Health

Summary

Ms C complained about the medical care and treatment and also the nursing care provided to her when she attended the emergency department at the Royal Infirmary of Edinburgh. Ms C was brought to the hospital by ambulance as she was short of breath and had asthma. She complained that the clinical care and treatment she received was not reasonable and that she was discharged when she was still unwell.

We took independent advice from a consultant in emergency medicine and from a nursing adviser. We found that Ms C was carefully examined and that no abnormal findings were made. As such, we found that the medical care and treatment provided to Ms C had been reasonable, and that it was reasonable to discharge Ms C. We did not uphold this aspect of the complaint. We also found that the nursing care and treatment provided to Ms C at this attendance was reasonable. Therefore, we did not uphold this part of the complaint.

Summary

Ms C's late partner (Ms A) was given drug treatment for multiple sclerosis (a condition which can affect the brain and/or spinal cord). During the treatment, Ms A experienced stomach pain. After this she was referred for tests and she was diagnosed with cancer. Ms A underwent surgery to treat the cancer, however her condition deteriorated after the surgery and she later died.

Ms C complained that Ms A was not appropriately monitored during her multiple sclerosis treatment. Ms C considered there was a delay in diagnosing the cancer and that cancer treatment options were not fully discussed with Ms A. In addition, Ms C complained that the risk of surgery was not fully explained to Ms A and that the decision to go ahead with the surgery was unreasonable. Ms C also had concerns about the nursing care Ms A received after the surgery and about how the board dealt with her complaint.

We took independent advice from a consultant neurologist, a consultant gynaecologist and a nurse. We found that Ms A was appropriately monitored during her multiple sclerosis treatment. We found that there was no unreasonable delay in diagnosing Ms A's cancer. We also found that the decision to proceed with surgery was appropriate and that the nursing care Ms A received afterwards was of a reasonable standard. Therefore, we did not uphold these aspects of Ms C's complaint.

However, we did find that the discussions with Ms A about the cancer treatment options available to her were not properly recorded. We found that the consent form she signed for the surgery did not document all of the risks. We also found that the board did not respond appropriately to all of the concerns that Ms A raised and that there were delays in investigating the complaint, which the board had acknowledged. Therefore, we upheld these aspects of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to properly document any discussions with Ms A about the cancer treatment options available. Also apologise that the consent form Ms A signed for the surgery did not document all of the risks. Also apologise for failing to appropriately address all of Ms C's concerns in their response to her complaint. These apologies should comply with the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-guidance.

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

• Every discussion with a patient about treatment options should be documented in the medical records.
• The risks of surgery discussed with a patient should be documented, in order to reduce the likelihood of a miscommunication or misunderstanding.

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 sustained a burn to his lower left leg. He received treatment for his injury at the burns unit at St John's Hospital over a number of months. Mr C said that he did not have any feeling in his lower leg, had no movement in his left foot and that his lower leg was cold all the time. He said he was in constant pain and that the painkillers the board gave him did not work anymore. Mr C complained that when he asked the board to amputate his lower left leg, the board refused to do this. Mr C complained to us that the board's decision not to amputate his lower left leg was inappropriate.

We took independent advice from a consultant vascular surgeon. The adviser said that the treatment and advice given to Mr C was appropriate, that it adhered to Scottish and UK guidelines and that there was no indication for amputation of Mr C's left leg. The adviser explained that a patient could not, in law, dictate an operation to a surgeon, and if a reasonable body of medical opinion agreed that an operation was not in the best interests of the patient, such an operation should not be performed on the patient's instructions alone. We considered that the board's decision not to amputate Mr C's lower left leg was reasonable and we did not uphold the complaint.

Summary

Mrs C had a fall in her home and sustained a fracture of her upper arm. She complained about the way a body bandage had been fitted at Monklands Hospital the following day and about the aftercare advice she was given. A nurse had fitted the bandage over her clothing, with advice that the bandage should be removed each night. Mrs C said that when she returned to the fracture clinic three days later, a nurse told her the bandage had been incorrectly fitted, and re-fitted it underneath her clothing.

Mrs C's fracture had not healed properly, leaving her in pain and requiring surgery. She believed that the way the injury was bandaged when she initially attended Monklands Hospital, and the aftercare advice about removing it at night, had caused her ongoing problems.

We took independent advice from a consultant orthopaedic surgeon. The adviser explained that the purpose of the body bandage for fractures of this type is to provide some support and comfort to the patient, not to provide fracture stability. They advised that the way it was fitted was not material to the outcome in terms of Mrs C's recovery. They noted, however, that removing it would have caused her more pain. The only failing the adviser noted was the lack of consistency of advice regarding the way the bandage was fitted, but they noted that the board appeared to have addressed this by coming up with a standard protocol for these fractures.

In relation to the advice to remove the bandage at night, the adviser reiterated that the purpose of the bandage was not to provide fracture stability, and accordingly its removal would not have affected recovery. Because the focus of our investigation was on whether Mrs C's recovery was affected by the fitting of the body bandage and the aftercare advice, we did not uphold the complaints.

Summary

Mrs C complained on behalf of her husband (Mr A) regarding treatment he received at Wishaw General Hospital after collapsing whilst he was out running. Mr A has a history of heart problems so, on admission to hospital, the symptoms he was experiencing, including ongoing headaches and worsening balance, were initially attributed to a suspected heart issue. However, as these symptoms continued to worsen in the following couple of days, a scan was arranged and a bleed to his brain was identified. Mrs C complained that, as a result of the delay in identifying the bleed, the board had failed to provide appropriate treatment for Mr A's head injury.

