Health

Summary

Miss C complained on behalf of her mother (Mrs B) about the care and treatment provided to her late father (Mr A) following his admission to Victoria Hospital with a painful hip. Mr A, who had prostate cancer, underwent a hip replacement. The oncology (cancer) consultant who had been caring for Mr A went on leave for a number of weeks. During this period a scan found that Mr A's cancer had spread and he was later admitted to a hospice where he died a short time later. Miss C complained about the care and treatment Mr A received following his admission to hospital. In particular, that Mr A had not been informed that his cancer had spread significantly and that his life expectancy was much shorter than he had previously thought.

We took independent advice from an oncology consultant. We found that, during the period Mr A's oncology consultant was on leave, there was no record of him being informed that his cancer had progressed significantly and that his life expectancy was reduced. We also found that the delay in referring Mr A to the oncology team and informing him of the progression of his cancer appeared to have been caused by a lack of senior oncology cover when Mr A's oncology consultant was on leave. However, we noted that had the oncology medical team been contacted earlier it would not have changed Mr A's management as there had been no further treatment available to him. We also found that, in terms of palliative care, there had been no impact on his management as he had continued with his medication. We upheld Miss C's complaint. Whilst we noted that the board had already accepted that there had been a delay in informing Mr A of his cancer progression and had apologised for this failing, we made a further recommendation.

Recommendations

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

• If a consultant goes on leave there should be adequate supportive cover.

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 was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD - a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness) by a private specialist, and she reported a very positive response to the medication prescribed. She had previously been seen by a consultant psychiatrist at Queen Margaret Hospital, who noted longstanding symptoms of anxiety.

Mrs C saw the psychiatrist again following receipt of the private opinion but the psychiatrist did not agree with the ADHD diagnosis and was not willing to support the recommended medication prescription. As Mrs C's GP practice would not agree to prescribing this medication without the support of her NHS psychiatrist, she was required to pay for it privately.

The board offered Mrs C a second opinion from another consultant psychiatrist, who confirmed her ADHD diagnosis and supported the prescribing of the recommended medication. Mrs C complained that the initial psychiatrist unreasonably failed to diagnose her ADHD and did not follow relevant ADHD protocols.

We took independent medical advice from a consultant psychiatrist, who considered that it was reasonable for the first psychiatrist not to have followed specific ADHD diagnostic protocols at Mrs C's initial out-patient appointment. We found that the psychiatrist's management plan following this consultation was appropriate and that it allowed for review of Mrs C's diagnosis, and specific diagnostic protocols to be considered, at future appointments.

However, the board were unable to provide any written record of Mrs C's follow-up consultation with the psychiatrist. We found that the psychiatrist appeared to only have phoned Mrs C's GP to recommend referral for a second opinion. They did not document the call and no clinic letter was produced. Therefore, we considered that there was an absence of adequate medical documentation to support the psychiatrist's diagnosis and, in particular, their rationale for disagreeing with the medical opinion of the private specialist. We upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the psychiatrist's failure to appropriately document details of their consultation with her, including their rationale for disagreeing with a specialist opinion.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:

• Clinicians should ensure that they adhere to General Medical Council Good Medical Practice guidelines on record keeping and, in particular, they should clearly document their clinical rationale where there is a difference of opinion.

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 transferred to the practice from another practice and, on first attendance at the new practice, was prescribed Sertraline (an anti-depressant medication used to treat anxiety). However, he suffered side effects as a result of this prescription. He was of the opinion that this would have been immediately obvious to the doctor he saw, had they checked with his previous GP, as Mr C had previously been prescribed this medication and had suffered side effects. He was also unhappy with the manner and tone adopted by the doctor. He complained about these matters to the practice and was further concerned by the tone and content of the response he received, which he considered to be confrontational and unprofessional.

Mr C brought his complaints to us. He complained that the practice unreasonably failed to consider his medical history before prescribing Sertraline and that the prescription of Sertraline was inappropriate due to the potential side effects. We took independent advice from a GP. We found that, in order to justify immediately prescribing Sertraline, rather than first trying therapies that did not require medication, the doctor should have documented a pressing clinical need or sought further evidence from Mr C's previous practice to ensure that this was appropriate. However, we found no evidence that this took place. Therefore, we upheld these two aspects of Mr C's complaint.

We also considered that the tone and content of both the clinical records and the practice's complaints responses, both to Mr C and to us, was inappropriate. We upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to sufficiently evidence the decision to prescribe him Sertraline and for failing to communicate appropriately with him. 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:

• Records should fully evidence any clinical decisions.
• Records and communication should be factual, neutral, and professional in tone and content.

