Health

Summary

Mr C complained on behalf of his late wife (Mrs A) that the practice failed to provide a reasonable standard of care and treatment. Mrs A attended the practice with pain in her right chest wall which was thought to be related to an injury. The practice noticed a small lump over her clavicle (collar bone) and requested an x-ray, which showed no significant abnormality. Mrs A attended the practice again with worsening shoulder pain and was referred to orthopaedics (the branch of medicine involving the musculoskeletal system). Mrs A was later diagnosed with bone and liver cancer. Mr C complained that the practice failed to note Mrs A's history of breast cancer on the x-ray request form and that they had not chased up the orthopaedic referral.

We took independent advice from a general practitioner. We found that there was no indication for the practice to consider cancer as a possible diagnosis. The practice had been investigating Mrs A's shoulder pain and lump as an injury and we considered that the practice's diagnosis was reasonable. We did not uphold Mr C's complaint. However, we identified failings in the way the practice handled his complaint and made recommendations in light of this.

Recommendations

In relation to complaints handling, we recommended:

• The practice should ensure that they have adopted the model complaints handling procedure and all staff should be aware of this. The model complaints handling procedure and guidance can be found here: http://www.valuingcomplaints.org.uk/handling-complaints/complaints-procedures/nhs.

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 on behalf of his late wife (Mrs A) about the treatment she received at Monklands Hospital. Mrs A attended her GP with pain in her right chest wall and was referred to hospital for an x-ray which found no significant abnormalities. Mrs A later attended her GP with worsening shoulder pain and her GP sent an urgent referral to the orthopaedics department (the branch of medicine concerned with the musculoskeletal system). This referral was downgraded by the board from urgent to routine. Mrs A was later diagnosed with bone and liver cancer. Mr C complained that the board unreasonably failed to check the x-ray for signs of cancer and that they unreasonably downgraded the urgent referral to routine.

We took independent advice from a consultant radiologist. We found that Mrs A had been referred for an x-ray due to an injury and that an x-ray is not the correct test to reliably pick up on a tumour. We also noted that the x-ray had showed a subtle change in bony texture of the clavicle (collar bone). As Mrs A had been referred for an x-ray due to an injury and the abnormality was so subtle, it would have been unreasonable to expect a radiologist to pick this up. Therefore, we did not uphold this aspect of Mr C's complaint.

In relation to the referral downgrade, we took independent advice from a consultant physician. We found that the orthopaedic referral letter did not suggest any need for the appointment to be urgent, no mention of cancer and no indication that the problem was considered to be anything other than shoulder pain that had not responded to physiotherapy. Therefore, we did not uphold this aspect of Mr C's complaint.

Summary

Mr C complained that the board unreasonably failed to provide him with appropriate care and treatment for his prostate cancer. He said that a consultant urologist (a doctor who specialises in medicine focusing on diseases of the urinary tract and the male reproductive organs) at Hairmyres Hospital advised him that his cancer was confined to his prostate, that it was T3 (had grown through the prostate capsule, outwith the prostate and was just outside the prostate) and that a laparoscopic radical prostatectomy (removal of the prostate via a small incision using robotic surgery) was an appropriate treatment. The consultant referred Mr C to a second consultant urologist at another board. Mr C said that when he was seen by the second consultant, he was told that the surgery proposed was not appropriate.

We took independent advice from a consultant urologist. We found that the first consultant referring Mr C for consideration of laparoscopic radical prostatectomy was appropriate and was in keeping with the West of Scotland Management Guidelines for prostate cancer. We found that, ideally, the first consultant should have pointed out that in their opinion Mr C's disease was suitable for radical prostatectomy, but that the final decision on suitability for surgery lay with the surgeon performing the surgery. The adviser explained that the main issue was one of a difference in clinical opinion between surgeons, and not a change in the extent of Mr C's cancer during the time between his appointments. On balance, we did not consider that the board unreasonably failed to provide Mr C with approprite care and treatment for his prostate cancer, and we did not uphold this aspect of the complaint.

