Health

Summary

Mr C complained about the prison healthcare team's decision to withdraw his suboxone medication (medication used to treat opiate addictions). He also complained that it took an unreasonable amount of time for him to be reviewed by a GP when his prescription was discontinued.

We took independent advice from a medical adviser. Mr C was found to be concealing his medication and so it was stopped. The advice we received was that this decision was reasonable as it was in line with the medication contract that Mr C had signed. We did not uphold this aspect of Mr C's complaint.

Regarding the time taken for Mr C to be reviewed by a GP, we found that Mr C's records were reviewed by a GP within three days and that he subsequently received an appointment. The advice we received was that this wait was not unreasonable. We did not uphold this part of Mr C's complaint.

Summary

Mr C, who is an advocacy and support worker, complained on behalf of his client (Ms B) about the clinical treatment provided to Ms B's son (Mr A). Mr A had been attending the practice over a number of months with recurrent symptoms, and Ms B felt that further investigations should have been carried out to determine the cause of Mr A's symptoms.

We took independent advice from a general practitioner. We found that Mr A had been appropriately assessed, examined and investigated by the practice. We also found that appropriate referrals were made for further investigations in light of Ms B's concerns. We found that the care and treatment provided was in line with the General Medical Council Good Medical Practice guidance. We did not uphold this aspect of Mr C's complaint.

Mr C also complained that the practice had unreasonably refused to provide Mr A with a medical appointment. We found that there had been no indication for an urgent appointment when Ms B had contacted the practice and that appropriate and adequate advice had been provided by the practice to Ms B based on Mr A's past clinical record, past attendances and persistently normal investigations. We did not uphold this aspect of Mr C's complaint.

Summary

Mrs C complained to us about the care and treatment she received at her GP practice. She considered that the practice delayed in diagnosing the severity of circulation problems in her leg and she questioned the treatment she had received. Mrs C felt that she should have been referred to the hospital's vascular department sooner. She believed that if she had been provided with appropriate clinical treatment and referred to vascular surgeons earlier then she may not have had to have her lower leg amputated.

We took independent advice from a GP adviser. We found that the assessment and treatment provided to Mrs C by the practice doctors was reasonable and appropriate and was in accordance with national guidelines. We found that there was no unreasonable delay by the practice in making the referral to the vascular department and that the referral did not require to be urgent because, at the time Mrs C was assessed, there was nothing to suggest critical ischaemia (an advanced state of peripheral artery disease and a threat to a limb). In addition, the referral had appropriately requested further investigation and clearly stated that Mrs C's doctor suspected vascular disease and asked that a doppler scan (a non-invasive test that can be used to estimate the patient's blood flow through blood vessels by bouncing high-frequency sound waves off of circulating red blood cells) be arranged. We also considered that there was no evidence to support the view that an earlier referral by the practice could have avoided the loss of Mrs C's lower leg.

Taking account of the evidence available, and the advice we received, we did not uphold Mrs C's complaints.

Summary

Mr C, who was diagnosed with gastric lymphoma (a cancer originating in the stomach), complained that there had been an unreasonable delay by the practice in referring him for a specialist opinion. We took independent advice from a general practitioner. We found that there was no undue delay in referring Mr C for a specialist opinion given the information the practice had on which to base their decision. We also found that the practice had been diligent in their review of Mr C's case and that the action taken by the practice was reasonable. We did not uphold Mr C's complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mr A). Mr A had been on a waiting list for a prostate operation for severe incontinence for a number of months and, despite several letters from the board saying that he would undergo the operation within weeks, he was still waiting when Ms C made the complaint to us, approximately nine months after Mr A was first put on the waiting list. Ms C said this was contrary to the treatment time guarantee (12 weeks) and did not take into account Mr A's clinical need. She also noted that Mr A was willing to travel to any hospital in the UK to undergo the operation. Ms C told us that Mr A's operation had been cancelled on three occasions at the very last minute and said that, as a result of the board's failings, his physical and mental health had deteriorated.

