Health

Summary

Mrs C complained that her late husband (Mr A) had been taken to the wrong hospital by the ambulance service. Mrs C explained that, when Mr A became ill, she recognised signs of a stroke and called an ambulance. She said she thought that, according to the protocol in place at the time, Mr A should have been admitted to the Hyper Acute Stroke Unit at a particular hospital. He was taken to a different hospital and Mrs C felt that this had had an impact on the treatment he was given.

We took independent advice from a paramedic. We found that, on the basis of the information given by Mrs C in the emergency call, the ambulance crew should have suspected a stroke and on this basis should have taken Mr A to the stroke unit at the hospital where Mrs C thought he should have gone. We, therefore, upheld this complaint. We noted that the ambulance service had carried out stroke education since the events of this complaint; however we recommended that they carry out an audit to confirm that patients are being taken to the correct hospital. We also noted that the ambulance crew had failed to document a test they carried out, and we made a recommendation on this point.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for unreasonably taking Mr A to the hospital they did, rather than the specialist stroke unit elsewhere.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:

• Tests carried out by ambulance crews when attending a patient should be documented.
• In similar situations, suspected stroke patients should routinely be taken to the Hyper Acute Stroke Unit, as opposed to the local emergency department in line with protocol.

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 care and treatment provided by the ambulance service to her mother (Mrs A). Miss C raised concerns that the ambulance crew did not handle Mrs A's transfer to hospital appropriately. In particular, that she had been dropped in the vehicle and that she had bruising on her back. Miss C also complained that the ambulance services' investigation and response to her complaint were unreasonable.

We took independent advice from a registered nurse who is experienced in moving and handling issues. We found that based on the paramedic records, staff undertook the handling and transfer of Mrs A appropriately. Therefore, we did not uphold this aspect of Miss C's complaint.

In relation to complaints handling, we found that there was no evidence of factual inaccuracy in the complaints response from the ambulance service, and that they had apologised for the delay in providing the response. Therefore, we did not uphold this complaint.

Summary

Following an x-ray of her spine, Mrs C's GP made a referral for a DEXA scan (dual-energy x-ray absorptiometry scan - a scan which is used to measure bone density). This referral, and a further referral, were rejected by the board as Mrs C did not meet the criteria. Mrs C was unhappy with this decision and complained to the board. The board said that because DEXA uses ionising radiation and they were required to assess whether the radiation detriment was outweighed by the benefit of receiving the scan. The board said that the referral criteria require a patient to have a predicated fracture risk of 10%, and since Mrs C's calculated risk was lower than this she did not meet the referral criteria.

We took independent advice from a general medical adviser. We found that the board's referral criteria were based on appropriate national guidance, and we were satisfied that it was reasonable not to offer Mrs C a DEXA scan as she did not meet the criteria. We did not uphold the complaint.

Summary

Mr C, who is a solicitor, complained on behalf of his client (Mr A) about the treatment Mr A had received from the prison health centre. Mr A was assaulted and suffered a broken jaw. Some months after this, he started experiencing headaches. Mr A attended a number of GP consultations and his pain relief medication was adjusted at various points as a result. When Mr A suggested that the prescribed medication was not effective, he was referred to neurology (a branch of medicine that looks at the brain and nervous system) and had a scan. The results of this came back as normal and Mr A continued to be treated through adjustments to his pain relief medication. Mr C complained that the pain medication provided to Mr A was not reasonable or appropriate.

We took independent advice from a GP adviser. We were satisfied that Mr A had been treated in line with General Medical Council and World Health Organisation best practice guidelines. We found that the medication prescribed had been appropriate.

The board acknowledged that they did not pass on Mr A's scan results to him and apologised to him directly for this. They also outlined steps that they had taken to ensure this didn't happen again. We were satisfied that the fact that Mr A was not provided with his scan results had no impact on the treatment provided or medication prescribed. On balance, we did not uphold the complaint.

