Health

Summary

Mrs C complained about the care and treatment her father (Mr A) received from the board at Caithness General Hospital. Mrs C complained that the board unreasonably failed to take into account her father's dementia, unreasonably failed to establish that Mrs C held a welfare power of attorney in respect of her father and unreasonably failed to obtain appropriate consent for a gastroscopy procedure (an examination of the inside of the gullet, stomach and the first part of the small intestine).

We took independent advice from a nurse and from a consultant in acute medicine. Based on the information in Mr A's records and the advice we received, we considered that the board did not unreasonably fail to take into account Mr A's dementia while he was in hospital and we did not uphold this part of the complaint. However, we were concerned that some documents relating to this were not completed by hospital staff and so we made a recommendation regarding this.

On the issue of welfare power of attorney, we found that attempts should have been made to establish if Mr A had a welfare power of attorney within 24 hours of admission. We found that this had taken the board three days and that this was an unreasonably long time for this to take. We upheld this aspect of the complaint.

Mr A had more than one gastroscopy and Mrs C's complaint was that the board had not obtained appropriate consent for the first gastroscopy. We found that it was reasonable for staff to conclude that Mr A had sufficient capacity to give his consent for his first gastroscopy procedure and that appropriate consent was obtained. We, therefore, did not uphold this part of Mrs C's complaint. However, we were concerned about the consent process for Mr A's second gastroscopy and we found that an adult with incapacity form (completed for patients deemed not to have capacity to consent) should have been completed and that the procedure should have been discussed with Mrs C. We also found that the board's response to Mrs C's complaint was inadequate. We, therefore, made recommendations on these matters.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C, Mr A and their family for the failings in establishing if Mr A had welfare power of attorney, the failings in record-keeping and the complaints handling failures. 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:

• Patients' Admission/Care Records and Treatment Escalation Plans should be completed fully and accurately.
• In cases such as this, staff should establish if patients have a welfare power of attorney in a timely manner.
• In cases such as this, staff should obtain appropriate consent for patients' surgical procedures.

In relation to complaints handling, we recommended:

• Information in internal investigations of complaints should be accurately reflected in complaint responses and full explanations of decisions should be provided.

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 that the medical practice wrongly provided her with the flu vaccination a number of years ago and that, as a result, she suffered from numerous medical conditions. These included brain damage, multiple sclerosis, uveitis (inflammation in the eye), reactive arthritis and facial disfigurement. Ms C was concerned that she had not been advised of the risks or potential side effects of the vaccination.

We took independent advice from a GP and found that it was appropriate for the practice to have offered Ms C the vaccination as she suffered from asthma. There was nothing in Ms C's medical records that showed she was suffering from any medical conditions which would have prevented her from receiving the flu vaccination. We also noted that Ms C had signed the consent form for the vaccination at the time. In addition, Ms C's later health issues were not recognised as being attributed side effects from the vaccination. Therefore, we did not uphold the complaint.

Summary

Mr C, who works for an advice and support agency, complained to us on behalf of his client (Mrs A) that her GP practice failed to provide her with appropriate medical treatment for a painful shoulder. Mrs A asked the practice to give her a steroid injection as her frozen shoulder was causing her pain and distress but was referred to physiotherapy who would decide whether or not to provide the injection. Mrs A was unhappy as she had been given the steroid injection by the practice the year before.

We took independent advice from a GP and found that the practice had provided a reasonable level of care. Although some practices can administer steroid injections to patients if they have additional training, there is no requirement for them to do so. We found that the practice had acted reasonably by asking Mrs A to attend physiotherapy and that they would determine if it was appropriate to administer a steroid injection. We also found that the practice had acted reasonably by prescribing painkilling medication to Mrs A in order to address her symptoms. Therefore, we did not uphold Mr C's complaint.

Summary

Mr C complained that his dentist had failed to provide him with appropriate dental treatment. In particular Mr C felt that his dentist had taken a radiograph which was not required and that they had tried to promote the use of private dental treatment over NHS treatment.

