Health

Summary

Ms C complained about the care and treatment provided to her late partner (Mr A) by GPs at the practice. Ms C complained that GPs incorrectly diagnosed a viral illness, and that they should have recommended hospital admission at an earlier point.

We took independent advice from a GP. We found that, on the two occasions that GPs from the practice attended Mr A, they assessed and examined him reasonably and that, based on this, the diagnosis of viral illness was reasonable as there was no evidence of any more serious cause of Mr A's illness. We did not uphold this complaint.

Summary

Ms C complained about the care and treatment provided to her late partner (Mr A) by an out-of-hours GP and at Belford Hospital. She complained that the GP did not reasonably assess Mr A and that, when he was later admitted to hospital, there was a delay in diagnosis which resulted in no treatment options being available for his perforated duodenal ulcer (when the lining of the stomach splits due to a sore).

We took independent advice from a GP and a consultant physician. We found that the care and treatment provided to Mr A by the GP was of a reasonable standard and that his symptoms were most fitting with a diagnosis of viral illness at this time. We also found that, whilst there was some delay in diagnosing Mr A when he was admitted to hospital (which the board had acknowledged), this did not have any impact on Mr A's outcome as, due to his other illnesses, surgery would not have been an option for him. We did not uphold this complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Ms A). Over the past twenty years Ms A has suffered from balance issues and problems with her eyes. Over a period of years, Ms A attended the ophthalmology (eye) and neurology (brain and nervous system) departments of Raigmore Hospital. Her symptoms were assessed and investigated and she was referred for a second opinion, but no causes were found for her symptoms. The ophthalmology department decided not to arrange further appointments for her and it was suggested that she attend the rehabilitation clinic. Ms A considered that clinicians had given up on her and that she had been disbelieved. Ms C complained to us that the decision to discharge Ms A to the rehabilitation clinic was unreasonable, as she had not yet been diagnosed.

We took independent advice from consultants in ophthalmology and neurology. We found that all of Ms A's care and treatment had been reasonable and appropriate but that, despite this, Ms A's symptoms remained. It was acknowledged that this was very challenging for her, however we considered that the absence of a diagnosis or abnormal test findings did not mean that she had been disbelieved. Furthermore, we found that it was sensible and reasonable to refer her to the rehabilitation clinic which was best placed to deal with her continuing condition. We did not uphold the complaint.

Summary

Ms C complained about maternity care and treatment she received at Raigmore Hospital in relation to her labour and birth. Ms C had previously had a caesarean section and had planned a vaginal delivery for this birth. Ms C went to the hospital as her waters had broken, however, she was not experiencing contractions. She was admitted and the following day, a drip was administered to augment her labour. Ms C's labour progressed with continuous monitoring of the baby's heart rate. When this dropped, the drip was stopped and Ms C had an emergency caesarean section to deliver her baby. During the operation, it was discovered that a scar from a previous caesarean section had ruptured. Ms C complained about the care she received as she considered that she was left too long without action after her waters had broken and that the drip had not been prescribed at a safe level, given her previous caesarean section. Ms C was also concerned about the board's handling of her complaint as there were delays and inaccuracies in the final response.

We tookindependent advice from a consultant obstetrician (a doctor who specialises in pregnancy and childbirth). We found that the risks and benefits of vaginal delivery following caesarean section had been discussed during Ms C's pregnancy. We found that the care and treatment Ms C received was in line with local protocols and national guidance. We did not uphold this aspect of Ms C's complaint. However, we made a recommendation that the board consider recording that the Royal College of Obstetricians and Gynaecologists leaflet on birth options after previous caesarean section is provided to patients like Ms C.

Regarding complaints handling, we found that during the board's own consideration of the case, they apologised that there had been delays in Ms C's complaint reaching the appropriate team, although we were unable to determine the reason for the delay. We found the board's final response was open to misinterpretation in terms of the timeline and plan for Ms C's care. We also noted there was an inaccuracy in relation to the rate that Ms C's drip was administered at. We upheld Ms C's complaint about the way the board handled her complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise for the inaccuracies in the final response to Ms C's 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:

• Consider ensuring (and documenting) that the Royal College of Obstetricians and Gynaecologists Patient Information Leaflet on Birth Options After Previous Caesarean Section has been provided to patients to confirm that the risks and benefits have been appropriately shared.
• The final response to complaints should be clear, accurate and easy to interpret.