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's father-in-law (Mr A) attended the Emergency Department (ED) at Victoria Hospital with severe facial injuries following a fall from a bicycle. He was reviewed by a doctor and transferred to oral and maxillofacial surgery (OMFS - surgery which treats diseases and injuries of the mouth, head, neck, face and jaws) for treatment of the cut to his face, then discharged.

Within the following week, Mr A attended two out-patient appointments at Queen Margaret Hospital to check his wound and remove the stitches. While waiting for the second appointment, Mr A collapsed at the hospital. Medical and nursing staff attended, but no record was made. They told Mr A to visit the ED after his out-patient appointment. However, Mr A remained quite unwell and the family returned to the hospital to ask for help. An ambulance was arranged to take Mr A to Victoria Hospital where a scan showed that he had a skull fracture and bleeding inside the skull. Mr A died shortly afterwards.

The board undertook a Rapid Event Investigation which found failings in the clinical care and processes. They said that there was no communication about head injury care when Mr A was transferred from the ED to OMFS. This meant that nursing staff did not carry out neurological observations (observations of the brain and nervous system), and Mr A was not given information about head injuries when he was discharged. Mr A was also given the wrong advice following his collapse in the hospital, as he should have been taken to the minor injuries unit for further assessment and transfer to Victoria Hospital. The board apologised for the failings found. The family felt that the board's response was unreasonable, and Mr C brought the complaint to us.

Mr C complained that the medical care and treatment provided to Mr A throughout his attendances at Victoria Hospital and Queen Margaret Hospital was unreasonable. We took independent advice from consultants in emergency medicine and OMFS. We found that regular neurological observations should have been taken while Mr A remained in hospital (either in the ED or OMFS) and he should have been given information on head injuries on discharge. Whilst we acknowledged that the board had taken appropriate action to address some of the failings, we were concerned that some of the Rapid Event Investigation recommendations were not specific and clearly linked to the failings found, and two recommendations had been marked off as complete without any evidence of action being taken. In light of this, we upheld Mr C's complaints about medical care and treatment.

Mr C also raised concerns that the nursing care provided to Mr A at Victoria Hospital was unreasonable. We took independent advice from a nurse. We did not find any evidence that nursing staff had missed any concerning signs or symptoms, and we found that the nursing care provided to Mr A was reasonable. Therefore, we did not uphold Mr C's complaint about the nursing care provided to Mr A.

Mr C also complained that the board's response to the complaint was unreasonable. We found that, although it could have been more clearly written at points, the board's response was reasonable. We did not uphold this part of Mr C's complaint.

Recommendations

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

• Patients with an injury to the head should receive neurological observations, regardless of where they are cared for.
• Patients with an injury to the head should be given head injury information on discharge from the ward.
• Recommendations arising from a review of a patient's care should clearly identify changes to prevent the situation reoccurring.

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 raised a complaint about the care and treatment he had received from his dentist when he had two teeth removed and two new teeth added to his existing denture. Mr C later found his denture to be too loose fitting and returned to his dentist. Mr C had clips fitted to make his denture more secure, however, he still felt that it was too loose and was advised by his dentist that a new denture was the only other option. Mr C was unhappy with his treatment and brought his complaint to us.

We took independent advice from a dentist. We found that the dental treatment Mr C received was reasonable and in accordance with usual practice. However, we found issues with patient communication and record-keeping. Mr C was not given a full explanation of his treatment at the outset or advised of the all the possible options and outcomes. We also found that dental records did not mention the advice that the dentist had given to Mr C. On balance, we found Mr C's treatment to be unreasonable and upheld his complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for not outlining all his options to him at the start of treatment. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.
• Refund Mr C the money he paid for the clips to be fitted.

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 that her late mother (Mrs A) received at Dumfries and Galloway Royal Infirmary. Mrs A was admitted for emergency treatment of a bowel issue and after some time in the intensive care unit, she was moved to the high dependency unit (HDU). Mrs A's condition deteriorated while she was in the HDU and she later died. Ms C was concerned about the standard of both medical and nursing care that Mrs A received. Ms C also complained about the level of communication with family members and the way that the board dealt with her concerns.

We took independent advice from a critical care consultant and a nursing adviser. We found that the care and treatment provided to Mrs A by both medical and nursing staff was appropriate and reasonable. Therefore, we did not uphold these aspects of Ms C's complaint.

However, we found communication with the family during Mrs A's time in hospital to be unreasonable. The nursing adviser noted that staff will refer to the 'ceiling of care' indicating the level of intervention that is appropriate for that particular patient. We considered that the records made of discussions with Mrs A's family were insufficient as they did not document enough information about ceiling of care and to what extent this was discussed. Therefore, we upheld this aspect of Ms C's complaint. However, we noted that the board had already identified areas for improvement.

