Health

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.

Summary

Miss C complained on behalf of her late mother (Mrs A) that the practice unreasonably admitted Mrs A to hospital when it was her wish to remain at home. Mrs A had terminal cancer and was being cared for at home. A GP from the practice visited her at home and was concerned about the ability to meet her care needs there. Therefore, the GP arranged for Mrs A to be admitted to hospital where she died two days later. Miss C was concerned that this was against Mrs A's wishes as she had wanted to remain at home.

We took independent advice from a GP. The adviser considered that the initial decision to have Mrs A admitted to hospital was reasonable. However, by the time that the ambulance crew had arrived, she had lost consciousness. We found that, at that point, the GP should have consulted the family about having Mrs A admitted to hospital. We considered that Mrs A should have been allowed to remain at home if that was what her family wanted. Therefore, we upheld Miss C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for not clarifying and acting in line with her family's wishes about Mrs A's admission to hospital. 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:

• When someone is in the final days of their life, there should be shared decision making with them and with their family, as appropriate, about their care.

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 to us on behalf of her late mother (Mrs A). Mrs A was admitted to Victoria Hospital with stomach pain, which was thought to have been gallstones (small stones that form in the gallbladder). Mrs A was later diagnosed with cancer. Miss C complained that there was an unreasonable delay in diagnosing Mrs A's cancer.

We took independent advice from a consultant surgeon and a consultant radiologist. We found that the board carried out appropriate investigations into Mrs A's condition. However, we found that the board's interpretation of a scan was not reasonable as the scan results raised the possibility that Mrs A had liver cancer or a liver infection and that further investigations should have been recommended as a result of this. We found that there was an unreasonable delay in giving Mrs A an appointment to discuss those scan results and we noted that the board had identified this failing. We considered that the failings in the interpretation of Mrs A's scan led to an unreasonable delay in diagnosing her cancer. Therefore, we upheld this aspect of Miss C's complaint.

Miss C also complained about an unreasonable delay in proceeding with surgery on Mrs A's gallbladder. We found that it was appropriate that the board tried to treat her without surgery first. We, therefore, did not uphold this aspect of Miss C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for the delay in diagnosing Mrs A's cancer. 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:

• As far as possible, scan findings should be accurately reported.

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 that the board failed to process an autism spectrum disorder (ASD) assessment for her child (child A). Mrs C said there were a range of administrative errors in the process, which led to significant delays. Mrs C also said that the board unreasonably tried to transfer child A's care to a different health board, based on child A attending a new school outwith the board area.

The board upheld Mrs C's complaint and apologised for some administrative errors in the process. They acknowledged that they were responsible for the assessment (rather than the other health board) and that their current wait times for assessment were unacceptable. The board said that they were introducing a new assessment pathway to improve this, including a new central point of contact for processing referrals. Mrs C remained dissatisfied and brought her complaint to us.

We took independent paediatric and nursing advice. We found that the board failed to process child A's referral in line with their own guidance, including failing to follow-up the paperwork sent to Mrs C. The board also failed to arrange a planned follow-up appointment with a paediatrician. We also found that it was unreasonable that the board tried to transfer child A outwith the board area, as staff should have been aware that they were responsible for all children resident in the board area, regardless of schooling. We upheld Mrs C's complaint.

While the board had acknowledged some failings, we found that their response to Mrs C did not give a clear and full apology for all the failings we identified. We considered that the action taken by the board to improve waiting times and communication was appropriate. However, we were concerned that, in 2014, we made similar findings about a delay in an ASD assessment (case 201401014) and, while the board took action following that case to reduce waiting times, these appeared to have extended again significantly. The board said that they had implemented a new pathway for ASD assessments, and we asked to see evidence of this and other actions the board is taking to reduce waiting times. We also made a number of recommendations.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C's family for the unreasonable delay in the ASD assessment, their error in attempting to refer child A outwith the board area, the administrative failings in their handling of the assessment pathway, and the failure to provide a follow-up paediatric review. 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:

• Information about patients within the board's area of responsibility should be easily accessible to all staff.
• Requests for consent to ASD assessment should be followed up, in line with the relevant guidance, when there is no response.
• Planned follow-up reviews should take place. If this is subsequently considered not necessary, clear explanations should be provided to the patient.

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 clinical and nursing care and treatment she received when she was admitted to Victoria Hospital. In particular, that there was an unreasonable delay in surgery being carried out to remove her ovaries and an unreasonable delay in arranging surgery for the repair of an incisional hernia (a type of hernia caused by an incompletely-healed surgical wound). Mrs C also complained that the nursing care and treatment of her wound following surgery was unreasonable.