Summary

Mr C complained about the treatment he received form the prison health care service. He reported numerous health problems including persistent headaches, bodily twitching, and concerns about his testicles.

We took independent advice from a GP adviser. We found that Mr C had received a reasonable standard of treatment. He had been referred to urology (the area of medicine specialising in the kidneys, bladder, urinary tract and men's sexual organs) and neurology (the area of medicine specialising in the brain and nervous system) on several occasions, and we considered that the referrals had been made appropriately and in line with clinical guidelines, without any delay.

We found no evidence that Mr C's treatment was not of a reasonable standard. We, therefore, did not uphold his complaint.

Summary

Mr C complained about the care and treatment provided to his father (Mr A) at the Western General Hospital. Mr C complained that there was a delay in the board diagnosing Mr A's non-Hodgkin's lymphoma (a form of blood cancer), and that the board did not follow-up his complaint in a reasonable way.

We took independent advice from a consultant radiologist (a doctor who specialises in x-rays and scans) and from a consultant geriatrician (a doctor who specialises in medicine of the elderly). We found that there was an error in the reporting of a scan that Mr A had undergone for an unrelated condition, which resulted in a delay in the cancer diagnosis. We found that the board had acknowledged this delay and had taken some action to address this failing, however we made a further recommendation on this matter.

We also found that, after a meeting had been held with Mr C regarding his complaint, there appeared to be some uncertainty within the board as to what action they had agreed to take. We found that they should have contacted Mr C to clarify what outcome he was seeking and the failure to do so meant there were perceived delays in complaint handling.

We upheld both of Mr C's complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for the unreasonable delay in diagnosing him with non-Hodgkin's lymphoma; and apologise to Mr C for failing to follow up his complaint in a reasonable way. 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.

In relation to complaints handling, we recommended:

• Where it is not clear what outcome is expected from a complaint, steps should be taken to find out.

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 that the board unreasonably refused to support an out of area referral for a specialist neurosurgical assessment of his chronic migraines. Mr C suffered from chronic migraines for a number of years and had explored non-surgical treatment options but they did not help his situation. He wished to receive a professional opinion on surgical treatment options including occipital nerve stimulation (a procedure where a surgical implant is inserted near the occipital nerve - a nerve in the brain - which can be controlled by the patient to deliver electrical impulses with the aim of masking pain). However, this treatment is not available in Scotland. Mr C saw a consultant neurologist (a doctor who specialises in the brain and nervous system) in another Scottish health board area, who wrote a referral to a specialist centre in England. However, Mr C's consultant neurologist at his local board refused to support such a referral and funding was not approved. The board's view was that there was not a good evidence base for such interventions for patients with migraine. Mr C was unhappy with this response and brought his complaint to us.

We took independent advice from a professor of neurology with specialist expertise in headache disorders. We found that the board's decision was reasonable and was consistent with relevant guidance. Therefore, we did not uphold this complaint.

Summary

Mrs C presented to the practice with weakness and pins & needles in her limbs and head. The practice reviewed her and arranged blood tests. She was informed that these came back normal and no further action was taken. Mrs C's symptoms began to improve over the following months and had resolved by the end of the year. However, her symptoms returned and she presented to the practice again, nearly two years after her initial appointment. She was referred to neurology and, following an MRI scan, was diagnosed with relapsing remitting multiple sclerosis (MS). Mrs C complained that this could have been diagnosed sooner, had she been referred for further tests following her first appointment at the practice.

In responding to Mrs C's complaint, the practice said that the possibility of MS was considered but due to the fact that this was Mrs C's first presentation, that there was a lack of symptoms and that there was an absence of positive family history, they felt that the symptoms were unexplained. They said that the plan was to 'book bloods and review' and they apologised that they did not express clearly enough to Mrs C that she was expected to return for review. They observed that she was referred promptly at her second appointment as this was a second presentation of sensory symptoms, and that she was also exhibiting further symptoms.

