Health

Summary

Mrs C complained about the care and treatment her late husband (Mr A) received from his medical practice. She said that over an eight week period, staff at the practice failed to provide her husband with appropriate clinical treatment in view of his reported symptoms. Mrs C said her husband was subsequently diagnosed with terminal lung cancer and died shortly after. Mrs C complained that the practice failed to look at, examine and listen to her husband. She complained that they were dismissive and that they took too long to recognise how ill he was. She said her husband had a past diagnosis of cancer and that this should have alerted the practice to the possibility of a return of the cancer.

We obtained independent advice on the case from a GP. We found that the care and treatment the practice provided to Mr A was appropriate. We found that Mr A's medical records did not evidence any failure in taking his history or in examining him, that Mr A's investigations and referrals were of a reasonable standard and there was not any significant delay in these being carried out.

The adviser did not consider that a history of treated cancer 37 years earlier should have alerted the practice to consider an alternative diagnosis in Mr A's case. We found that Mr A's chest x-ray, taken in hospital approximately six weeks after Mr A first attended the practice, was normal with no evidence of lung cancer. We found his case records did not contain evidence of him reporting red flag symptoms or signs to either the GP or to the hospital doctor.

We concluded that the practice did not fail to provide Mr A with appropriate clinical treatment in view of his reported symptoms and we did not uphold Mrs C's complaint.

Summary

Mr C attended A&E at the Royal Infirmary of Edinburgh on two occasions. The first occasion was for constipation and increasing back pain. Mr C's second attendance was due to concern that he may have deep veinous thrombosis (a blood clot in a vein).

Mr C complained that when he attended A&E, the board failed to provide him with reasonable nursing and medical care. He also complained about the way the board dealt with his complaint. In reply, the board said that Mr C had been treated in accordance with his symptoms and with national and local guidance. However, they apologised to Mr C for the delay in responding to his complaint.

We took independent nursing and emergency medicine advice. We found that on his first attendance, Mr C was examined in a reasonable way and had been checked for any symptoms requiring urgent admission or imaging. None were present. We found that on his second attendance, the doctor failed to conduct a Wells test (a test to ascertain the risk of blood clot) and that the neurological examination of Mr C's lower limbs was not thorough or to a high standard. In light of these failings, we upheld the complaint and recommended that the board issue an apology to Mr C.

Although the board had taken steps to address Mr C's complaint, they took 120 days to reply. The board's timeframe for responding to complaints is 20 days. We therefore upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for the delay in dealing with his complaint;
• emphasise to staff involved the necessity of adhering to timescales in line with the complaints policy; and
• apologise to Mr C for the failure to conduct a Wells test and carry out a thorough neurological examination of Mr C's lower limbs.

Summary

Mr C complained to us that the medical practice had failed to provide appropriate care and treatment to his late wife (Mrs A). He said that Mrs A died from cancer and that he requested a copy of her medical records from the practice. He noted that two years prior to his wife's death she had attended the practice with an eight week history of abdominal pain. He had checked the National Institute for Health and Care Excellence (NICE) guidance and this said that a CA125 blood test (a test used to diagnose ovarian cancer) should have been carried out. The blood test was not performed at the first consultation. Mr C felt that his wife had met the criteria for the test and had it been carried out, it may have identified her cancer earlier. He also said that his wife attended the practice 12 months later and again the CA125 blood test was not taken.

The guidance states that clinicians should carry out tests if a woman (especially if 50 or over) reports having any of a number of symptoms on a persistent or frequent basis (particularly more than 12 times per month). Abdominal pain is one of the stated symptoms. We took independent GP advice and found that at the first consultation, the practice had provided a reasonable level of care. It was recorded that Mrs A had reported an eight week history of right sided abdominal pain and tiredness with no change in bowel habit. Antibiotics were prescribed along with blood tests (not including CA125) with a further review. The adviser said that it was not a failing in care not to have requested a CA125 blood test as the guidance does not define 'persistent or frequent basis' in terms of length of time of having symptoms. Although Mrs A was over 50 and had symptoms for eight weeks, the guidance does not specifically state that a CA125 blood test is required in such a situation. We did not uphold the complaint, but highlighted that it would have been best practice for Mrs A to have been asked to return if her symptoms persisted following the course of antibiotics.