Mr C also complained that the board unreasonably failed to arrange his referral for prostate surgery within a reasonable time and that they did not take the issue of the delay in arranging the referral appointment seriously. We found that the board had failed to respond to Mr C's phone calls about his referral and to take the issue of the delay seriously. We upheld this aspect of the complaint. We noted that the board had already apologised for this, and had taken steps to avoid this happening again in the future. We asked them to provide us with evidence of the action they had taken, however we made no further recommendations.

Summary

Mr C complained about treatment that he received at Raigmore Hospital when he was admitted via the emergency department. Mr C had undergone a vasectomy procedure (a procedure where the tubes that carry sperm from a man's testicles to the penis are cut, blocked or sealed) over two weeks earlier and had developed painful swelling. Mr C complained that, after admission for assessment/investigation in the urology department, he was examined and then discharged with advice to manage his symptoms conservatively. Mr C later had to be admitted for a number of days for treatment of an abscess.

We took independent advice from a consultant urologist. We found that there were several factors in Mr C's presentation that meant that, on balance, a more proactive approach to his symptoms would have been appropriate. We upheld this aspect of his complaint.

Mr C also complained that the board's response to his complaint was inaccurate. We found that key dates in the response were incorrect. We noted that the board acknowledged this failing and advised that they had taken steps to address it going forwards. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise for the failure to consider and/or document consideration of, a more proactive approach to Mr C's care and for the inaccuracies in the final response to Mr C's complaint. The apology should comply with the SPSO guidelines on making an apology, available at www.spso.org/leaflets-and-guidance.

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

• All relevant clinical factors should be taken into account and this should be apparent from the notes made in the contemporary 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

Mr C, a solicitor, complained on behalf of his client (Mr A) about the care and treatment he received at West Glasgow Ambulatory Care Hospital. Mr A was suffering from heart problems and was seen by a consultant cardiologist (a doctor who specialises in finding, treating and preventing diseases of the heart and blood vessels) and it was decided that no further investigations were appropriate. Mr C said that although Mr A continued to experience heart and chest pain, the board failed to take his concerns seriously and refused unreasonably to offer him appropriate treatment.

We took independent advice from a consultant cardiologist. We found that it was appropriate for the board not to investigate Mr A further as doctors had assessed the risks and benefits of more investigations and concluded, based on a number of points, that he should not be offered more. It was also noted that further cardiac investigations carried risks and could result in complications. We found that it was appropriate for no further tests to be carried out unless there was a solid indication to do so. Therefore, we did not uphold Mr C's complaint.

Summary

Mr C complained that the board failed to arrange his appointment for prostate surgery following a referral from another board within a reasonable time. Mr C's concerns included that the board unreasonably failed to send the letter for his appointment with the consultant at New Victoria Hospital to his correct address and that it was nearly three months until he was seen at the hospital. He also said the board failed to acknowledge the impact of the delay in arranging his appointment on the treatment of his cancer, including that he was advised by the board that he could not have the proposed surgery.

We took independent advice on the case from a consultant urologist. We found that the delay in Mr C's appointment was not acceptable. The board explained that they had Mr C's old address in their patient management system and when they received his referral, they failed to update the address. The board apologised for this and said that staff had been reminded of the importance of checking patient details on receipt of referrals and carrying out updates where necessary. They said the member of staff involved had been made aware of the considerable impact the error had on Mr C and would be given additional training, following which their performance would be closely monitored. We asked the board to provide us with evidence of their remedial action.

We found that the board correctly stated that the delay in Mr C's appointment would have been unlikely to have accounted for Mr C's cancer moving from operable to inoperable. The adviser said they did not think that there was a change in the extent of Mr C's cancer between him being referred to the board and him being seen by the consultant at the board.

We upheld Mr C's complaint. We asked the board to provide us with evidence of the steps they have taken to stop these failings occuring again in the future, however we made no further recommendations.