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 to us about the psychiatric care and treatment his daughter (Miss A) had received from board staff. Miss A was subject to compulsory measures in a care home under mental health care legislation.

Mr C complained that the board had failed to consider the family's requests for Miss A to be moved to a different care home. We took independent advice from a consultant psychiatrist. We found that the board had acted reasonably in relation to the family's requests for Miss A to be moved. We found that the issue was discussed with the family and that attempts were made to identify and understand Miss A's views on the subject. We also found that the board had made reasonable efforts to listen to and respect the family's views. We did not uphold this aspect of the complaint.

Mr C also complained that the board had failed to provide Miss A with adequate psychiatric care while she was in the care home. He considered that this led to her admission to a psychiatric hospital. We found that there were no significant failings in the psychiatric care provided to Miss A in the care home. Her care plan had been reasonable and she had received adequate psychiatric care and supervision during the relevant period. Additional attempts to monitor or supervise Miss A would not have changed the outcome and board staff had acted reasonably in relation to this. Although we did not uphold this aspect of Mr C's complaint, we found that Miss A's records about her care plan were not of an adequate standard and we made a recommendation in relation to this.

Recommendations

Sector: health

Subject: clinical treatment / diagnosis

Decision: not upheld, recommendations

• Summary
• Mr C complained to us about the psychiatric care and treatment his daughter (Miss A) had received from board staff. Miss A was subject to compulsory measures in a care home under mental health care legislation.
• Mr C complained that the board had failed to consider the family's requests for Miss A to be moved to a different care home. We took independent advice from a consultant psychiatrist. We found that the board had acted reasonably in relation to the family's requests for Miss A to be moved. We found that the issue was discussed with the family and that attempts were made to identify and understand Miss A's views on the subject. We also found that the board had made reasonable efforts to listen to and respect the family's views. We did not uphold this aspect of the complaint.
• Mr C also complained that the board had failed to provide Miss A with adequate psychiatric care while she was in the care home. He considered that this led to her admission to a psychiatric hospital. We found that there were no significant failings in the psychiatric care provided to Miss A in the care home. Her care plan had been reasonable and she had received adequate psychiatric care and supervision during the relevant period. Additional attempts to monitor or supervise Miss A would not have changed the outcome and board staff had acted reasonably in relation to this. Although we did not uphold this aspect of Mr C's complaint, we found that Miss A's records about her care plan were not of an adequate standard and we made a recommendation in relation to this.
• Recommendations [1]

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

• Care plans in care programme approach documentation should be clear and the objectives should be focussed and specific, with responsible persons or agencies identified. There should also be a clear discussion of the outcomes of each objective recorded at each crae programme approach review. Where the board is working with another care provider, there should be a clear record of the discussion around care plan objectives allocated to such care providers and the attempts to meet these objectives.

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 to us that the practice had failed to provide appropriate care and treatment to her when she reported symptoms of altered bowel habit. When she was referred to hospital cancer specialists after a period of some months it was established that she had bowel cancer. Ms C belived that the practice should have referred her to the hospital cancer specialists earlier and that the diagnosis would have been reached sooner.

We took independent advice from a GP adviser and concluded that there were no delays in the practice making a referral for a specialist hospital opinion. Ms C had attended the practice on a number of occasions with a number of physical and psychological symptoms and initially it was felt that a referral to a respiratory clinician was appropriate. However, when Ms C continued to report different symptoms it was then appropriate for a referral to be made to the hospital cancer specialists. We found this to be reasonable and we did not uphold the complaint.

Summary

Mr C complained about the care and treatment his late mother (Mrs A) received at Queen Elizabeth University Hospital. Mrs A suffered from kidney failure. Mr C complained that her high blood pressure was not properly managed and that the care and treatment provided to her during three hospital admissions was not of a reasonable standard.

