Health

Summary

Mrs C complained about the care and treatment the board provided to her late husband (Mr A) at Wishaw General Hospital.

Mr A underwent an urgent left groin lymph node biopsy. He re-attended hospital the next day with a serious infection. Mr A remained at the hospital for approximately five months. He was discharged and remained out of hospital for approximately eight months. Mr A was readmitted with a urinary tract infection, but his condition deteriorated over approximately two months and he died.

Mrs C raised a number of concerns relating to the medical and nursing care during Mr A's admissions, as well as communication within the hospital and with Mr A's family. This included concerns that the initial procedure was carried out incorrectly, that Mr A was mishandled physically by staff, and that hygiene practices were poor.

We took independent advice from consultant in general medicine and from a nurse. We found that consent for the initial operation had been appropriately obtained, and that the infection was a rare but recognised complication of the procedure. We noted that the seriousness of this infection had severely impacted on Mr A's health and had led to two long and complicated admissions. We found that the nursing care was reasonable, with appropriate monitoring and wound care recorded. We also noted that we were unable to identify evidence to support Mrs C's concerns about Mr A being mishandled physically at the hospital. We did not uphold these aspects of Mrs C's complaint.

We upheld Mrs C's complaints regarding communication within the hospital and communication with the family. However, we found that the board had already accepted these failings and had apologised. As such, we made no further recommendations.

Summary

Mrs C complained about the treatment provided to her late husband (Mr A) by an advanced nurse practitioner (ANP). The ANP had attended Mr A at his nursing home as staff had reported that he was having breathing problems. Mrs C said that the ANP did not make arrangements for Mr A to be assessed by a doctor or arrange for him to be taken to hospital. Mr A continued to have breathing issues and was admitted to hospital the following day, where he died two days later.

We took independent advice from a nursing adviser. We concluded that the ANP had carried out an appropriate clinical assessment of Mr A's condition by listening to his chest and establishing that there was no evidence of a chest infection or that Mr A was in respiratory distress. We found that the ANP had also appropriately prescribed a treatment to assist Mr A's breathing, and that there was no indication at that time that Mr A had to be reviewed by a doctor or should have been referred to hospital for a specialist opinion. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment his wife (Mrs A) received at Dunbar Hospital. Mr C and Mrs A had just moved to the area and had not yet registered with a local GP practice when Mrs A became unwell with flu-like symptoms. NHS 24 advised her to attend Dunbar Hospital, where she was diagnosed with a respiratory infection and prescribed antibiotics. Mrs A had two further attendances and phone contact with the hospital, before registering with a local GP. The GP diagnosed pneumonia, prescribed a new course of antibiotics and subsequently arranged an emergency admission to a different hospital for treatment.

Mr C complained that the doctor who initially assessed Mrs A at Dunbar Hospital failed to diagnose her pneumonia. He also complained that Mrs A was assessed by nursing staff on her subsequent attendances at the hospital and not a doctor, despite his understanding that the plan was for further medical review. In addition, he complained that the nurse Mrs A spoke to when she phoned Dunbar Hospital did not make appropriate arrangements for her to be seen by a doctor and simply advised her to register with a local GP.

We took independent advice from both a GP and a nurse. Both advisers considered that the respective assessments of Mrs A were reasonable and they considered it appropriate for her to have been advised to register with a local GP. They noted that the out-of-hours service at Dunbar Hospital is for emergency care when GP surgeries are closed. They also noted that routine follow-up and the arrangements of tests is usually carried out by the GP. The GP adviser considered that Mrs A's initial diagnosis and treatment were appropriate and noted that the treatment would have been the same if pneumonia had been suspected initially. We did not uphold this aspect of the complaint.

Mr C also raised concerns that the board's response to his complaint contained a number of inaccurate and misleading statements. In particular, he considered that it inappropriately contained continual reference to the GP registration issue and that the response did not justify the poor quality of care that he considered was provided by Dunbar Hospital. We reiterated that we found the advice to register with a GP to have been appropriate and we found no evidence to support Mr C's concerns that the detail of the board's response was inaccurate or misleading. We did not uphold this aspect of the complaint.

Summary

Miss C complained about the treatment that she received from her dentist, after they removed one of her teeth. She explained that, following the removal, she felt that the wrong tooth had been removed. This led her to attend another dentist, who found a crack in the remaining tooth, meaning this also had to be removed. Miss C was also unhappy with the dentist's handling of her complaint, as it took almost a year to receive a response.

In their response to Miss C's complaint, and in response to our enquiries, the dentist defended their decision to remove the tooth based on the symptoms Miss C presented with. They said that this tooth was loose and the area around it was badly infected, leading them to conclude that this was not saveable and the most likely source of Miss C's pain. We sought independent advice from a dental adviser, who reviewed the records and agreed with this assessment. For this reason, we did not uphold the first complaint.

