Health

Summary

Mrs C complained that the practice had not provided her with reasonable care and treatment when she raised concerns about her skin condition. We took independent advice from a GP adviser. We found that the GPs at the practice had taken Mrs C's concerns seriously and that they had made reasonable and appropriate referrals to several specialists. We found that they had sent samples to a microbiology laboratory to be tested and that they had communicated thoroughly with the specialists regarding Mrs C's symptoms. We also found that the practice staff had communicated appropriately with Mrs C during consultations and when advising her of her diagnosis, and that the prescribed medications were appropriate. We did not uphold Mrs C's complaint.

Summary

Mr C complained about the care that his wife (Mrs A) received as a patient at both the Western General Hospital and Astley Ainslie Hospital. Mr C was unhappy that Mrs A was occasionally attended to by male nurses. Mr C also felt that Mrs A was given unreasonably high doses of medication.

We took independent advice from a nurse. The adviser explained that male nurses routinely carry out the same care as female nurses, for both female and male patients. This includes personal care such as toileting and washing. The adviser reviewed Mrs A's medical records and found that it was reasonable in the circumstances for her to be attended to, on occasion, by male nurses. The adviser also found that Mrs A was not kept sedated and was given the recommended doses of medication. We did not uphold Mr C's complaints.

Summary

Mr C complained that he was unreasonably discharged from the Royal Infirmary of Edinburgh following hip replacement surgery, as he was unable to pass urine and was constipated at the time of discharge. Mr C eventually had a catheter fitted and was advised by a consultant at the Western General Hospital that he would be put on a waiting list for transurethral resection of the prostate (a surgical procedure that involves cutting away a section of the prostate - a small gland in a man's pelvis located between the penis and bladder). Mr C complained that the board misled him about the date for his surgery and that they failed to carry out his operation within a reasonable time.

We took independent advice from a nurse. They said that it was appropriate for Mr C to be discharged from hospital, as his notes indicated that he was not experiencing any issues with passing urine or that his bowels were not working. Therefore, we did not uphold this part of the complaint. However, we noted that the board recognised they should have provided Mr C with oral laxatives on discharge and will take action to address this issue in future.

Based on the information available we did not consider that the board misled Mr C about the date for his surgery and we did not uphold this part of the complaint. However, we noted that the board had indicated that they had taken steps to try to ensure that in future, the medical team and their secretaries were kept notified of waiting times for procedures and we asked the board to provide evidence of this.

The adviser said that Mr C's surgery was completed outwith the 12 week treatment time guarantee and as the procedure was classified as 'urgent', this appeared unreasonable. The board explained the steps that they had taken to try to reduce the waiting times for patients and identify alternative providers and we asked for further evidence of this. We also found that there was poor communication between the board and Mr C regarding the delay in his surgery, advice and support available to him and in their handling of Mr C's complaint. Therefore, we upheld this part of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the unreasonable delay in providing surgery, not discussing the advice and support available to him and for the communication error in complaints handling. 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 board should inform patients as soon as possible of any inability to meet treatment targets and provide them with all the required information. This should include options available to them in the circumstances and how to provide comments/feedback or make a complaint about the delay.

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 an advocacy and support worker, complained on behalf of her client (Mrs B) about the care and treatment provided to Mrs B's son (Mr A) at the Royal Edinburgh Hospital. Mr A had a range of complex psychiatric and physical health conditions and spent long periods of time in hospital. Mr A's health deteriorated while he was in the hospital and he was transferred to another hospital for treatment and died the following day. Ms C complained that the board failed to provide Mr A with appropriate treatment for both his mental health and his physical health. She also complained that the board failed to respond appropriately to Mr A's deteriorating physical health in the two weeks leading up to his death.

We took independent medical advice from a psychiatrist, a mental health nurse, and a consultant in general medicine. We found that Mr A received appropriate mental health treatment and that the board had followed the relevant guidelines. We did not uphold this part of the complaint.

In terms of Mr A's physical health conditions, the psychiatric adviser said that a more systematic approach to assessing/managing Mr A's risk of infection should have been taken. We also found failings in Mr A's nursing care, including a failure to adequately complete charts to monitor his weight, food and fluid intake. We upheld this part of the complaint.