We took independent advice from an adviser in general dentistry and found that the dentist had acted in accordance with the national guidance for taking radiographs. The radiographs indicated that there was decay present in Mr C's teeth and that the dentist had suggested appropriate treatment to be carried out. The records also contained evidence of discussions between the dentist and Mr C where it was explained what treatment was available on either NHS dental treatment or private dental treatment. There was no evidence to suggest that the dentist had promoted private dental care. Therefore, we did not uphold Mr C's complaint.

Summary

Mr C, who works for an advice and support agency, complained on behalf of his client (Mrs A) about aspects of her admission at Royal Alexandra Hospital. Mrs A was admitted to the hospital after she experienced flu-like symptoms. She was initially treated in the acute medical unit before being transferred to the acute stroke unit. Following a CT scan, a diagnosis of dural venous sinus thrombosis (a type of blood clot that affects part of the brain) was confirmed. Mrs A continued to receive care on the ward, and after she was able to move independently, she was discharged home with a follow-up consultation arranged in the neurology department.

Mrs A was unhappy about the lack of information provided to her about her condition, during her admission. She said that she was not informed that she had two clots in her brain until she attended a consultation with the neurologist three months after discharge. In response to the complaint, the board said that the stroke physician recalled discussing the diagnosis and the need for anticoagulation treatment (treatment with drugs that reduce the body's ability to form clots in the blood) with Mrs A, and also recalled Mrs A's agreement to this treatment. Mrs A was unhappy with this response and brought her complaint to us.

We took independent advice from a medical adviser with experience in stroke care. We found that the care and treatment provided to Mrs A was of a good standard. However, there was no documentation indicating that Mrs A was given an explanation of what was being done, and why, at the time of her treatment. The adviser said that it would have been good practice to record the important parts of the communication with the patient. We could not find evidence of this in the board’s record-keeping and we, therefore, were not satisfied that Mrs A was provided with appropriate information about her condition during her admission. We upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs A for failing to provide her with appropriate information about her condition and any anxiety this might have caused her. 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:

• Medical staff should provide patients with the information they want or need to know in a way they can understand, and ensure this is documented.

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 visited her GP practice a number of times as she had concerns about a loss of appetite and unexplained weight loss. The practice carried out blood tests, and referred Ms C for an x-ray and an ultrasound. When these tests reported as normal, the practice referred Ms C to a gastroenterologist (a doctor specialising in the treatment of conditions affecting the liver, intestine and pancreas). Ms C complained that the practice unreasonably delayed in investigating her weight loss.

We took independent advice from a GP. We found that the practice carried out the relevant tests and referred Ms C to gastroenterology at the appropriate time. The practice acted appropriately and did not delay in investigating Ms C's weight loss. Therefore, we did not uphold this complaint.

Summary

Mr C, a prisoner, complained to the board that his prescription of pregabalin (a medication used to treat anxiety and nerve pain) was not reinstated. This medication is commonly misused in the prison environment and his prescription was stopped after he was found giving his medication to another prisoner.

We took independent advice from a GP. We found that the decision not to reinstate Mr C's medication was reasonable. Due to his history of drug misuse, the adviser considered that a prescription for pregabalin would potentially increase the risk of overdose, particularly as he was already on other medications. We found that the board had also offered Mr C reasonable alternative medication to treat his anxiety and nerve pain. Therefore, we did not uphold this complaint.

Summary

Mr C complained that the board failed to provide him with clinic appointments within a reasonable timescale. He also raised concern that the board failed to provide him with adequate notice of the cancellation and rescheduling of appointments, and he was unhappy with the board's handling of his complaint.

The board did not provide us with records and correspondence about Mr C's appointments, cancellations and rescheduled appointments. We also found that their own complaints file did not include relevant evidence, such as records of actions taken by staff in relation to Mr C's appointments and the initial handling of his complaint. The board did not explain why they offered Mr C an appointment for nine months after the originally scheduled appointment, and seven and a half months after the first rescheduled appointment that was offered (which Mr C told the board he could not attend). As we did not receive this information from the board, we had to assume that relevant records were not made at the time. We found that the board failed to follow their complaints procedure, as they did not give Mr C a written explanation for delays, updates on progress, or indicate when they expected to be able to reply. In addition, the board failed to send a response to Mr C's second complaint email, apparently due to an administrative error. We upheld all of these aspects of Mr C's complaint.