With regards to the complaints handling, we found that there had been a considerable delay caused by the dentist awaiting an independent expert report they had commissioned in order to respond to Miss C's complaint. During this time, the dentist failed to provide Miss C with regular updates, or to formally agree extensions to the deadline for response, which is not in line with the most recent model complaints handling procedure. For these reasons, we upheld the second part of the complaint. However, we considered that the eventual response was reasonable in its content and conclusions.

Recommendations

In relation to complaints handling, we recommended:

• Adopt the model complaints handling procedure and ensure that all staff are aware of this.

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 A had a miscarriage and she felt that her appointment for a surgical evacuation of the uterus (SEU) (a procedure sometimes carried out after a miscarriage to ensure that the uterus is fully evacuated and to prevent infection) at Royal Alexandra Hospital was unreasonably delayed, which she felt put her at increased risk of infection or haemorrhage. Ms A also complained that the board had unreasonably failed to provide her with information about support groups and counselling in relation to miscarriage and that the board had unreasonably failed to provide her with details of her scan results when she elected to pursue private treatment at another hospital for the SEU.

We took independent advice from a consultant obstetrician and gynaecologist. We found that earlier treatment would have been desirable to minimise psychological distress to Ms A, but that the time she waited for the SEU was within the National Institute for Health and Care Excellence guidelines. We found that it was likely that the first available appointment was offered to Ms A, and that there was no reason to think that Ms A was at risk of infection or haemorrhage because of the wait. We concluded that the actions of the board were not unreasonable and we did not uphold the complaint.

The adviser noted that there was evidence in the medical records that Ms A had declined information about counselling and support organisations. We did not uphold this complaint.

The adviser said that it was evident from the medical records that the consultant obstetrician had refused to provide information about Ms A's scan results when she requested this information to help with pursuing private treatment for the SEU. Although the still images that were available would not have been helpful for staff at the private hospital, the adviser said that the board could have provided Ms A with copies of scan results or a handwritten letter with little inconvenience. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise for failing to provide Ms A with information about her scan results when she decided to pursue private health care.

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 the urological surgery care provided to her son (child A). At birth, child A was diagnosed with hypospadias (a condition where the opening of the urethra is on the underside of the penis). He also had severe chordee (where the penis is curved) and a right side hydrocele (accumulation of fluid in a body sac). He underwent a number of operations over several years to attempt to correct these issues. Ms C complained that her son was now in a worse condition that when the treatment began, and she felt that the multiple operations he had been through had not been done correctly.

We took independent advice from a paediatric urological surgeon. We found that the type of surgeries child A had undergone have a high rate of complication and that there was no evidence that the surgeries had not been carried out to a reasonable standard. However, we found that there was at one point a delay of over a year between child A being reviewed and him being listed for further surgery. We considered this delay in adding child A to the waiting list to be unreasonable. We upheld this aspect of Ms C's complaint.

Ms C also complained that the board had failed to provide a response to her complaint within a reasonable timescale. We found no evidence that the board had failed to follow their complaints procedure or that there had been an unreasonable delay, and therefore 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 enter child A onto the waiting list for further surgery after his review. 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:

• Robust mechanisms should be in place to ensure that patients are entered on the surgical waiting list in a timely manner.

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 given to her late husband (Mr A) on a number of occasions that he was admitted to Southern General University Hospital. Mr A suffered from a number of medical conditions, including heart failure, vascular disease, kidney impairment and epilepsy. Mrs C said that he was not treated holistically and she complained that her concerns about this were ignored. Mrs C said that this had severe consequences and that, when Mr A died, the family were totally unprepared and shocked as they had been given no indication of the seriousness of his condition. Mrs C also complained that Mr A had not been offered palliative care towards the end of his life.

The board accepted that communication with Mrs C and the family had been poor, but said that the nature of Mr A's condition meant that it could change very quickly. The board considered that Mr A had been treated and cared for reasonably.

We took independent advice from consultants in acute medicine and cardiology and from a senior nurse. We found that communication with the family was limited and that there was very poor documentation of what was said. We found that staff did not respond to the issues Mrs C and her family raised with them. We further found that there was no evidence to suggest that Mr A's seriously deteriorating condition was discussed with the family, and that opportunities to do so were lost. As a consequence, the family were unprepared for Mr A's death. Finally, we found that there were no discussions about palliative care. Had these taken place, there would have been an opportunity to establish what Mr A's wishes were and how to best manage his symptoms. We upheld all of Mrs C's complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for:
• failing to respond to her concerns
• failing to advise her and the family about Mr A's condition
• missing opportunities to start a discussion about palliative care
• 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:

• Any concerns raised by a patient's family should be recorded appropriately in the notes.
• Where appropriate, families should be kept fully informed of a patient's medical condition and the options for treatment.
• Unless otherwise indicated, patients and their families should be given clear and honest information about the severity of illness and risk of death.

