Health

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.

Summary

Mr C complained to us on behalf of his client (Mrs B) in relation to the care provided to her late husband (Mr A). Specifically, Mrs B had concerns about the end of life care Mr A received. During our investigation, Mrs B advised us she wished to withdraw the complaint and explained she was considering legal action.

Summary

Mr C complained about the care and treatment he received at Wishaw General Hospital (WGH) when he attended the emergency department after falling at home and injuring his lower back. Mr C was concerned that he was discharged home without having had an x-ray. He was also dissatisfied about the in-patient hospital care he received after being admitted to hospital two days later at which time an x-ray confirmed a spinal fracture. Mr C was unhappy about delays in transferring him to a different hospital spinal unit and being informed that he had a second spinal fracture.

We took independent advice from a consultant in emergency medicine and a consultant orthopaedic surgeon (a specialist concerned with the musculoskeletal system). In relation to the care Mr C received in the emergency department, we considered that the decision not to do an x-ray and the delay in diagnosis were reasonable given that a number of factors made this type of injury unlikely in Mr C's case. Therefore, we did not uphold this aspect of Mr C's complaint.

In relation to the orthopaedic care received, the board acknowledged that it would have been appropriate to have discussed Mr C's case again with the spinal unit of another hospital. We found that there was a lack of communication with Mr C in relation to his second fracture and that a more senior discussion with the spinal unit may have led to more timely transfer. Therefore, we upheld this aspect of Mr C's complaint. However, we noted that these issues were unlikely to have influenced his subsequent treatment.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failings in communication regarding his second fracture. 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:

• Patients should be informed of relevant test results and this should be fully 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 complained about the care and treatment she received at Wishaw General Hospital. Following a heart attack, Mrs C attended the hospital on a number of occasions in the period whilst she waited for heart surgery. She was unhappy with the way the board managed her condition in this period and the way the board coordinated her care.

We took independent advice from an emergency medicine consultant, an acute physician and a consultant cardiologist (a doctor who specialises in finding, treating and preventing diseases of the heart and blood vessels).

Mrs C firstly raised concern that the board failed to investigate her symptoms and provide her with appropriate treatment. We found that, during the first admission, Mrs C was diagnosed with an acute coronary syndrome (symptoms attributed to obstruction of the coronary arteries). Mrs C also had hyperglycaemia (high blood glucose) but was not prescribed insulin. The adviser noted that tight blood glucose control is important in acute coronary syndrome and considered that the board failed to monitor Mrs C's blood glucose levels appropriately and failed to prescribe insulin. We also concluded that there had been a delay in Mrs C being reviewed by a cardiologist and that a GRACE score (which takes into account a patient's age, heart rate, systolic blood pressure, kidney function, signs of heart failure, as well as other parameters in order to calculate the risk of in hospital death) should have been calculated earlier as this can inform the need for angiography (a type of x-ray used to check the blood vessels). In relation to a later hospital admission, we considered that it was unreasonable for the board to have discharged Mrs C without assessment by a senior physician, in view of her medical history and presenting symptoms. We upheld this aspect of Mrs C's complaint.

Mrs C also complained that the board failed to coordinate her surgery with another NHS organisation that was involved in her care. The board acknowledged that there was a lack of detail in the documentation of the conversation between their medical staff and the staff from the other organisation. We found a number of points in Mrs C's care where the communication with the other organisation could have been better. We upheld this aspect of Mrs C's complaint.

Finally, Mrs C complained that the board failed to investigate her complaint reasonably. The board acknowledged that they had not addressed all the issues raised in her complaint letter. We considered that since Mrs C's original complaint spanned two NHS organisations, and the co-ordination and communication involved between each, the board should have worked more closely with the other organisation and issued a single complaint response. We upheld this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to provide reasonable care and treatment; unreasonably discharging her without assessment by a senior physician; failing to coordinate her care with another board reasonably; and not fully responding to her 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:

• Where a patient presents with an acute coronary syndrome and has hyperglycaemia, close monitoring of blood glucose levels should be a routine part of acute coronary syndrome management. Insulin should be prescribed for patients who require insulin and adm
• Patients who have been diagnosed with an acute coronary syndrome should be reviewed by a cardiologist within a reasonable timescale. In line with guidelines, patients should be risk assessed for future adverse cardiovascular events and the timing of coron

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 attended the prison health service on a number of occasions with chest infections and high blood pressure. He complained that he did not receive appropriate medication and that there were delays in being referred to specialists.