We took independent advice from an adviser who specialises in urology. We found that the board's failure to meet the treatment time guarantee or consider other healthcare providers meant that Mr A suffered severe lower urinary tract symptoms unnecessarily for an unreasonable number of months, with significant implications for his physical and emotional health as a result. In relation to communication, we also found it unreasonable that, at times, Mr A had to take the initiative to find out what was happening once the 12 weeks treatment time guarantee period had passed. We were not satisfied from the evidence available that the board had reasonably had regard to the legislation concerning the treatment time guarantee, and we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for failing to provide treatment within a reasonable time.

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

• Review their process and patient letters to ensure that they comply with the treatment time guidance, including considering alternative providers and communication with patients.
• Reflect on this case in relation to whether opportunities to reassess Mr A's clinical priority were missed and report back to us on the findings.

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 son (Mr A) about the care and treatment provided to him by the board in relation to his Crohn's disease (a chronic inflammatory disease of the intestines). Mrs C had a number of concerns, including that one of the medications he was prescribed resulted in him developing steroid-induced diabetes and that this had not been monitored appropriately. She was also concerned that Mr A was not appropriately prepared prior to surgery to remove the colon. Mrs C felt that Mr A should have been offered support and counselling on the seriousness and potential consequences of the surgery.

We took independent advice from a gastroenterologist, a GP, and a colorectal surgeon. We found that there were aspects of Mr A's care that were reasonable, including the care provided to him prior to his surgery. However, we found that there was a failing of a consultant to clearly delegate the monitoring of Mr A's blood sugar levels to his GP. We also found that the board had not followed the UK Inflammatory Bowel Disease standards when managing Mr A's care in that they did not discuss him at a multi-disciplinary meeting. Therefore, we upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise for failing to provide reasonable clinical 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.

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

• Any instructions from a consultant to a GP should be communicated to the GP in a clear manner.
• The board should consider adopting the UK Inflammatory Bowel Disease standards in the management of similar patients.

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 from the board in relation to a urodynamics assessment (a test which uses pressure readings to assess the function of the bladder) carried out at the Queen Elizabeth University Hospital. Although Mr C returned home on the day of the assessment, he later became unwell and was admitted to the hospital for over two weeks. Mr C considered that the urodynamics assessment had not been carried out appropriately and he complained that this resulted in his subsequent symptoms, including haematuria (blood in the urine) and urine retention (the inability to completely empty the bladder). Mr C also complained that, after he had received treatment as an in-patient, his discharge was unreasonably delayed.

After taking independent advice on this case from a consultant urologist, we upheld Mr C's complaint about the urodynamics assessment as we found that there were technical problems with the way that the assessment was carried out. We did not, however, find that these failings had resulted in Mr C's later symptoms. We found that verbal consent had been obtained from Mr C before the procedure, and we made a recommendation to the board that they consider obtaining consent in writing in the future. We made a number of further recommendations on the basis of our findings, including that the board review their patient information leaflet for urodynamics procedures.

Regarding Mr C's discharge, the advice we received was that there had been no unreasonable delay in discharging Mr C from hospital and we did not uphold this part of his complaint.

Recommendations

What we asked the organisation to do in this case:

• Provide Mr C with an apology for the failure to carry out the urodynamics assessment in line with relevant guidance and advise him if any re-assessment is necessary. 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:

• Staff should be aware of the guidance on good urodynamics practice.
• Consideration should be given to introducing a documented informed consent process for urodynamics assessments.
• The patient information sheets should be reviewed and consideration should be given to including reference to urinary retention and haematuria, plus advice on what to do if these symptoms are experienced.

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 had a vaginal hysterectomy (a surgical procedure to remove the uterus through the vagina) at the Royal Alexandra Hospital. Two weeks after the surgery, Ms C started to experience sharp pains in her vulva (the skin surrounding the entrance to the vagina). She attended the gynaecology clinic at Inverclyde Royal Hospital on three occasions over the following months for treatment and was seen by a consultant and an associate specialist. Ms C's pain persisted and by the following year was intolerable. Ms C continued to try to obtain treatment for her pain and, nearly three years after her hysterectomy, was diagnosed with vulvodynia (persistent unexplained pain in the vulva). She then started treatment for this condition.

Ms C complained that the board unreasonably failed to make her aware, prior to her surgery, that vulvodynia was a possible complication of the hysterectomy surgery. She also raised concerns that the consultant and the specialist at Inverclyde Royal Hospital failed to provide her with adequate care and treatment in the three months following her surgery. She also complained that in their response to her complaint, the board failed to adequately acknowledge that the pain she experienced, and continued to experience, was directly linked to the hysterectomy surgery.