Summary

Mrs C complained about the care and treatment that was provided to her late niece (Miss A) by Hairmyres Hospital and Wishaw General Hospital. Miss A had been referred to the board by her GP due to gynaecological problems she had been suffering with. The GP referral was downgraded from urgent to routine by the board. Miss A attended the board's out-of-hours service at Hairmyres Hospital on two occasions between the date of the GP referral and her gynaecology appointment.

Miss A was seen at the gynaecology department at Wishaw General Hospital within the timescales for a routine appointment and, following examination, arrangements were made for day surgery investigations. A number of weeks before the arranged date for surgery, Mrs C became increasingly worried about Miss A's health and took her to Wishaw General Hospital, where she was admitted. Miss A was subsequently diagnosed with cervical cancer.

Mrs C complained that there was an unreasonable delay by staff at Wishaw General Hospital in diagnosing that Miss A had cancer and that the out-of-hours service at Hairmyres Hospital did not take reasonable action in light of the symptoms that Miss A presented with.

In investigating Mrs C's complaints, we took independent advice from a consultant gynaecologist, an out-of-hours GP and a consultant histopathologist (a consultant in the study of changes in tissues caused by disease).

On the basis of the advice we received, we upheld Mrs C's complaint about the delay in staff diagnosing that Miss A was suffering from cancer. While we found that it was reasonable to downgrade the GP referral to routine on the basis of the information available at that time, the advice we received was that there was insufficient urgency in arranging appropriate investigations after Miss A was seen at the gynaecology department at Wishaw General Hospital. Although we considered that there was an unreasonable delay, the advice we received was that earlier diagnosis would not have affected Miss A's prognosis. We found that the board had already identified some improvements to be made in this area, but we made further recommendations as a result of our findings.

We did not uphold Mrs C's complaint about the out-of-hours service at Hairmyres Hospital as the advice received was that reasonable care and treatment were provided for the symptoms that Miss A reported.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C that appropriate investigations were not urgently arranged for Miss A following her attendance at the gynaecology department at Wishaw General Hospital. This apology should comply with SPSO guidelines on making an apology, found at www.spso.org.uk/leaflets-and-guidance.

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

• Patients with symptoms that are potentially indicative of cervical cancer should be referred for colposcopy (a procedure used to look at the cervix in detail) and seen urgently.

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 provided to her late niece (Miss A) by the practice. Miss A had reported gynaecological symptoms and after examinations and tests, she was diagnosed with an infection. Miss A received treatment for this, however, a few months later, she reported similar symptoms. She was seen on a number of occasions and provided with treatment. When her symptoms persisted, a referral was made to the local gynaecology department and a scan was arranged. Miss A was later diagnosed with cervical cancer following an emergency hospital admission. Mrs C complained that, given the level of contact Miss A had with the practice, she had not received appropriate care for her reported symptoms.

After taking independent advice from a general practitioner, we did not uphold Mrs C's complaint. We found that Miss A had had an infection and that the symptoms she reported later were consistent with infection or complications of an infection. The advice we received was that it was reasonable to consider that her symptoms were due to infection and that the practice had arranged appropriate tests and referrals for Miss A.

Summary

Mr C raised a complaint on behalf of Ms A about the medical and nursing care and treatment she received during an admission to Hairmyres Hospital.

We took independent advice from a consultant in acute medicine and a nursing adviser. The advice we received from the consultant in acute medicine was that the medical care and treatment provided to Ms A was appropriate and reasonable. We did not uphold the complaint.

In relation to the nursing care given to Ms A, the advice we received from the nursing adviser was that while there were some record-keeping issues, overall the nursing care provided was systematically planned. Ms A's condition was monitored and assessments were effectively carried out and documented. Whilst we did not uphold Mr C's complaints about nursing care, we did make recommendations about record-keeping and the information given to Ms A about flowers being allowed on wards.

Recommendations

We recommended that the board:

• share with relevant nursing staff the need to ensure that nursing records are in line with Nursing and Midwifery Council guidance and, in particular, that any necessary amendments made to records are unambiguous, appropriately initialled and dated; and
• apologise to Ms A for the conflicting information given about whether flowers were allowed on wards.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Ms A). She said there had been a delay in Ms A's medical practice making a referral for her to attend the orthopaedic department when her back problems continued. She further said that the practice failed to follow up on the referral when it was eventually made. While the practice recognised that Ms A felt unsupported, they nevertheless said they had been appreciative of Ms A's difficulties and had tried to help her.

