal service should be made with appropriate senior supervision and this should be recorded.
• Orthopaedic Registrars should adhere to reasonable timescales when dictating medical correspondence.
• Patients with chronic back pain should be treated within national wait time standards. The board should consider advising patients in a timely manner that they may not be seen within waiting time targets.

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

Mr C has a chronic abdominal condition and regularly requires hospital treatment for severe pain and sickness. He was taken by ambulance to Glasgow Royal Infirmary (GRI), suffering from these symptoms. He told us that he advised the doctor treating him that he was ordinarily treated with a morphine drip. Instead, he was given oral pain relief, although he said he was vomiting repeatedly. After becoming frustrated with staff he was asked to leave under police escort, and required medical treatment at another hospital later that day. He complained that he was not given adequate pain relief or treatment at GRI.

We took independent advice from an adviser who specialises in acute and general medicine. We found that it was not apparent from the records whether an adequate assessment of Mr C’s pain had been carried out. We also noted no documentation of the events causing him to be asked to leave/escorted out, which we considered unreasonable. The adviser could see no definite cause for concern about the proposed treatment plan from GRI, but they noted that Mr C had chronic abdominal pain and that the pattern of his admissions made it likely that he would require admission for pain relief and that oral pain relief would be unlikely to manage his pain sufficiently.

We considered that, if Mr C had been aggressive and abusive to staff, it was reasonable to ask him to leave. We found that if he was tolerating oral pain relief and his pain had improved, then it was also appropriate that he was discharged. However, we found that it was not reasonable that none of this was documented. If Mr C’s pain was not controlled on oral medication, other routes or forms of pain relief should have been tried prior to discharge, assuming that staff were not placed in danger when attempting this. Without an adequate assessment of his pain having been recorded, we were not able to say with any certainty that his treatment was reasonable, or whether further steps to control his pain should have been taken at that time.

On balance, we upheld Mr C’s complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise for the lack of evidence of an adequate assessment of Mr C's pain, and for not adequately recording the circumstances surrounding them asking him to leave. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.
• Given Mr C's condition is chronic, the board should put in place a care plan for him. This should cover pain control (what to try, what route to administer), likelihood of requiring admission, which team to admit under, risk of self-discharge, risk of violence and aggression, and how to manage any behaviour perceived as violent or aggressive.

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

• Staff should be familiar with Royal College of Emergency Medicine Best Practice Guideline ‘Management of Pain in Adults’ December 2014. They should clearly document their assessment of patients’ pain.
• There should be clear guidelines in place for pain management. Junior doctors should be trained in pain management.
• All relevant staff should be trained in dealing with violence and aggression and understand the importance of documentation in these situations.

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

Mr C complained about the care and treatment provided to him at the Queen Elizabeth University Hospital. Mr C had suffered visual disturbance and had attended the Emergency Department (ED). He was assessed and discharged as there were no abnormal findings. The following day, Mr C attended the ED again as he again was suffering from visual disturbance, and also had some leg numbness. Clinical examination was again normal and he was discharged. Later that day, Mr C attended the ED again with new symptoms of facial muscle weakness. He was admitted for further investigation and was found to have suffered a stroke. Mr C complained that it took three attendances for him to be diagnosed and he felt that if he had been given treatment on his first attendance the visual loss which he subsequently suffered would have been prevented.

We took independent advice from a consultant in emergency medicine and from a consultant stroke physician. We found that, whilst the overall standard of Mr C's care and treatment was reasonable, on his second attendance the possibility of transient ischaemic attack (a ‘mini stroke’ caused by temporary disruption of blood supply to the brain) should have been considered. We, therefore, upheld this aspect of Mr C's complaint.

Mr C also complained that he had not received appropriate follow-up. We found that follow-up was of a reasonable standard and, therefore, did not uphold this aspect of Mr C's complaint.

Finally, Mr C complained that the board failed to respond to his complaint in a timely manner. We found that the board had taken well over 20 working days to respond to his complaint, and had failed to keep him updated about the delays. 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 consider the possibility that he had suffered a transient ischaemic attack. 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:

• In similar circumstances, a differential diagnosis of transient ischaemic attack should be considered.

In relation to complaints handling, we recommended:

• Where a complaint response takes more than 20 working days, the board should explain the reasons for the delay and agree a new timeframe.

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.