We took independent medical advice from a GP, who considered that an appropriate level of assessment and investigation took place for a first presentation of such symptoms. We found that it is generally accepted that MS is suspected if there are two or more episodes of suspicious symptoms. We noted that it would have been reasonable for the practice to have clearly explained to Mrs C that they wished to follow up her symptoms following the blood tests. The General Medical Council's Good Medical Practice (GMC GMP) guidance refers to this as 'safety netting'. However, the adviser did not consider this to be a serious oversight, as it is reasonable for GPs to expect patients to return if their symptoms persist. Mrs C's symptoms subsequently resolved and she did not present again until around 22 months later. We found that the practice acted reasonably and did not uphold Mrs C's complaint. However, we made a recommendation to the practice in light of our findings.

Recommendations

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

• The practice should familiarise themselves with GMC GMP guidelines on 'safety netting' and ensure that they clearly communicate follow-up arrangements to 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

Mrs C complained about the care and treatment her late husband (Mr A) received at the Western General Hospital during two admissions. Mr A had been admitted to hospital with side effects of chemotherapy that he was receiving for plasmablastic lymphoma (a rare and aggressive form of blood cancer). During his first admission, Mr A had a couple of falls and was later discharged. Mr A was then readmitted and died a short time later. Mrs C complained that communication with the family about Mr A's condition was unreasonable and that nursing staff did not administer his medication properly. Mrs C also complained that the medical care and treatment Mr A received was unreasonable and that the board failed to handle her complaint appropriately.

We took independent advice from a consultant haematologist (a doctor who specialises in medicine of the blood) and from a registered nurse. We found that there had been communication failings with the family during Mr A's hospital admissions, in particular towards the frailty of his condition. Therefore, we upheld this aspect of Mrs C's complaint. However, we noted that the board had acknowledged these failings and had apologised.

In relation to Mr A's medication, we could not find any evidence to show that his medication had been administered inappropriately by nursing staff. Therefore, we did not uphold this aspect of Mrs C's complaint.

Overall, we found that the care and treatment Mr A received was reasonable and we did not uphold this aspect of Mrs C's complaint.

Finally, we found that the board's response to Mrs C's complaint was generally of a good standard. However, they had not kept her informed of delays in their response and they did not address a new issue that was raised. On balance, we upheld this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to handle her complaint to a reasonable standard. 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:

• There should be proper discussions about advanced care planning with patients and their relatives/carers, where relevant, and these discussions documented clearly.

In relation to complaints handling, we recommended:

• Updates should be provided where the 20 working day timescale for complaints cannot be met; and follow-up correspondence should be carefully reviewed and appropriately responded to.

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 practice failed to provide appropriate care and treatment to her late husband (Mr A). Mr A, who had type 2 diabetes, had thought he was suffering from a urine infection but the practice dismissed the suggestion and did not provide medication. Mr A subsequently developed chest and back pain over the next week. A house visit was then requested early in the morning but it took until early evening for a GP to visit. The GP felt that Mr A required a hospital admission and an ambulance was called to take Mr A to hospital. He died the following day. Mrs C complained that the practice failed to diagnose that Mr A had a urine infection and that, on the day he was taken to hospital, there was an unreasonable delay in a GP making a home visit.

We took independent advice from an adviser in general practice medicine and found that the practice provided Mr A with reasonable treatment regarding his perceived urine infection. The practice carried out an appropriate assessment, including testing for a urine infection, which was reported as negative. Therefore, we did not uphold this aspect of Mrs C's complaint.

In relation to the home visit, we found that there was an unreasonable delay in arranging the home visit to Mr A as there was a breakdown in communication when the request for a home visit was considered. Initially, it was felt that an advanced nurse practitioner should visit but they felt that it was outwith their remit and there was a delay in the request being picked up by the GP. Therefore, we upheld this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the delay in advising the duty doctor that a home visit had been requested. The apology should meet the standards set out in the SPSO guidelines on apology available at https://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.