We took independent advice from a GP adviser. We found that Mr C had been assessed and treated appropriately. We also considered that appropriate referrals had been made, and that the waiting times for appointments were normal. We noted that there had been a delay in discussing x-ray results with Mr C, but the board had apologised for this and had provided evidence of improvements in their recording and checking system, to prevent this from happening again.

We did not uphold this complaint.

Summary

Miss C raised a complaint about the care and treatment she had received from her dentist over an extended period of time. Miss C had suffered from pain in one of her lower teeth and was advised she would require root canal treatment. Miss C continued to be in pain; the treatment had to be repeated and also caused problems with an adjacent tooth. Miss C said she was told the tooth required extraction and was referred to the dental hospital for further treatment. Miss C was dissatisfied with the way the dentist managed her dental care.

We took independent advice from a dentist. We found that the dental treatment which Miss C received was appropriate and in accordance with usual practice. The symptoms which Miss C had reported were uncertain, therefore a period of monitoring was required. The suggestion by the dentist for root canal treatment or extraction was reasonable in view of the dental records and x-rays which were taken. We did not uphold the complaint.

Summary

Mrs C complained to us on behalf of her late sister (Ms A). Ms A had cancer and was receiving radiotherapy treatment (a treatment using high-energy radiation) in hospital. Mrs C complained that there was an unreasonable delay in providing Ms A with radiotherapy treatment and Mrs C felt that Ms A should have been prioritised due to her pain levels. Mrs C also complained that the board did not investigate her complaint reasonably.

We took independent advice from a consultant oncologist (a doctor who specialises in cancer treatment). We did not find that there was an unreasonable delay in providing Mrs A with treatment. The adviser commented that it is not routine practice to prioritise patients' scans or treatment slots based on symptoms. We also considered that the board took reasonable steps to manage Ms A's pain whilst in the hospital, as she had been provided with pain relief medication during her admission. We did not uphold this aspect of the complaint.

Regarding complaints handling, we were unable to definitively assess how accurate or inaccurate the board's response to Mrs C's complaint was as they could not provide us with evidence on Ms A's admission timings. The board, therefore, failed to demonstrate that their response to Mrs C's complaint was evidence-based and we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for not investigating her complaint reasonably. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

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 and Mrs C complained on behalf of their daughter (Ms A) about the orthodontic treatment (a speciality field of dentistry that deals with malpositioned teeth and the jaws) she received. Ms A underwent orthodontic treatment to treat mild crowding of her teeth (when there is not enough space for all teeth to fit normally within the jaws). Four of her teeth were removed, and braces were fitted. After the braces were removed Mr and Mrs C were concerned that the treatment had changed Ms A's facial profile and affected her lip support. They believed that there had been other methods of treatment available, which they felt that the orthodontist had failed to discuss with Ms A.

We took independent advice from a dental and orthodontic adviser. We found that Ms A's overcrowding was treated appropriately and that a good result was achieved. We did not uphold the complaint about the treatment provided.

Mr and Mrs C also complained that the orthodontist failed to obtain Ms A's informed consent before proceeding with the treatment. We found that there was no evidence of a proper discussion of the problem that Ms A presented with or the expectations she had of any treatment. We also did not see any evidence of any information being given to Ms A about what treatment options were availale. We upheld this aspect of the complaint.

Finally, Mr and Mrs C complained about their way that their complaint was handled by the orthodontist. We found that the complaint had been handled appropriately and in a timely manner. We did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise for failing to obtain valid consent to the treatment plan, with recognition of the implications of failing to obtain full consent on the choices made. The apology should meet the standards on apology 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:

• The quality of the orthodontist's clinical treatment notes should be improved. In particular, they should focus on improving the way they document orthodontic assessments, gather orthodontic records and use them to ensure that a comprehensive explanation

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.