On the events leading up to Mr A's death, we found that his deteriorating physical condition was not responded to adequately, on occasion, by nursing staff and that there was a delay in requesting a medical review. Based on the evidence provided, we upheld the complaint. However, the advisers said that the remedial action taken by the board in relation to this part of the complaint was reasonable and we therefore had no further recommendation to make regarding this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs B and her family for the failings in care and treatment that Mr A received in hospital. 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:

• Charts used by nursing staff to monitor patients weight, nutritional screening and food and fluid intake should be completed in full and in line with organisational expectations.
• Nursing care should be effectively and transparently planned and evaluated.

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

Miss C complained about the medical care and treatment she received following a facial injury she sustained as a result of dental treatment. Miss C pursued a complaint about her dental treatment separately with another organisation and, when that process concluded, she decided not to pursue her complaint with us. Therefore, we closed our file on the complaint and took no further action.

Summary

Mr C complained that there was a delay in a scan taken of his chest area being formally reported at the Glasgow Royal Infirmary. Mr C had lung cancer and was undergoing treatment for this. At an appointment with a cancer specialist he reported symptoms of breathlessness and the specialist referred him for a scan and to a respiratory consultant. Mr C underwent the scan the same day as his respiratory appointment, at which point there was no formal report of his scan. The formal report was produced ten days later, and it was discovered that Mr C had a pulmonary embolism (blockage of a blood vessel in the lung). He was therefore immediately admitted to hospital for treatment. Mr C complained that the scan should have been checked and reported on the same day as it was taken, in order to ensure there were no significant problems.

We took independent advice from a consultant radiologist. We found that there are no specific standards for reporting scans and that there was not an unreasonable delay in Mr C's scan being reported. We also found that the area of pulmonary embolism shown on the scan was relatively small and would not have been recognised by a non-radiologist. We found it reasonable that the scan was not reviewed by a radiologist on the day it was taken and that the board had reasonable protocols in place to ensure significant pathology was related to clinicians in a timely manner. We did not uphold Mr C's complaint.

Summary

Mrs C complained that the board had failed to provide her with reasonable treatment at the Ear, Nose and Throat (ENT) service at Inverclyde Royal Hospital in relation to her balance problems. Mrs C considered that the problem was being caused by fluid in the tubes in her ears. She was referred to a number of clinicians in the ENT service, but they were unable to establish what was causing her balance problems.

We took independent advice from an ENT consultant. We found that staff in the ENT service had carried extensive tests and there was no evidence that Mrs C's balance problems were being caused by fluid in the tubes in her ears. Mrs C felt that some tests had not been carried out because of her age and because of cutbacks. We found that there was no evidence of this and we found that the investigations carried out by the board into the problem had been reasonable and appropriate. In addition, there had not been any unreasonable delays in carrying out the tests. In view of all of this, we did not uphold Mrs C's complaint.

Summary

Ms C attended the plastic surgery clinic at Glasgow Royal Infirmary, after being referred by her GP because of concerns about changes to her breast implants and a discharge from her nipple. Ms C said that she had many symptoms and, after doing her own research, concluded that these were the consequence of problems with her breast implants. However, she complained that the consultant she saw failed to listen to her, and as a result, misdiagnosed her and referred her to a psychiatrist. Ms C said that she felt that she had no alternative but to pay to have her breast implants removed privately. She complained to the board who took the view that she had been treated reasonably, holistically and in accordance with usual practice. Ms C remained unhappy and brought her complaint to us.

We took independent advice from a consultant plastic surgeon. We found that the consultant at the clinic had spent a considerable time discussing Ms C's symptoms with her and examined her appropriately. However, as Ms C had expressed thoughts about self-harm, the consultant was duty bound to recommend and arrange for psychological assessment. They did not refuse to remove her implants but wanted to ensure that any treatable conditions or symptoms she was experiencing could be dealt with appropriately. The adviser confirmed that Ms C had been treated in accordance with current practice. For these reasons, we did not uphold Ms C's complaint.

