Health

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mrs A) that the consent process followed for an above knee amputation of Mrs A's leg was unreasonable. Mrs A had been admitted to Balfour Hospital for treatment of severe chronic leg ulcers and amputation was planned when other options were exhausted.

We took independent advice from a consultant physician. Although we found that Mrs A had been fully aware of the plan for surgery and had discussed this with staff on the ward, we found that the consent form had not been signed until the day of the procedure. We also found that there was a lack of evidence in both the medical records and the consent form to confirm that the risks and benefits of the surgery were appropriately discussed with Mrs A. The advice we received highlighted that this did not follow national guidance on consent and that, while Mrs A's post-operative care was appropriate, her delirium had not been monitored using the appropriate test. We upheld Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs A that the consent process for her above the knee amputation was unreasonable. 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:

• The consent process should follow national guidelines. Consent should be taken, where possible, prior to the day of surgery and what is discussed as part of the consent taking process, including risks and benefits, should be documented.
• Where appropriate, patients should be tested for post-operative delirium.

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 arranged an emergency appointment at the out-of-hours dental service as she was suffering from toothache. The dentist performed the first stage of a root canal treatment, however they experienced difficulty in accessing all the root canals. Ms C's tooth pain worsened and she had to return to the out-of-hours dental service the following day and she opted to have the tooth extracted. Ms  C complained that the dentist failed to properly explain the treatment options to enable her to give informed consent. She also complained the dentist failed to provide the appropriate treatment and that, had the dentist informed her of the difficulty they would have performing the treatment, she would have opted to have the tooth extracted.

The board explained that the dentist had difficulty accessing all the root canals and this would explain why Ms C had significant post-operative pain, however, they did not consider that the dentist failed to provide the appropriate treatment or that they failed to appropriately explain the treatment options.

We took independent advice from a dentist. We found that it was not possible to identify from scans taken of Ms C's mouth that the root canal treatment would be so difficult to perform, therefore the appropriate treatment was provided. We also found that the information provided to Ms C in terms of treatment options was reasonable in the context of an emergency service setting. We did not uphold Ms C's complaints.

Summary

Mrs C complained about the respiratory care (care of the lungs and other organs) and treatment provided to her by the board. She said that she did not feel she was given appropriate follow-up care and that this resulted in her respiratory problems becoming worse.

We took independent advice from a consultant in respiratory medicine. We found that Mrs C was appropriately investigated and that no follow-up was necessary. We also found that there was no evidence that her respiratory problems had been caused by, or became worse as a result of, lack of follow-up. We did not uphold Mrs C's complaint.

Summary

Mr C complained about treatment he received at the Royal Infirmary Edinburgh after suffering a head injury. He raised concerns that the board had failed to identify a fracture to his skull on his first attendance, as they did not carry out a CT scan until he was referred back to hospital by his GP two days after being discharged.

This case was very similar to a complaint we had recently upheld (201508264). In that case, we recommended that the board carry out an audit of similar head injury cases treated at the hospital. As the audit was still in progress at the time of Mr C's complaint, we asked the board to include his case in their consideration. They did so, and repeated what they had told Mr C in their response to his complaint - that they considered the treatment he received was appropriate. They also maintained this position in response to enquiries we made throughout our investigation.

We took independent advice from a consultant in emergency medicine. The adviser told us that the board's failure to carry out a CT scan on Mr C's first admission was unreasonable as the board had recorded that Mr C had a severe and persisting headache and Mr C had suffered a fall from a height greater than one metre. Under guidance from the Scottish Intercollegiate Guidelines Network  (SIGN) and the board's protocol in place at that time, this should have led to a CT scan being arranged. We also found that the board had failed to carry out enough observations of Mr C's level of consciousness. In particular, the board had failed to record that Mr C was reviewed by an experienced doctor before being discharged. SIGN guidelines specify that an experienced doctor should review all head injury patients before they are discharged to ensure that six specific criteria are met. However, this failling had since been remedied by a new procedure implemented following case 201508264.

We were also concerned that, despite a number of these failings being a repetition of those highlighted in case 201508264, the board had failed to identify the failings, either in response to Mr C's complaint, as part of the audit they carried out into his care or when responding to our enquiries. For these reasons, we upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to provide appropriate treatment for his head injury. 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:

• All staff should follow the protocols in place with regards to patients with head injuries.

In relation to complaints handling, we recommended:

• The board's investigations at all stages should identify failures in care and, where failings are identified, make proportionate changes to avoid similar mistakes in future.

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 attended the practice with symptoms of a hoarse voice, burning and tightness in her chest, decreasing over five days. Mrs C explained to the practice that she was due to go on holiday in three days and queried whether she was fit for travel. The doctor considered that she was suffering from a viral infection, recommended fluids and paracetamol and considered her to be fit for travel. However, in the following days her condition worsened, causing her to attend a hospital's emergency department who prescribed antibiotics. Mrs C was still unwell when her holiday commenced. Mrs C complained that the practice had not provided her with reasonable treatment, which caused her to be unwell on her holiday.

We took independent advice from a GP. Based on the information available at the time, we considered that the practice provided a reasonable standard of medical treatment and that the practice could not have foreseen that Mrs C's condition would worsen, impacting on her holiday. Therefore, we did not uphold the complaint.

Summary

Mr C complained about the care and treatment provided to his late father (Mr A) at Monklands Hospital. Mr A had terminal cancer and was admitted to hospital after he developed pneumonia (a lung infection). Following admission, Mr A received an x-ray, pain medication, fluids and antibiotics, and test results indicated that he had neutropenic sepsis (a potentially fatal complication of anti- cancer treatment in which the ability of bone marrow to respond to infection is supressed). During the admission, doctors considered whether to transfer Mr  A to the Intensive Care Unit (ICU). It was felt that, due to the severity of Mr  A's presenting illness as well as the background of cancer undergoing palliative treatment (end of life treatment), ICU treatment would not have altered his chance of survival. Mr A continued to receive treatment on the medical ward, and he died the day following admission to the hospital.