We took independent advice from a consultant in emergency medicine. The advice we received was that the treatment provided to Mr A was reasonable. The adviser considered that, based on Mr A's presenting symptoms, medical history and the information provided by the ambulance service, it was reasonable for the board to conclude that this was a cardiac event and that they had then offered appropriate treatment for this diagnosis. For this reason, we did not uphold Mrs C's complaint.

Summary

Miss C, who is an advocacy and support worker, complained on behalf of her client (Miss A) about the clinical treatment Miss A received for her urinary problems. In particular, Miss C complained about the board's decision to withdraw support from community nursing services. Miss C also complained about a delay in actioning Miss A's request for a second opinion from the urology service.

We took independent advice from a consultant urologist. We found that a number of clinicians involved in Miss A's care had taken the decision to withdraw the support from community nursing services as the care being provided was no longer clinically appropriate. We found that there was no evidence of failings in the urology care provided to Miss A. We were also satisfied that Miss A's needs had been taken into account in arriving at the decision. As such, we did not uphold this aspect of Miss C's complaint.

We found that there had been a delay in actioning Miss A's request for a second opinion from urology services. We considered this to be unreasonable and we upheld this part of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss A for the delay in actioning the request for a second opinion.

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

• Requests for second opinions should be actioned timeously.

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 palliative care and treatment provided to her late husband (Mr A) at Cowal Community Hospital. Mrs C highlighted concerns about the prescription of pain relief, arrangements for a blood transfusion and communication with the family. Mrs C particularly felt that meetings with staff had been misrepresented in his medical records. She also complained that the board had failed to handle her complaints reasonably.

As the doctors who cared for Mr A at the hospital were general practitioners, we took independent advice from a GP adviser. The advice we received was that Mr A's pain relief had been appropriately reviewed and adjusted, and that there had been no indication that a blood transfusion was necessary. We did not uphold these aspects of Mrs C's complaint.

We did not uphold Mrs C’s complaints about communication or meetings. We found evidence that there had been regular and appropriate communication with Mr A's family, although we acknowledged that Mrs C's recollection differed from that recorded in the medical notes and other records. The advice we received was that the actions taken by the board were reasonable, on the basis of what was recorded in the relevant records.

We upheld Mrs C's complaint about the way that the board had handled her complaint. We found that there was an inaccuracy in the final response around the timeframe of Mr A dying and the complaint being raised. We also found that an issue Mrs C had raised had not been fully addressed when the board responded to her concerns. We made two recommendations to address these issues, including one regarding the new model complaints handling procedure introduced in April 2017.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the complaints handling issues identified. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

In relation to complaints handling, we recommended:

• In keeping with the new complaints handling procedure, complaint responses should be accurate and address the points made by the complainant.

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 medical practice failed to provide appropriate care and treatment to her late husband (Mr A), who died in hospital of double pneumonia a few days after last seeing a GP. She said that her husband had seen a GP on two occasions before the hospital admission and that the GP had not carried out appropriate assessments to diagnose the pneumonia or to have referred her husband to hospital for a specialist opinion.

We took independent advice from an adviser in general practice medicine and concluded that the practice had provided a reasonable level of care. The records showed that the GP had carried out appropriate assessments and that, based on the symptoms which Mr A had reported, it was reasonable for the GP to have diagnosed a viral illness. The GP had advised Mr A to rest, take fluids and paracetamol. It was clear that, following the last GP appointment, Mr A's symptoms had changed and that he had deteriorated and at that time a hospital referral was appropriate. We did not uphold the complaint.

Summary

Mrs C complained to us that the medical practice had failed to provide appropriate care and treatment to her son (Mr A) who had attended an appointment with one of the GPs with symptoms of sore lungs and a cough. Ms C said that the GP had failed to listen to Mr A's lungs or chest and did not prescribe an antibiotic for him to take. Mr A was still unwell the following week and was taken to hospital, where he was diagnosed with pneumonia.

We took independent advice from an adviser in general practice medicine and concluded that the GP had provided a reasonable level of care. We found that the GP had examined Mr A's lungs and had found no signs of an infection. We also found that an adequate medical history was recorded and that it was not unreasonable for the GP to have diagnosed a viral infection. As such, it was not unreasonable that the GP did not prescribe antibiotics. We did not uphold the complaint.

Summary

Ms C complained on behalf of her late brother (Mr A) about the treatment he received from the practice in the four months prior to his diagnosis of lung cancer. She complained that the standard of care and treatment provided to her brother was unreasonable.

We took independent advice from a GP adviser who said that the initial symptoms Mr A presented with had led doctors to believe that he had a problem with his hormones, and that doctors had referred him appropriately at that time. When Mr A complained of different symptoms, which could have indicated cancer, his GP then asked him to complete a form to arrange an x-ray. The practice were unable to reach Mr A by phone and Mr A either did not receive the letter sent to him, or did not respond to it. When Mr A re-attended the practice it was noted that the x-ray request had not been returned and he was referred urgently to hospital that day. The adviser said that this was reasonable.

We accepted the advice we received and we did not uphold the complaint.