Summary

Mrs C complained about the care and treatment provided to her late relative (Miss A). Miss A attended the GP practice with an abdominal swelling and was urgently referred to the gynaecology department at a hospital. Surgery was subsequently carried out to remove an ovarian cyst. Over the course of the following year, Miss A attended the practice on several occasions with various symptoms and ultimately attended the emergency department at a hospital. After various attendances at hospital, tests identified that Miss A had advanced cancer and she died within a few weeks. Mrs C believed that tests could have been carried out sooner if the practice had not ignored a family history of bowel cancer.

We took independent advice from GP adviser. We found that, prior to final visits to the practice, Miss A had not presented with symptoms that required urgent investigation or referral to a colorectal specialist (a doctor specialising in the colon and the rectum), in accordance with the relevant guidelines. We considered that there was no indication for genetic screening. We also found that it was reasonable of the practice to accept hospital staff's advice that the ovarian cyst that had been removed was non-cancerous and did not require follow-up. In light of these findings, we did not uphold Mrs C's complaint.

Summary

Mrs C complained about the care and treatment provided to her late relative (Miss A). Miss A attended her GP practice with an abdominal swelling, which led to an urgent referral to the gynaecology service at Glasgow Royal Infirmary. Tests showed that Miss A had an ovarian cyst and arrangements were made for her to have it surgically removed. She was then discharged from the gynaecology service. Over the course of the following year Miss A attended her GP with various symptoms and ultimately attended the emergency department at Glasgow Royal Infirmary. After several attendances at hospital, tests identified that she had advanced cancer. Miss A was then transferred to the Beatson West of Scotland Cancer Centre for treatment and she died a short time later.

Mrs C complained that there was an initial failure to diagnosis that Miss A had cancer when she was referred to gynaecology and the ovarian cyst was removed. Mrs C also complained that there was a delay in diagnosing Miss A with cancer after she attended the emergency department the following year, and that appropriate treatment had not been given to Miss A.

We took independent advice from consultants in pathology, gynaecology and surgery. We found that appropriate tests and investigations were initially carried out when Miss A attended the gynaecology service. However, we found that there should have been a record to show that family history of ovarian or breast cancer had been enquired into, in line with relevant guidance. In addition, we found that there was evidence to indicate that the ovarian cyst had burst during surgery, but that the records did not contain clear information about this having occurred. We also found that there was a failure to accurately report the pathology specimens after the cyst was removed. We considered that, had these been reported in a timely manner, this would have altered Miss A's clinical management and she would not have been discharged from the gynaecology service with no follow-up. We upheld Mrs C's complaint about an initial failure to diagnose Miss A.

Regarding the delay in diagnosing Miss A the following year, we found that biopsies taken at the time of a sigmoidoscopy (a procedure to visualise the rectum and lower colon) showed evidence of cancer, but that there was a two week delay in this being recognised by the clinical team and Miss A being informed of the results. We upheld this aspect of Mrs C's complaint.

We found that the appropriate option of palliative chemotherapy was decided upon and that reasonable surgical care had been provided to Miss A. However, we concluded that there may have been a lost opportunity to halt the progression of the cancer because of the time taken to communicate the findings of the sigmoidoscopy and also because of a delay in arranging treatment for blocked kidneys which Miss A had also developed. On balance, we concluded that Miss A had not been provided with appropriate treatment, and we upheld this part of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C and the family for the inaccurate reporting of the pathology specimens, the delays in communicating the cancer diagnosis and a delay in treating blocked kidneys. The apology should comply with the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-guidance.

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

• Staff should follow the guidance about enquiring into family history of ovarian or breast cancer, as recommended in the Royal College of Obstetricians and Gynaecologists' Green-top guideline No.62.
• Consideration should be given to amending the proforma to include a subheading for family history.
• Staff should record whether a cyst has been removed intact or has burst during surgery.
• Staff should ensure that pathology specimens are sampled and correlated in accordance with the Royal College of Pathologists' guidelines on ovarian tumours.
• Staff should ensure they are aware of the Royal College of Pathologists' guidelines on the examination of ovarian tumours.
• Pathology staff should ensure that new cancer diagnoses are communicated promptly to the clinical team.
• Staff should ensure in similar cases that appropriate treatment for blocked kidneys is commenced in a timely manner. An appropriate care pathway should be in place.

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.