We took independent advice from a consultant in obstetrics and gynaecology (the medical specialty that deals with pregnancy, childbirth, and the post-partum period and the health of the female reproductive systems and the breasts), a consultant general surgeon and a nursing adviser.

In relation to the clinical care and treatment provided to Mrs C, we found that the delay in carrying out surgery to remove Mrs C's ovaries was not unreasonable. However, we were concerned that some of Mrs C's medical records were missing. We did not uphold this aspect of Mrs C's complaint but made a recommendation about the missing medical records.

With regard to arranging surgery for the repair of an incision hernia, we found that the board failed to meet the legal treatment guarantee time, which states that health boards should take all reasonable steps to ensure that patients receive in-patient and day case treatment within 12 weeks of treatment being agreed. We also found that there was no evidence that Mrs C was advised of her options given the failure to meet this guarantee. Therefore, we upheld this aspect of Mrs C's complaint.

In relation to the nursing care and treatment provided to Mrs C's wound, we found that there was no evidence of failings in care and that the treatment she received was reasonable. Therefore, we did not uphold this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the unreasonable delay in arranging surgery for the repair of an incisional hernia. 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 be kept in accordance with the Scottish Government Records Management: NHS Code of Practice (Scotland).
• The board should inform patients as soon as possible of any inability to meet treatment targets and provide them with information about the options available to them in the circumstances.

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 about the care and treatment he received at University Hospital Crosshouse following a referral made by his GP. He was suffering from chest pain and was seen by a consultant cardiologist (a doctor who specialises in finding, treating and preventing diseases of the heart and blood vessels) at the hospital. Mr C complained that the examination he received was poor and that the consultant failed to take into account all the information provided by his GP. At a later appointment, Mr C underwent an echocardiogram (echo - a heart scan that uses sound waves to create images) and was fitted with a Holter monitor (a device that measures and records the heart's activity). Mr C considered that the results were not properly reported and no follow-up appointment was made. He complained to the board who confirmed that there had been errors in the consultant's note taking but that they did not impact upon his care. Mr C was unhappy with this response and brought his complaint to us.

We took independent advice from a consultant cardiologist. We found that some records contained inaccuracies and that there had been no reference made to Mr C's chest pain which was the reason for his attendance. We also found that no investigations were made at his initial referral and the adviser noted that they would have expected an electrocardiogram (ECG - a test that records the electrical activity of the heart) to be carried out. We found that the subsequent echo was reported as normal although there were some abnormalities. We considered that the board failed to provide reasonable care and treatment and upheld Mr C's complaint. However, we noted that although some information was not recorded correctly, this would not have affected Mr C's treatment.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to provide a reasonable level of cardiology care and treatment. 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 cardiology department should consider whether all new cardiology patients should have an ECG on arrival and consider whether or not provision should be made to arrange other tests prior to, or very soon after, consultation.
• In their clinical records, the named consultant in cardiology should consider and offer opinion about their patients' presenting symptoms.

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 during out-patient consultations at University Hospital Crosshouse. Mrs C initially attended a consultation in the renal medicine department (department of medicine relating to the kidneys) and it was felt that her test results showed that she had sub-clinical hypothyroidism (a condition where thyroid stimulating hormone level is higher than normal). Mrs C was prescribed a small dose of medication to treat this. Mrs C subsequently attended a consultation in a different department. This department did not agree that Mrs C had sub-clinical hypothyroidism and recommended that the medication should be stopped. A review appointment was arranged for three months' time. Mrs C was unhappy with this decision and undertook to self-source a supply of thyroid medication. She attended a further consultation in the renal medicine department approximately a year later. At this time, Mrs C was advised to discontinue taking her self-sourced thyroid medication as it was considered that it was causing suppression of her thyroid stimulating hormone. Mrs C disagreed with the board's findings and explained that she felt better taking the thyroid medication, which she reported had also improved her kidney function. She complained to us that the board were not providing her with the medication she felt she needed. Mrs C also complained that she was unreasonably advised to stop taking her self-sourced thyroid medication.

We took indepdendent advice from a consultant physician. We found that the test results over a number of years did not show evidence of sub-clinical hypothyroidism. For this reason, we considered it was reasonable for the board to discontinue the medication and to advise Mrs C of the risks of continued use. In relation to Mrs C's consultation in the renal medicine department a year later, we found that it was reasonable for the board to recommend that Mrs C stop taking the medication. We did not uphold Mrs C's complaints.