We took independent medical advice from a GP. We found that while Ms A attended the practice prior to her referral, the medical records showed that she had been treated reasonably, that her condition had been monitored, that she had been appropriately examined, and that she had been prescribed medication in accordance with her symptoms and published guidance. There were no 'red flags' (signs to warrant urgent referral).

Although we found that the practice did not issue the referral immediately, once the error was discovered it was issued and sent within the time-frame required by local guidance. An apology had been given to Ms A for the oversight. We did not uphold Ms C's complaint.

Summary

Mrs C complained about the level and type of support her adult son (Mr A) was receiving from community support services to help him manage his mental health. Mrs C was especially concerned that there was no proper regime for cover when the regular support worker was on planned or unexpected leave. Our investigation showed that the board's investigation had not properly considered this matter and could not demonstrate that the proper level and type of support had been in place. Whilst Mrs C told us that the arrangements had improved since she complained, we upheld this complaint and made recommendations to ensure future investigations were appropriately robust and that the improved support arrangement was sustained for the future.

Mrs C was also concerned that on one occasion her son had been assessed by the community mental health team because his mental health had been deteriorating, but a decision was taken not to admit him to hospital. Mr A's condition worsened and he later became aggressive and violent towards Mrs C's property, causing her considerable anxiety and distress. The police also became involved and Mr A was admitted to hospital for compulsory treatment. Mrs C considered that Mr A met the criteria for admission when first assessed and that a psychiatrist should have been involved and should have made the decision to admit Mr A at that time. We obtained independent advice from a mental health specialist who concluded that it was not necessary to have a psychiatrist involved in the assessment and that the initial decision not to admit Mr A was reasonable. We did not uphold this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to adequately or appropriately investigate her concerns about the level of support Mr A was receiving. This apology should comply with SPSO guidelines on making an apology, found at www.spso.org.uk/leaflets-and-guidance.

In relation to complaints handling, we recommended:

• All complaints submitted and accepted by the board should be thoroughly investigated and final responses should include details of investigations undertaken and the outcomes of such investigations. Guidance and standards for good investigations are set out in the SPSO Investigations Toolkit, available at www.valuingcomplaints.org.uk/learning-and-improvement/best-practice-resources/decision-making-tool.

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 about the care and treatment he received when he attended at the board's out-of-hours service at the New Victoria Hospital. Mr C had been suffering from abdominal pain, nausea, vomiting and fever. He saw a GP on his first attendance and although Mr C had suggested he might have appendicitis, the GP dismissed this and felt it was viral gastroenteritis. Mr C was sent home after having an injection for the nausea. The pain continued and Mr C re-attended the out-of-hours service three days later and saw another GP. The GP thought Mr C was suffering from trapped wind and gave a further injection and told Mr C to return home. He did so but returned to the same GP two hours later as the pain had not settled and he was then referred to hospital for a specialist opinion. The hospital then diagnosed that Mr C had appendicitis where he was required to undergo emergency surgery. Mr C felt that the GPs at the out-of-hours service had failed to take his concerns seriously and that he should have been referred for a specialist hospital opinion sooner.

After taking independent medical advice, we did not uphold Mr C's complaint. The advice we received was that the examinations carried out by both GPs were reasonable with appropriate advice and treatment being provided on the basis of the findings. The adviser explained that Mr C had not shown any of the classical signs of appendicitis at the time of the first two examinations and that it was appropriate to refer him to the hospital specialists on the third attendance as his clinical condition had worsened.

Summary

Ms C complained about the care and treatment she was given by a consultant surgeon after her GP made an urgent referral for her to attend the board's breast service. She said that her appointment took too long to be arranged after referral and then the examination given had been brief. She believed that she should have been sent for a mammogram because of her presenting symptoms and her reported family history. Ms C complained that by the time she was diagnosed with breast cancer, she required a full mastectomy. The board considered that she had been treated reasonably and appropriately in terms of the relevant protocol. Ms C remained unhappy and complained to us.

We took independent advice from a consultant breast surgeon and we found that when Ms C presented initially, there was no need to perform a mammogram and she was appropriately examined and investigated. Five months later, after being urgently referred, Ms C was examined and had a mammogram and ultrasound imaging with biopsies taken. She was diagnosed with an invasive form of breast cancer for which she was given chemotherapy and then a mastectomy.

We found that Ms C's treatment had been reasonable, appropriate and timely, in accordance with Scottish Government targets. For these reasons, we did not uphold the complaint.