Summary

Ms C, who works for an advocacy and support service, complained about the care and treatment provided to her client's late father (Mr A) at the Southern General Hospital. Mr A had terminal cancer and other serious conditions, including heart failure. Mr A was admitted to the hospital after becoming unwell following chemotherapy. Ms C complained that the medical care he received for his complex presentation was unreasonable and highlighted concerns about him being given penicillin when his medical records noted he was allergic to this antibiotic. Ms C also complained that nursing staff had not treated Mr A with dignity and respect, and that staff communication with the family had been unreasonable.

We took independent advice from a consultant physician and geriatrician (a doctor who specialises in medicine of the elderly). We found that the medical care provided to Mr A had been reasonable for his condition and that he had not been allergic to penicillin. We did not uphold this aspect of the complaint.

We also took independent advice from a nursing adviser. We found that the nursing care provided to Mr A was reasonable and that there was no evidence that he was not cared for in a dignified manner. Consequently, we did not uphold this part of the complaint.

We found that there was evidence of reasonable communication with the family in the records. We did not uphold the complaint about communication with Mr A's family.

Summary

A number of years ago Mrs C was diagnosed as suffering from pseudoseizures (episodes that resemble, and are often misdiagnosed as, epileptic seizures). However, after a referral to cardiology from her GP some years later, it was determined that she had a heart problem and required a pacemaker. Mrs C subsequently had a pacemaker fitted and said that, since then, she had not suffered any further seizures.

Mrs C said that there had been a failure to recognise that her problems could relate to her heart, despite being under the care of the board in between her diagnosis with pseudoseizures and the diagnosis of a heart condition. She complained to the board, who responded and said that they felt her condition had been treated reasonably. They said that, until Mrs C was referred to cardiology, there had been no reason to suspect that she had heart problems. Mrs C was unhappy with this response and brought her complaint to us. Mrs C complained that, over the number of years she was under their care, the board had failed to diagnose and treat her heart condition.

We took independent neurology advice. We found that Mrs C was experiencing 'faints, fits or other funny turns' which, according to the relevant Scottish Intercollegiate Guidelines Network (SIGN) guidance, should prompt an electrocardiogram (ECG - a procedure used for measuring the electrical activity of the heart). We found that Mrs C was appropriately monitored with ECGs. For this reason, we did not uphold her complaint. We also noted that the ECGs, had not, in any event, revealed her heart problem, as only a prolonged recording would have been likely to have detected this.

Summary

Mr C, an MP, complained on behalf of his constituent (Mr B) about the lack of care provided to his late partner (Ms A) who had attended an out-of-hours service after reporting severe pain. Ms A was examined by the GP and sent home with laxatives (medication to help increase bowel movements). Ms A subsequently collapsed at home a short time later and died. Mr B obtained a copy of the death certificate which showed evidence of bowel obstruction. Mr B felt that due to the severity of the condition, the GP should have identified the problem and that the issue could have been rectified in hospital earlier.

We took independent advice from an adviser in general practice medicine and concluded that the GP had carried out an appropriate assessment of Ms A given her reported symptoms. She had a history of constipation and was on painkilling medication which would have contributed to her constipation. It would not have been appropriate to have prescribed additional painkillers as that would have worsened the constipation. We also found no evidence of bowel obstruction and, therefore, the decision to send Ms A home with laxatives to allow them time to take effect was reasonable. We found no medical requirement for a hospital admission at that time, and there was no information within the medical history or examination which would have alerted the GP to the subsequent events, or that the laxatives would not be effective. We did not uphold Mr C's complaint.

Summary

Mr C complained about the care and treatment that his wife (Mrs A) received at Aberdeen Maternity Hospital. Mrs A called and was seen at the hospital over a number of weeks with symptoms, including bleeding, before she suffered a miscarriage at 20 weeks into her pregnancy. Mr C was concerned about the care she received and that alternative action could have prevented the miscarriage.

We took independent advice from a consultant obstetrician (a doctor who specialises in pregnancy, childbirth and the female reproductive system). We found that the care Mrs A received at the hospital was reasonable and that there was no treatment to prevent spontaneous miscarriage at that stage of a pregnancy. We did not uphold the complaint.