Health

Summary

Mrs C complained on behalf of her daughter (Mrs A) about the care and treatment provided to Mrs A at Raigmore Hospital. In particular, she complained that the board had failed to provide reasonable care and treatment when Mrs A had first attended the breast clinic at Raigmore Hospital and that Mrs A's breast cancer, which was diagnosed a few years later, may have been present at the initial consultation. Mrs C also complained that the board had unreasonably delayed in carrying out genetic testing.

We took independent advice from a consultant breast surgeon. We found that the care and treatment provided to Mrs A had been reasonable and that there had been no delay in diagnosing Mrs A's breast cancer. We also found that there had been no missed opportunities by the board to have diagnosed the cancer earlier. We did not uphold this aspect of Mrs C's complaint.

We also found that there had been no indication for genetic testing when Mrs A first attended the breast clinic and that there had been no red flag criteria to prompt genetic testing at that time. As such, we did not uphold this part of Mrs C's complaint.

Summary

Mrs C was admitted to Raigmore Hospital as she had a two day history of stomach pain and vomiting. She was found to have a small bowel obstruction for which she needed major surgery. The operation was carried out the next day and Mrs C was given an epidural (anaesthetic by spinal injection) and a general anaesthetic.

After the operation, Mrs C noted reduced mobility in her legs and a scan was carried out, but this showed no abnormality. Mrs C's mobility did not improve and she was seen by a neurologist and a repeat scan was performed but, again, was normal. It was explained to Mrs C that the likely cause of her lack of nerve sensation was a spinal stroke (where there is an interruption in blood flow to the spinal cord). Later, Mrs C complained to the board because she believed that she should not have been given an epidural and a general anaesthetic together because she had a history of heart problems. The board confirmed that she had had a spinal stroke, but said that the reason for it was unclear. Mrs C remained unhappy and brought her complaint to us.

We took independent advice from a consultant anaesthetist and a stroke specialist. We found that it was common practice for an epidural to be used in conjunction with a general anaesthetic for post-operative pain relief after major abdominal surgery like that given to Mrs C. We found that there was nothing in her medical history that would have discouraged clinicians from doing this and that the practice was in accordance with Royal College of Anaesthetists' advice. For this reason, we did not uphold the complaint. However, we also found that prior to the operation the full risks of an epidural, including the risk of nerve damage, were not discussed with Mrs C as we would have expected. We found that the consent checklist that was used did not have a box for relating to the risk of nerve damage. We made recommendations to address this failing.

Recommendations

What we asked the organisation to do in this case:

• Apologise for failing to fully discuss the risks of an epidural with Mrs C.

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

• The consultants involved in this case should use it as part of their reflective discussion in their annual appraisal.
• The consent checklist should include nerve damage as a risk to be discussed.

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, an advocacy and support worker, complained on behalf of her client (Ms A). Ms C said that, following a referral from Ms A's GP because of her back pain, the orthopaedic department at Raigmore Hospital delayed unreasonably in offering Ms A an appointment and therefore delayed in offering her treatment.

The board acknowledged that there had been a delay and apologised for this. They said that this had been due to the demand for orthopaedic services and noted that Ms A had opted to begin investigations of her back pain privately. After a scan was carried out privately, an urgent GP referral was made to the board and Ms A then received an appointment. It was then determined that she would benefit from an operation.

However, because the board could not perform the operation within 12 weeks, Ms A exercised her right to have treatment outside the board's area. As a result of her complaint the board apologised and said that they had taken steps to avoid a similar situation occurring again in the future.

We took independent advice from a consultant orthopaedic and trauma surgeon. We found that the care and treatment offered to Ms A had been in accordance with national guidance. The adviser noted that Ms A had arranged a private consultation and scan whilst she was on the board's waiting list. The adviser said that this was a matter of her choice, as was her decision to go outwith the area for her operation. Nevertheless, there was no doubt that there had been delay in offering Ms A treatment. The board missed the initial 12 week waiting time after Ms A's first GP referral. They were also unable to meet the target for treatment after Ms A was seen subsequent to the urgent referral. Finally, the board had only discussed Ms A's options for treatment with her after the treatment time guarantee had expired. For these reasons, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms A for failing to make her aware that they would be unable to meet the required treatment standards until after the treatment target date had passed. Also apologise for failing to discuss the options for out of area treatment with Ms A until after the treatment time guarantee date had passed.