We took independent advice from a consultant gynaecologist. The adviser said that vulvodynia following vaginal hysterectomy is rare, but that there is no data to quantify how rare it is. They said that the average surgeon might never encounter it and that they would therefore not have expected Ms C to have been made aware during the consent process that vulvodynia could be a possible complication of her surgery. We did not uphold this part of Ms C's complaint.

The adviser said that Ms C should not have been discharged from care after each of her appointments with the gynaecological team at Inverclyde Royal Hospital, as her core problem was still unresolved. We upheld this aspect of Ms C's complaint.

In relation to complaints handling, the adviser explained that although Ms C's pain being directly liked to her vaginal hysterectomy was a rare risk, the timing of her symptoms in relation to the surgery was undeniable. The adviser said that at least a strong association should have been acknowledged by the board. On balance, 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 discharging her from care after each of her appointments at Inverclyde Royal Hospital, as her core problem was unresolved. Also apologise for failing to acknowledge the strong association between the surgery and the pain Ms C experienced.

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 standard of pressure area care which his mother (Mrs A) received while she was a patient in Woodend Hospital. Mrs A was in hospital for a number of months and, due to her reduced mobility, developed a grade two pressure ulcer which progressed to a grade four pressure ulcer. A grade four pressure ulcer is the most severe kind, and people with grade four pressure ulcers have a high risk of developing life-threatening infections.

We took independent advice from a nursing adviser who noted that appropriate risk assessments were not carried out and incorrect equipment had been used in an effort to prevent the development of and healing of pressure ulcers. While the staff had taken action to change Mrs A's position in bed and when she was sitting in a chair, these were not changed frequently enough. There was also a delay by the staff in referring Mrs A for an assessment by the tissue viability service. We upheld the complaint.

However, we did note that the board have since carried out an investigation and audit which identified learning opportunities for staff in regards to knowledge and awareness of pressure area care.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs A for the failings in pressure area care. The apology should meet the standards set out in the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-guidance.

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 on behalf of her brother (Mr A) about the care and treatment provided to him across numerous admissions to Aberdeen Royal Infirmary. Mr A underwent various surgeries to treat spinal cord compression and a spinal abscess. After surgery to drain the spinal abscess, Mr A was left paralysed from his waist down and was left with only partial movement in his upper body.

Miss C complained to the board as she felt that Mr A had not been properly cared for and treated. She believed that opportunities were lost to treat him sooner, and that his outcome may have been different if these opportunities had been taken. The board responded, however Miss C remained unhappy and brought her complaints to us.

Miss C complained that the board did not provide reasonable treatment to Mr A across his numerous admissions to the hospital. We took independent advice from consultants in radiology and neurosurgery, and from a nurse. We found that there was an opportunity missed to drain the spinal abscess. Had the abscess been drained at that time we considered that Mr A's outcome may have been different. We found that a scan that was carried out by an outsourced company out-of-hours did not meet a satisfactory standard, however this was not identified as having impacted Mr A's outcome. We also found that Mr A's case could have been considered in a more holistic way. We upheld this aspect of Miss C's complaint.

In relation to Mr A's discharge home from hospital, Miss C complained that he was unreasonably discharged on one occasion, and that the board unreasonably failed to ensure that there was a suitable home care package in place for him following that discharge. We found no evidence to suggest that Mr A was discharged unreasonably. We found that the relevant paperwork had been completed, and that Mr A had capacity and was in agreement with the decision to discharge him at that time. We also found that there was no evidence of a need for Mr A to have a home care package in place on his discharge home. We therefore did not uphold these aspects of Miss C's complaint.

Miss C also complained that the board did not respond reasonably to her complaints. We found that the board delayed in providing a response to Miss C's complaints and that she was not kept updated. We upheld this aspect of her complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for not draining his abscess at an earlier time and for the lack of a holistic approach to his care. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.
• Apologise to Miss C for the failure to provide a timely response to her complaint and for failing to reasonably update her. 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:

• In circumstances similar to those of Mr A, consideration should be given to draining any abscess. The decision should be fully documented and care should be considered holistically.
• All outsourced advice on scans should reach the same standards as those provided in-house.

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.