Mr C also complained that the board did not consult him about his availability for rescheduled appointments. We did not find evidence that the board were required to consult Mr C about his availability for rescheduled appointments, so we did not uphold this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to provide him with adequate notice of the cancellation and rescheduling of appointments, failing to provide rescheduled appointments to him within a reasonable timescale, failing to inform him of the cancellation of a specific appointment, and for handling his complaint unreasonably. 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:

• Relevant staff should be reminded of the process for dealing with cancelled or reduced clinics, and the necessity of keeping records.

In relation to complaints handling, we recommended:

• Staff investigating complaints should obtain the actual evidence, in addition to comments from colleagues on such evidence, and include it in their complaints file.

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 care and treatment provided to her late mother (Mrs A) at Queen Elizabeth University Hospital. Miss C complained that both the nursing and medical care and treatment provided to Mrs A were unreasonable.

We took independent nursing advice. We found that, whilst a number of aspects of nursing care and treatment were reasonable, there was a failure by staff to discuss continence issues with Mrs A. We also found that nursing staff failed to complete fluid balance documentation fully and accurately, and failed to appropriately complete pressure ulcer risk assessments. We also found that there were issues with infection prevention and control. We upheld Miss C's complaint about the nursing care and treatment provided to Mrs A.

We also took independent advice from a consultant physician. We found that some aspects of medical care and treatment provided to Mrs A had been reasonable, however we determined that the frequency of dosing of morphine (a pain relief medication) was unreasonable and failed to take into account Mrs A's kidney function. We also found that there was a failure to document Mrs A's adverse reaction to tramadol (a pain relief medication) appropriately. Therefore, we upheld this aspect of Miss C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for failing to provide a reasonable standard of nursing and medical care and treatment to Mrs A. The apology should meet the standards set out in the SPSO guidance on apology, available at www.spso.org.uk/leaflets-and-guidance.

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

• When a patient has continence issues, these should be discussed with them and their continence should be assessed. They should be assisted to manage any issues in a way that protects and promotes dignity, in line with the Nursing and Midwifery Code.
• Fluid balance charts should be fully completed when required.
• Pressure ulcer risk assessments should be completed when required.
• Infection prevention and control guidance, such as the Healthcare Improvement Scotland standards for Healthcare Associated Infections, and the National Institute for Health and Care Excellence quality statement on Vascular Access Devices, should be followed.
• Kidney function should be considered when prescribing morphine.
• If a patient suffers a reaction to medication, this should be documented.

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 works for an advocacy agency, complained on behalf of her client (Ms A). Ms C complained that Ms A did not receive a reasonable standard of psychiatric care and treatment when she was admitted to the Royal Alexandra Hospital. Ms A had been unwell and when she was admitted to hospital a psychiatrist diagnosed her as suffering from anorexia nervosa (an eating disorder) and implemented a care plan. Ms C said that Ms A did not agree to all aspects of the care plan, which she felt was very restrictive and intrusive, and that the communication with her and her family about the severity of her condition and treatment decisions was unreasonable.

We took independent advice from a psychiatry adviser. We found that, while there were no failings in relation to the psychiatric assessment and treatment provided to Ms A, the board had failed to evidence that Ms A had fully consented to her treatment, and that there were failings surrounding the extent to which she was informed of the details of her proposed care plan. We were also concerned that such a restrictive and intrusive care plan was implemented when Ms A disagreed with it, and that it was not subject to mental health legislation which would have afforded protection to Ms A. As a result, we found that Ms A was likely to have experienced distress which may have a long-term impact on her future relationships with mental health professionals. We upheld Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms A for failing to evidence consent to 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:

• Care plans (in particular intrusive or restrictive care plans) should be fully explained to patients and relevant consent procedures should be followed and clearly documented.
• Professionals taking decisions about detention under the Mental Health Act should be mindful of de facto detention (where a patient feels under pressure to agree to admission to hospital or to remain in hospital, often because they feel threatened by the possibility of detention, and are, therefore, not giving valid consent to their stay in hospital) and should document their reasoning for their decisions (including consideration of the mental health legislation) clearly.

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.