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

• 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 on behalf of his wife (Mrs A) about the behaviour of a consultant psychiatrist towards Mrs A at an appointment at Braeside Day Centre. Mr C also complained about the way the board had handled complaints that Mrs A had raised.

We found that the psychiatrist's account of what happened at the appointment differed from Mr C and Mrs A's account. There were no independent parties present at the appointment. In the absence of any independent evidence, we could not prove what was said at the appointment. This meant that we could not reach a finding on this part of Mr C's complaint and, therefore, we did not uphold this aspect of the complaint.

We found that the board's handling of Mrs A's complaints was reasonable, and that their response letter to Mrs A was also reasonable. We did not uphold this part of Mr C's complaint.

Summary

Miss C complained to us that that the medical practice had failed to provide her with appropriate care and treatment when she phoned to report that she was suffering from vaginal bleeding and cramps and was in the early stages of pregnancy. Miss C believed that the GP who she spoke to had inferred that she had suffered a miscarriage. However, later testing revealed that Miss C had not suffered a miscarriage.

The GP had apologised for the miscommunication and said that they had not meant for their comments to be interpreted that Miss C had suffered a miscarriage, but had meant that it was a possibility. We took independent advice from a GP adviser and concluded that the GP had not put themselves in a position to arrive at a potential diagnosis for Miss C's symptoms and that they should have offered Miss C a face-to-face consultation so that they could carry out an examination. This would also have given Miss C some reassurance about her condition. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise for the failure to offer Miss C a face to face GP appointment.

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 about a number of aspects of the care and treatment provided to her late mother (Mrs A) during two admissions to Queen Elizabeth University Hospital. Ms C complained that the standard of clinical care and treatment provided to her mother was not reasonable. Ms C also complained that the nursing care provided to Mrs A was not reasonable. Ms C's third concern was regarding the board's communication with Mrs A and the family during the admissions.

We took independent advice from a cardiologist and a nursing adviser. We found that the clinical care and treatment provided to Mrs A was reasonable. We found that the medications prescribed were appropriate and that Mrs A was reasonably reviewed. Whilst there was a failure to refer Mrs A to a heart failure nurse when she was discharged, we found that this was picked up at a later out-patient appointment and that an earlier follow up would not have impacted on Mrs A's treatment. We did not uphold this aspect of Ms C's complaint.

With regards to nursing care, we found that, whilst for the most part the nursing care was reasonable, the fluid balance charts were not always complete. We found this to be unreasonable and we upheld this aspect of Ms C's complaint.

Finally, based on the records available, we found that the board's communication with Mrs A and the family was reasonable. We did not uphold this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to complete fluid balance charting.

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

• Nursing staff should complete all care rounding charts, including fluid balance charts, as required.

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 was unhappy that the doctor in the prison health centre decided that his prescription for pregabalin medication (medication used to treat pain from damaged nerves) would be reduced. He was also unhappy that, shortly after this, the decision was made to stop the medication entirely as a result of a failed spot check. The following month the medication was restarted, but on a supervised, reduced dosage. Mr C was concerned about this as he said that this medication was very important in helping him manage pain. He complained to us that the board unreasonably reduced his dose of pregabalin.

We took independent advice from a GP. The adviser explained that the decision to prescribe this medication is a clinical one based on the patient's need and the medical assessment. It is not prescribed based on a patient's request and, in this case, the adviser considered that there had been no clinical failings. The adviser also noted that the decisions had been in line with the relevant policy and were also in line Mr C's medication contract, which said that medication would be stopped if a spot check was failed. We did not uphold this complaint.

Summary

Mrs C complained about the care and treatment provided to her late husband (Mr A) at Queen Elizabeth University Hospital.

Mr A attended the board's respiratory clinic over the course of a number of months. The board's consultant respiratory physicians were concerned that Mr A was suffering from mesothelioma (a rare type of cancer that is linked to asbestos exposure). The board arranged for blood tests, a scan, and a biopsy. The results showed no evidence of cancer. However, the consultant remained concerned about this. Mr A's condition deteriorated over the course of the following months, and the consultant said that while a diagnosis of mesothelioma was not proven, it was very likely. The board made arrangements for oxygen therapy for Mr A, however his condition deteriorated and he suffered a cardiac arrest and died.