Mr C was unhappy that Mr A was not treated in ICU and he felt that Mr A did not receive appropriate care and treatment during the admission. We took independent advice from a consultant in acute medicine. We found that Mr A received rapid assessment and treatment on admission to the hospital and we considered that the care provided was reasonable. We also considered that the board's decision not to treat Mr A in ICU was reasonable in the circumstances. The adviser noted that specialist cancer nurses had been involved in Mr A's care and they considered that the care provided both before and after the nurses' involvement was reasonable. We did not uphold Mr C's complaint.

Summary

Following a fall at home, Mrs C was taken to Wishaw General Hospital where scans were taken. Mrs C was told by a doctor that the scan results suggested that breast cancer, which she had suffered from previously, had returned. Discussions were held with the breast cancer nurse and the oncology (cancer  treatment) department, who were not convinved that the results were evidence of metastases (when cancer spreads from the initial site to a secondary site). Mrs C had to wait until the outcome of further scans over an eight week period before being told that her condition was benign (non-cancerous) and that there was no metastases. Mrs C complained that it was inappropriate for staff to have told her that scans had shown the possibility of metastases.

We took independent advice from a consultant radiologist. We found that it was reasonable for staff to conclude that intial scan results showed signs which could have been attributable to metastases. We found that Mrs C had symptoms that are considered concerning for metastatic disease from breast cancer. We, therefore, considered that it was appropriate to make Mrs C aware of the concerns around potential metastases. We also found that there was no delay in reaching a definite diagnosis. We did not uphold the complaint.

Summary

Mr C noticed a lump in his chest and he was concerned that it was related to a previous abscess (a painful swelling caused by a build-up of pus) he had suffered with. His GP referred him to Hairmyres Hospital for a scan, where it was found that he had an abscess in the fat under the skin that was unlikely to be tracking elsewhere in his body. Mr C had a procedure to have this abscess drained at the hospital and afterwards he began to feel very unwell. He attended a private hospital and was found to have a very large, deeper abscess that was spreading down under his liver and pushing up to his chest. Mr C complained that the board had unreasonably failed to diagose and treat this abscess.

We took independent advice from a consultant vascular and general surgeon. We found that Mr C's condition was appropriately assessed and investigated when he attended the hospital. The adviser explained that the scan that had been taken did not show any deeper abscess. We noted that Mr C did not have symptoms that suggested a larger, deeper abscess. We found that, although Mr  C would have had the larger, deeper abscess when he attended the hospital, the failure to diagnose was not unreasonable. We did not uphold Mr C's complaint.

Summary

Ms C complained about the care and treatment provided to her late sister (Miss  A). Miss A had attended a routine appointment with a practice nurse for her asthma, and had reported symptoms of a urinary tract infection. The nurse had taken a urine sample and had the on-call GP prescribe antibiotics. Several days later Miss A's condition deteriorated and she was admitted to hospital with sepsis (a blood infection), where she then died. Ms C complained that the practice nurse should have realised how unwell Miss A was and carried out further checks such as heart rate, temperature and blood pressure. Ms C felt that if these had been carried out Miss A would have had appropriate treatment sooner.

We took independent advice from a practice nurse and a GP. We found that there was nothing in the medical record to note what symptoms Miss A presented with or any assessment undertaken, and we considered this to be unreasonable. We found that based on the symptoms described by the practice nurse in her complaint investigation statements, the practice nurse should have undertaken a thorough history of Miss A's symptoms, checked her temperature, pulse and blood pressure, and checked for signs of pain. We upheld this aspect of Ms C's complaint.

Ms C also raised concerns that Miss A's blood test results were not acted upon in the weeks leading up to her death. We found that the blood tests that were being monitored were part of the practice's routine screening for chronic disease, and that any abnormal results were followed up appropriately and were not related to Miss A's later diagnosis of sepsis. We did not uphold this aspect of Ms  C's complaint.

Finally, Ms C complained about the practice's handling of her complaint. We found that the practice failed to handle Ms C's complaint reasonably and that it did not meet the complaints handling guidance in place at the time. We upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to appropriately assess Miss A and for failing to handle her complaint reasonably. The apology should meet the standard 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 receive full and appropriate assessments, from the appropriate person, based on their reported symptoms. These should be documented in accordance with recognised standards such as the NMC Code of Conduct.

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. Ms C became pregnant and had a high body mass index (BMI, a measure for estimating human body fat) when she booked in for a scan. As a result, Ms C was tested for gestational diabetes (diabetes that develops in women who did not have diabetes before their pregnancy) and was later prescribed medication to reduce her high blood sugar levels. This dose was later increased as her blood sugar levels remained high. Ms C was admitted to hospital as her baby stopped growing and had an emergency caesarean section to deliver her baby. After she was discharged home, Ms C developed an infection and her stitches burst. She later went on to develop nerve damage and fibromyalgia (a long term condition that causes pain all over the body). Ms C complained that the treatment she received towards the end of her pregnancy led to nerve damage and fibromyalgia.

We took independent advice from a consultant obstetrician and gynaecologist (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 Ms C was correctly started on medication because of her persistently high blood sugar levels and that this helped with problems associated with gestational diabetes. This was in keeping with national guidelines. We noted that Ms C's high BMI and gestational diabetes were significant risks in pregnancy and wound healing. While Ms C suffered nerve damage and developed fibromyalgia, these were not known to be associated with caesarean section surgery. Therefore, we found that she had been treated reasonably and appropriately. We did not uphold Ms C's complaint.