Health

Summary

A firm of solicitors (Firm C), raised a complaint on behalf of their client (Mrs A) that, during an examination under anaesthetic, a consultant had carried out a rectal examination without her knowledge or consent. She only found out about this when she received a copy of her medical records. When Firm C raised concerns about this with the board, they passed the correspondence to the consultant (who no longer worked for the board), who responded to Mrs A directly. The board subsequently accepted the consultant's response as their response to the complaint and did not investigate the complaint through their complaints handling procedure.

We took independent advice from a consultant in obstetrics and gynaecology (the medical specialty that deals with pregnancy, childbirth, and the post-partum period and the health of the female reproductive systems and the breasts). We found that it was not routine practice to perform a rectal examination as part of the examination Mrs A was having conducted. The Royal College of Obstetricians and Gynaecologists guidance on Obtaining Valid Consent states that procedures should not fall out-with that which the patient consented to, unless there is an unanticipated emergency. We found that Mrs A should have been aware that a rectal examination was a possibility prior to the procedure and consented as such. In the absence of consent, it was not reasonable for a rectal examination to be carried out. We upheld the complaint.

We also had concerns about the way in which Firm C's concerns had been handled. Firm C had clearly raised a complaint and our view was that the board should have investigated and responded to this in line with their complaints handling procedure. We made recommendations regarding this.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs A for conducting a rectal examination on her without her knowledge or consent and for failing to consider her complaint through the complaints handling procedure. 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:

• Ensure that clinical staff in the Obstetrics and Gynaecology department are aware of the Royal College of Obstetricians and Gynaecologists guidance on Obtaining Valid Consent.
• Consideration should be given to a discussion about consent at the departmental induction for doctors and/or a training session.

In relation to complaints handling, we recommended:

• Complaints handling staff should be aware of the board's complaints handling procedure and how to recognise a complaint.

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 practice had failed to provide her with appropriate care and treatment. She had reported to her GP that she was feeling down since the death of a relative and that she had self harmed. She was also concerned about a mouth infection. Mrs C said that the GP showed no interest, telling her to attend a dentist for the mouth problem and that she should wait for contact from the mental health services, who were already in contact with Mrs C. The GP told Mrs C that it was her responsibility to chase up the mental health services.

We took independent advice from a GP adviser. We found that it was appropriate for the GP to have referred Mrs C to her dentist as it would not be within a GP's remit to treat patients with dental problems. We also found that, when Mrs C attended the GP, there was no clinical indication for an immediate referral to the mental health services. The department within the mental health services which Mrs C was already attending operated a self-referral facility and there was no need for the GP to make a formal referral. We did not uphold the complaint.

Summary

Mr C complained that his GP unreasonably stopped his diabetic medication, and that the practice later inapppropriately removed him from their patient list. Mr C subseuqently withdrew his complaint and no findings were reached. We closed our case.

Summary

Miss C suffered ongoing complex urological problems (problems relating to the urinary tract, bladder or kidneys), and underwent a dilation and cystoscopy procedure (a procedure to look inside the bladder and stretch the urinary opening) at Ninewells Hospital. During the procedure biopsies (samples of tissue) were taken. Miss C complained about the medical and nursing care during this procedure, which she found very painful and distressing. Miss C also complained about her medical care following the procedure, and that it took several months for the board to refer on to a urological specialist in another board area after she requested this.

Medical and nursing staff met with Miss C to discuss her concerns. The board apologised for some aspects of the nursing care, and said the day-of-surgery admission pathway had not been suitable for Miss C, as it could not provide much of the support she required. Miss C was not satisfied with this response, and she brought her complaint to us.

We took independent advice from a consultant urologist and a nurse. We found that most of the medical care Miss C received was reasonable. However, the operation note was not sufficiently detailed to show why it was necessary to take biopsies, which caused Miss C post-operative pain. We upheld this aspect of Miss C's complaint.

In relation to the nursing care, we noted that the board had acknowledged certain aspects of care were staff could have acted differently and had taken action to discuss Miss C's concerns with staff. We considered these actions to be reasonable and found that the nursing care Miss C received was appropriate. We did not uphold this aspect of Miss C's complaint.

Finally, we found that there was a delay in referring Miss C to a specialist. We noted that some of the delay was due to her requiring urgent hospital admission in this period; however, part of the delay was due to a lack of cover arrangements during an unexpected staff absence. We upheld this aspect of Miss C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for the delay in referring her to a specialist and for the failure to document why the biopsies were necessary. 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:

• Operation notes should include sufficient detail to explain the clinical decisions taken during the operation.

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 about the care and treatment provided to her late grandfather (Mr A) at Ninewells Hospital. Mr A was admitted to hospital and treated for sepsis (a blood infection). It was initially thought that this was caused by a chest infection but investigation showed that the source was Mr A's gallbladder. Mrs C complained that staff had not listened to family concerns about the source of the infection and that this had affected his treatment. Mrs C was concerned that the placement of a drain or other treatment was unreasonably delayed and that an appropriate scan had not been done. Mrs C considered that a different approach could have prevented Mr A's death.

We took independent advice from a consultant interventional radiologist (a clinician who would place a drain in the gallbladder) and a consultant physician (a senior doctor). We found that Mr A had received appropriate treatment and investigation of his symptoms. The adviser indicated that staff were aware that the gallbladder could be the source of infection and that there were no unreasonable delays in the particular circumstances of Mr A's case. We considered that earlier placement of a drain would not have resulted in a different outcome for Mr A. We did not uphold Mrs C's complaint.

Summary

Mrs C, who works for an advocacy and support service, complained to us on behalf of her client (Mrs B) about the care and treatment Mrs B's late father (Mr A) received from the board.