Mrs C complained that the board failed to give Mr A a firm diagnosis of mesothelioma within a reasonable timeframe. She also raised concerns about a nurse failing to visit after the oxygen for oxygen therapy was delivered to Mrs C and Mr A's house. Mrs C also complained that the board did not communicate the severity of Mr A's illness to his family.

We took independent advice from a consultant respiratory physician and from a nurse. We found that there are recognised difficulties with diagnosing mesothelioma. We found that the board conducted appropriate investigations, but also balanced their concerns about mesothelioma with the possibility that Mr A was suffering from a different condition. We found this to be reasonable. Regarding Mrs C's concerns about nursing staff, we found that there were limited records available to suggest that staff had advised that they would attend. We found that whether nursing staff will follow up in these circumstances is dependent on local arrangements, and that it was reasonable not to arrange a follow-up. In relation to Mrs C's concerns about communication, we found that there were records which suggested that staff had attempted to explain the situation to Mrs C and Mr A. We did not uphold Mrs C's complaints.

Summary

Ms C, who is an advocacy and support worker, complained on behalf of her client (Mr A) regarding the care and treatment he received at the medical practice. In particular, she complained that the practice did not do more to assist Mr A in obtaining a clear diagnosis and appropriate treatment for his mental health difficulties. This included concerns that Mr A's repeated requests for cognitive behavioural therapy (CBT) were not actioned.

We took independent medical advice from a GP, who considered that the practice arranged appropriate referrals for Mr A to mental health services. They noted that the specialists involved in these clinics had shown reluctance to give a specific diagnosis. They observed from one of the clinic letters that a psychiatrist had suggested a CBT approach and, while this did not appear to have progressed, they said it was not the role of a GP to follow up treatment plans arranged by a separate specialty. The adviser concluded that the care provided to Mr A by the practice was reasonable. We accepted this advice and did not uphold this aspect of complaint.

As Mr A had moved to a new GP practice, the practice were only able to access his electronic records and not any older paper records. Ms C also raised concerns that the complaint was not fully investigated as all medical records were not accessed. The practice considered that they had enough information to respond to the complaint and the adviser agreed that sufficient records were accessible to enable a response to the concerns and queries raised. We concluded that the practice's investigation was reasonable and proportionate to the issues raised and we did not uphold this aspect of the complaint. We noted that the practice had failed to provide details of our office in their complaint response, but they acknowledged this and we were satisfied that this had since been appropriately addressed through the revision of their complaints handling procedure.

Summary

Mrs C complained to us about the care and treatment provided to her late husband (Mr A) at the Victoria Infirmary. Mr A had been referred to the board for investigation of macroscopic (visible) haematuria (blood in urine). Mr A had subsequently died from cancer of the bladder.

Mrs C complained that a discharge letter inappropriately referred to Mr A as having been treated for microscopic (non-visible) haematuria. We found that the letter did incorrectly say that Mr A had undergone a cystoscopy (a procedure to look inside the bladder using a thin camera) for microscopic haematuria instead of macroscopic haematuria. The board said that this had been due to a typing error. We upheld the complaint and recommended that the board apologise to Mrs C for this. However, we noted that the investigations that had been carried out where appropriate for a man presenting with macroscopic haematuria and that this typing error had not impacted on Mr A's care.

Mrs C also complained that the board failed to carry out a CT scan (a scan that uses x-rays and a computer to create detailed images of the inside of the body) at the time that Mr A underwent the cystoscopy. We took independent advice from a consultant urologist and we found that there had been no requirement at that time for the board to carry out a CT scan. We did not uphold this aspect of Mrs C's complaint.

Mrs C also complained that the board's response to her complaint had incorrectly stated that there had been no subsequent contact between Mr A's GP practice and the hospital after Mr A's cystoscopy. Mrs C provided evidence which showed that the GP practice had phoned the hospital after Mr A's cystoscopy to report that there was still blood in Mr A's urine. We found that, in line with the relevant guidance, this should have prompted the board to request a CT scan at that time. However, we found that even if a CT scan had been carried out, it was unlikely that Mr A's outcome would have been significantly different. Due to the evidence we saw that there had been contact between the GP and the hospital, 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 incorrect information on the discharge letter which inappropriately referred to microscopic haematuria. Also apologise for incorrectly stating in the complaints response that there was no subsequent contact from Mr A's GP practice after the cystoscopy. These apologies should be in line with 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 a GP surgery contacts a hospital with additional information, it should be recorded and acted on.

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.