Health

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.

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.