Mr A requested medical assistance at his home as he was feeling breathless and asthmatic. An advanced nurse practitioner (ANP) attended Mr A in the early hours of the morning. After carrying out an assessment, the ANP concluded that Mr A's symptoms were consistent with pneumonia (an infection of the lungs). The ANP provided treatment and advised Mr A to visit the health centre later that day for further review.

When Mr A presented at the health centre, his condition was noted to have worsened and he was subsequently referred to hospital. On arrival at the hospital Mr A suffered a cardiac arrest and died.

Mrs C complained that the board unreasonably delayed in referring Mr A to hospital and that they should have requested an air ambulance rather than travel by ferry and road.

We took independent advice from a GP adviser. We found that the ANP carried out a thorough assessment of Mr A's symptoms and that his diagnosis was appropriate. We found that it was not clinically indicated that an earlier referral to hospital was required. We also considered that the board's decision to transfer Mr A by ambulance on the ferry was safer and faster than an air ambulance. We did not uphold Mrs C's complaints.

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 he received in relation to a suspected hernia (a condition where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall) whilst he was in prison. In particular, that there were delays in being seen by his GP, being referred for an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body), being referred for surgery and concerns over his prescribed medication. Mr C also complained that he was not given a long-term sick line after an initial sick line expired.

We took independent advice from a GP. We found that the time Mr C had to wait for appointments with his GP was reasonable. We also found that he was referred for an ultrasound scan and surgery within a reasonable amount of time and that his medication was reviewed appropriately. Therefore, we did not uphold this aspect of Mr C's complaint.

In relation to Mr C's sick line, we found that it would be reasonable to expect that he would be able to attend classes and carry out light duties whilst waiting for surgery and, therefore, we considered that the GP's decision to refuse a sick line was appropriate. We did not uphold this aspect of Mr C's complaint.

Summary

Mrs C compained about the care and treatment that her husband (Mr A) had received during a number of admissions to Hairmyres Hospital. Mr A had initially been admitted with abdominal pain, and he was found to have a stone in his urinary tract and some thickened loops of small bowel. His pain decreased and, after review by the urologist (a doctor who specialises in the male and female urinary tract, and the male reproductive organs) and general surgeons, he was discharged home.

Mr A was readmitted three weeks later with similar symptoms and required surgery. During his stay he had thromnophlebitis (inflammation of a vein related to a blood clot) in his arm and it was felt that he should have his blood thinned with warfarin (a medication used to thin the blood and prevent blood clots). He was then discharged home, but was readmitted five days later because he had very high Internalised Normalised Ratio (INR - the higher the number, the longer the takes the blood to clot).

Mrs C complained that the board failed to provide reasonable treatment to Mr A.

We took independent advice from a consultant general surgeon. We found that it had been reasonable to discharge Mr A following his first admission. However, when he was readmitted he was prescribed warfarin outside of the guidance for anticoagulation (blood thinning), as thrombophlebitis is not an indication for anticoagulation. The justification for this had not been clearly recorded. We found that, whilst it had not been unreasonable to give Mr A warfarin, the clinical reasons for this should have been clinically documented.

We also found that there was some confusion about the dose of warfarin that Mr A should take at home. We found that Mr A's readmission with high INR could have been avoided by ensuring that his anticoagulation was stable before discharge. We found that the board's anticoagulation guidelines needed to be updated. In addition, we found that a blood sample had gone missing when Mr A was in hospital, and that he had to have this sample retaken. In view of these failings, we upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for the failings in relation to the warfarin he received. 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:

• The use of warfarin or similar medication should have clear and acceptable justification and any exception for clinical reasons should be documented and accessible.
• Review the pathway of blood tests to minimise the risk of losing samples.

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, who is a patient adviser, complained on behalf of her client (Mr B), who was unhappy about the care and treatment provided to his mother (Mrs A) at Hairmyres Hospital. Mrs A experienced a stroke and was assessed in the emergency department before being transferred to a medical ward. A week following her admission to the ward, Mrs A was admitted to a specialist stroke ward. Soon after the transfer, she experienced a further stroke and died a number of days later.

Mr B complained that there had been a delay in assessing and treating Mrs A in the accident and emergency department. We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) with experience in stroke care. We found that the records showed that Mrs A was assessed almost immediately following admission and that a scan was arranged promptly. We did not find evidence that there was an unreasonable delay in assessing and treating Mrs A, and we did not uphold this part of Ms C's complaint.

Mr B was also concerned about the care provided on the medical ward. We found that the board had apologised to Mr B for the delay in transferring Mrs A to a stroke ward. We considered that it was unreasonable that Mrs A was not transferred to a stroke ward sooner. While we considered that the general medical care provided was reasonable, we were critical that Mrs A did not receive the benefit of specialist stroke unit care sooner. We upheld this aspect of the complaint.

Finally, Mr B was unhappy with the level of communication with the family. We found limited evidence of staff communicating with the family in the period following Mrs A's admission and prior to her deterioration. We, therefore, upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr B and his family for the lack of communication in the period following Mrs A's admission and prior to her deterioration. 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:

• Stroke patients requiring admission to hospital should be admitted promptly to a stroke unit staffed by a co-ordinated multi-disciplinary team with a special interest in stroke care, in accordance with Scottish Clinical Guidelines.
• Medical staff should be mindful of the needs of family members/ significant others of the patient, as described in Scottish Clinical Guidelines, and ensure that there is adequate communication.

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 treatment she received at Wishaw General Hospital when she attended the emergency department (ED) after a road traffic accident.

We took independent advice from a consultant in emergency medicine. We found that Ms C had been correctly triaged (a process in which things are ranked in terms of importance or priority) when she attended the ED, that the history taking had been of a good standard, the examination carried out was thorough and of a good standard and the treatment was reasonable. Therefore, we did not uphold Ms C's complaint.