In relation to complaints handling, we found that there had been a short delay in issuing a final response to Ms C and that the board had not arranged an extension or apologised for this. Therefore, we upheld this aspect of Ms C's complaint. However, we noted that the board had acknowledged this failing and had made improvements to their approach to complaints handling.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the delay in responding to her complaint. 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:

• Communication with patients and their families should be in line with the General Medical Council's Good Medical Practice guidance, particularly sections 33 and 49. Ceilings of care should be discussed, agreed, documented and reviewed with all involved (patient, medical and nursing staff). The board should consider using a separate section within the notes to document discussions with relatives or carers.

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 on behalf of her husband (Mr A) about the care and treatment he received at Dumfries and Galloway Royal Infirmary. Mr A became unwell and was admitted to hospital. A heart scan identified that he had a gathering of fluid around his heart. Staff inserted a chest drain (a tube to remove fluid) but the next day staff discovered that the drain had become blocked. They made multiple unsuccessful attempts to insert another chest drain which resulted in significant bleeding. A decision was made to transfer Mr A to a hospital out with the board, which took place late in the evening.

Mrs C complained that the board failed to provide Mr A with appropriate medical care and treatment. She raised particular concerns about the actions of the staff in inserting chest drains and about the time taken to transfer Mr A to the other hospital. Mrs C also complained that the board failed to communicate appropriately regarding Mr A's condition.

We took independent advice from a consultant cardiologist. We found that bleeding is a recognised complication of the chest drain procedure and that it appeared reasonable. However, we found that records showed evidence of poor communication between staff and concerns about skills in relation to some members of staff. Regarding the transfer of hospitals, we found that the time taken to transfer Mr A to the hospital outside the board was unreasonable. We also found that the discharge arrangements were inadequate, given the complicated nature of Mr A's admission. Therefore, we upheld this aspect of Mrs C's complaint.

In relation to communication with Mrs C, we found that there was evidence of poor and limited communication with both her and Mr A, particularly surrounding the procedure to insert the chest drain and the transfer of hospitals. We upheld this aspect of Mrs C's complaint. However, we noted that the board had taken action to address a number of these problems.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A and his family for the failings in care, discharge arrangements and communication. 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:

• In similar cases, consideration should be given to ensuring appropriate out-patient follow-up on discharge.

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 his GP practice with symptoms of fatigue, reduced appetite and night sweats. Tests indicated an infection and Mr C was prescribed antibiotics and referred to hospital. Several weeks later, after discussing the matter with the GP, Mr C decided to cancel the hospital appointment offered. However, Mr C was unaware that the referral to hospital mentioned the possibility of serious pathology (red flag symptoms). When Mr C had the same symptoms a year later, an x-ray showed suspected cancer in his right lung and further tests showed stomach cancer.

Mr C complained that failings by the practice meant that he had been unable to make an informed decision about the initial referral the year before and that his life had been shortened considerably. Mr C complained that the practice failed to provide him with a reasonable standard of medical care.

We took independent advice from a GP. Overall, we found that the standard of medical care and treatment provided was reasonable. We were satisfied that Mr C had been investigated appropriately and that the tests taken were thorough. Therefore, we did not uphold the complaint.

Summary

Mr C complained to us that the board had unreasonably refused to accept referrals for his child (child A) to the Child and Adolescent Mental Health Services (CAMHS). There were concerns about child A's anxiety and that they possibly had symptoms of autism spectrum disorder (ASD). Mr C felt that the board had not provided adequate reasons for the refusal and had based their decision on events of some years ago.

We took independent advice from an adviser in mental health services. We found that the board's decision that child A did not satisfy the criteria for CAMHS was reasonable. Whilst child A had displayed some symptoms, they were not persistent in nature and their condition was variable at times. We did not uphold the complaint. However, we provided the board with feedback that they should have provided Mr C with more clarity of the exact rasons why they felt a referral to the service was not appropriate at that time.

Summary

Ms C complained to us that the medical practice had failed to provide her with appropriate care and treatment when she reported problems with her mobility and that she was not sent for x-rays or scans in order to arrive at a diagnosis. Ms C had subsequently registered at a new practice where the staff quickly identified her problems and arranged x-rays which resulted in her undergoing two hip operations. Ms C felt the previous practice should have addressed her mobility problems a number of years ago.

We took independent advice from a GP adviser. We found that the practice had provided a reasonable level of care. When Ms C reported hip pain, she had x-rays taken and was referred for physiotherapy and provided with painkillers. From then until Ms C left the practice, we found that she did not report any additional symptoms or that her pain had deteriorated or worsened and, as a result, there was no requirement for the practice to undertake further investigations. We did not uphold the complaint.