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 she had been given morphine both during and after an operation at the Royal Alexandra Hospital, despite refusing consent for this to be used because she was allergic to it. The board had disputed that Ms C had refused consent. They told us that the anaesthetist had explained to Ms C before the operation that she had a sensitivity to morphine, but was not allergic to it. They said that they also told Ms C that it would be almost impossible to give a general anaesthetic for an operation of this nature without the use of morphine or a derivative.

We took independent advice from a consultant in anaesthesia and intensive care medicine. We found that the anaesthetic technique used by the anaesthetist was appropriate for the procedure Ms C had, even with the risk of side effects. However, given Ms C's concerns about morphine, we found that there should have been an informed discussion about the risks and benefits, which should have been documented. The anaesthetist failed to adequately document such a discussion. Given the importance of this in relation to whether morphine should have been used, we upheld this aspect of Ms C's complaint.

Ms C also complained that the anaesthetist had failed to consider alternative anaesthetic for the operation. We found that the anaesthetist had acted reasonably by putting measures in place to treat any complications during the operation and by ensuring that anti-sickness drugs were available. However, we also upheld this aspect of the complaint, as the anaesthetist had failed to document any discussion with Ms C about alternative anaesthetic for the operation, in line with the relevant guidance.

Ms C complained that the board had lost images taken during the surgery. In their response to our enquiries, the board said that they had been unable to locate the images referred to and apologised for this. We, therefore, also upheld this aspect of the complaint.

Finally, Ms C complained about the board's handling of her complaint. We found that although there had been a short delay in responding to her complaint, this delay had not been unreasonable. We did not uphold this aspect of her complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for:
• not adequately documenting any discussion about the risks/benefits of using morphine and any alternatives
• being unable to locate the images taken during the operation.
• 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:

• Discussions about the risks and benefits of using medication that the patients is concerned about, and discussions about any alternatives, should be documented appropriately.

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 on behalf of her mother (Mrs A) about the way her medical practice managed the medication for her thyroid condition. Mrs A had a condition called hypothyroidism (where the thyroid gland is underactive and does not produce enough thyroxine hormone) and had received treatment for this for a number of years. Mrs A had attended the practice for a blood test to measure her levels of thyroxine. When the test results showed that her thyroxine level was too high, a GP at the practice advised Mrs A to stop taking her thyroxine replacement medication and to attend the practice in six weeks to have the levels checked again.

Shortly before Mrs A was due to return to the practice, she had a seizure and was hospitalised. Doctors at the hospital concluded that the seizure was caused by profound hypothyroidism following the withdrawal of thyroxine medication. Ms C complained that the medication should have been reduced more gradually and that follow-up tests should have been arranged sooner than they were. She also complained that Mrs A was not informed of the side effects of withdrawing the medication.

We took independent advice from a GP adviser who said that there were a number of risks associated with high thyroxine levels. In view of this, they considered that the GP's decision to cease thyroxine medication and review Mrs A in six weeks was reasonable. They did not consider that Mrs A's rapid development of hypothyroidism followed by a seizure was predictable, and noted this was a rare complication of her condition. While there was no evidence that discussion of side effects had taken place, the adviser did not think it was unreasonable had the GP not discussed the rare complications of a seizure in the circumstances of this case. We did not uphold this complaint.

Summary

Mrs C raised concerns about the care and treatment she received for urinary incontinence at a number of hospitals within the board's area.

Mrs C complained that there was a failure to provide her with a reasonable standard of care and treatment and a failure to provide her with a treatment plan. We took independent advice from a consultant urologist. We found that it was clear that Mrs C had struggled with severe urinary incontinence for several years. While the initial care and treatment that she received was managed correctly, there was subsequently unreasonable delays in her treatment and in providing her with an appropriate treatment plan. We therefore upheld these aspects of Mrs C's complaint.

Mrs C also complained that there was a failure to communicate with her appropriately about her treatment. The adviser found that the board had not been supportive of Mrs C, considering the unnecessary delays which she had experienced and the impact this had evidently had on her. The adviser concluded that, as Mrs C did not appear to have an understanding of the cause of her problem, she should have been offered an urgent discussion about this and should have been told about the best treatment to restore urinary control. We considered that this should have been recognised by the board at an earlier stage and we upheld this aspect of Mrs C's complaint.

Mrs C further complained that there was a failure by the board to respond to her complaint appropriately. The board accepted that their complaint response letter did not make it clear to Mrs C that they could only consider her treatment covering a specified period of time. We found that the board should have explained this to Mrs C and should also have explained the reasons why this was the case. Therefore, we upheld this part of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failings identified in our investigation, including:
• delays in Mrs C's care and treatment
• a delay in providing Mrs C with an appropriate treatment plan
• failing to communicate with Mrs C appropriately about her treatment
• failing to respond appropriately to Mrs 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:

• Measures should be in place so that other patients are not affected similarly by delays in treatment.
• Measures should be in place so that patients are provided with a treatment plan without delay.
• Staff should be reminded of the need to be supportive and to show empathy to patients, where there are delays in treatment.

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.