We took independent advice from a consultant nephrologist (a consultant who specialises in the kidneys). We found that Mrs A's blood pressure was managed appropriately, and that the care and treatment provided to her when she was an in-patient was reasonable. We did not uphold these aspects of Mr C's complaint.

Mr C also complained that a nurse did not provide him with an appropriate level of information when notifying him of his mother's admission to hospital. Based on the evidence available, we found that the level of information provided to Mr C was appropriate. We did not uphold this aspect of Mr C's complaint.

Summary

Ms C complained that the practice failed to provide a reasonable standard of medical care and treatment to her late father (Mr A). Mr A attended appointments at the practice over a period of two months. Mr A was initially referred to hospital by the practice to be assessed for deep-vein thrombosis (DVT, a blood clot that develops within a deep vein in the body) and was prescribed medication. The results of the ultrasound scan taken at the hospital did not indicate DVT and the medication was stopped, however, Mr A's condition deteriorated. He attended two more appointments at the practice but died of a pulmonary embolism (a blocked blood vessel in the lungs) a few days after his final appointment. Ms C said that the practice had failed to see that Mr A's symptoms indicated DVT and believed that his death could have been prevented. Ms C also complained that the practice failed to respond to her complaint in a reasonable way.

We took independent advice from a GP. We found that the medical care and treatment was of a reasonable standard based on the evidence provided and the information available to the practice at the time in question. We also noted that the practice fully addressed the issues raised and took account of the clinical evidence available when responding to Ms C's complaint. Therefore, we did not uphold Ms C's complaints.

Summary

Mr C complained that the prison healthcare centre's decision to stop his suboxone medication (medication used to treat opium addictions) was unreasonable. A prison nurse reported that Mr C appeared to act suspiciously when they were administering his suboxone medication. They did not consider that Mr C gave them an adequate opportunity to confirm that the medication had been taken correctly. His medication was subsequently stopped and he was later given methadone as an alternative opiate replacement therapy. Mr C disputed the nurse's allegation that he did not comply and brought his complaint to us.

We took independent advice from a GP. We found that Mr C's suboxone was stopped as prison healthcare staff felt that he had not complied with the instructions set out in the contracts. Mr C had signed two contracts in relation to medication and one of these declared that he understood he would be taken off suboxone if caught or suspected of concealing medication. Healthcare staff suspected that he was concealing medication and they were, therefore, entitled to act on that suspicion if they felt that there was a risk of clinical harm to Mr C and/or the good order within the prison. The adviser raised no concerns about the decision taken to stop Mr C's suboxone and we considered that this decision was reasonable in light of Mr C's suspected non-compliance. Therefore, we did not uphold this complaint.

Summary

Mr C, who works for an advocacy and support agency, complained on behalf of his client (Ms A) about the care and treatment she received at Royal Alexandria Hospital. Specifically, the complaint was about a procedure in which Ms A was given a femoral line (a tube placed by needle into a large vein near the groin) for pain relief. Mr C complained that Ms A was not given any warning or explanation before the procedure. Mr C also complained that it was not carried out properly, as Ms A found it extremely painful.

We took independent advice from a consultant in acute medicine. We found that Ms A should have been given alternative pain relief while medical staff prepared to insert the femoral line. We noted that Ms A's consent for the procedure was not properly obtained and/or documented. Finally, we found that the board had a checklist for carrying out this type of procedure but as it was not used, it was unclear if the procedure was carried out appropriately. Therefore, we considered that the board failed to provide Ms A with reasonable care and treatment and upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms A for not giving her appropriate pain relief, for failing to obtain and/or document her consent appropriately, and for failing to document the procedure reasonably. 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:

• Adequate pain relief should be given to all patients.
• Information given verbally to a patient about a procedure should be documented (including the rationale for the procedure, any alternatives, the risks involved and what the procedure will entail), along with the outcome of the consent discussion.
• Femoral lines should be inserted using the appropriate technique, equipment and anaesthetic, which can be ensured by using the central line checklist.

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.