Health

Summary

Mr C complained about the care and treatment his late wife (Mrs A) received from the Scottish Ambulance Service. Mrs A collapsed at home and Mr C phoned the ambulance service. Mrs A was taken to hospital and died shortly after arrival. Mr C said the ambulance service did not provide a reasonable standard of care and treatment for his wife and that there was an unreasonable delay in transferring his wife to hospital. He also said the ambulance service did not reasonably investigate and respond to his complaint.

We obtained independent medical advice on the case from a consultant in emergency medicine. The adviser said that after obtaining a first electrocardiogram (ECG) tracing (a test used to check heart rhythm and electrical activity), which was of adequate quality, the crew then spent 21 minutes obtaining a further five ECG tracings, the reason for which was unclear given that the first reading was adequate. The adviser also said the ambulance crew's clinical assessment of Mrs A was unreasonably minimal, especially with regards to regularly measuring her vital signs. For these reasons, we upheld this part of the complaint.

The adviser said that the time spent trying to obtain an ECG and communicate with the intended receiving hospital was unjustifiably prolonged. He said this was especially the case as Mrs A was only a ten minute drive from the hospital that she was eventually taken to, and because she was so critically unwell. The adviser said that when it became clear that obtaining the ECG and transmitting it to the first intended hospital was becoming problematic, the ambulance crew should have urgently taken Mrs A to the second hospital, which was the closer hospital, for medical assistance. From there a decision could have been made about Mrs A's onward transportation to the first intended hospital. We upheld this part of the complaint.

We also considered that the ambulance service did not reasonably investigate and respond to Mr C's complaint and we upheld this part of the complaint. We asked the ambulance service to provide documentary evidence of their remedial action they said that had taken regarding complaints handling.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failings identified in care, treatment and complaints handling. This apology should meet the standards set out in the SPSO guidance on making an apology, available at www.spso.org.uk/leaflets-and-guidance.

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

• The Scottish Ambulance Service should learn from this case. This learning should be across the organisation, and include governance and clinical staff (especially those involved in this case). Learning should be shared with appropriate support and training provided.
• Notes of patient encounters should be comprehensive, and completed timeously and accurately. The status of the patient, treatments administered and sequences of events should be clearly recorded. Clinical staff should be trained and competent to record such notes.
• Crews should understand when it is inappropriate to stay on scene with critically ill patients for prolonged periods, particularly when there are difficulties in obtaining ECGs and transmitting them to hospital.

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 and support agency, complained on behalf of her client (Mrs A). Mrs A said that for a number of years she had been experiencing symptoms which had caused her concern. She attended her GP again because she had developed a rupture at her navel. Her GP made a referral for her to general surgery and she was given an appointment. However, before the appointment, Mrs A attended again at her GP and at the emergency department because of increasing abdominal pain. Her GP contacted the consultant surgeon asking if she could be seen sooner but she had already been given the first available appointment. At her hospital appointment, Mrs A was given a number of tests which showed likely peritoneal disease (disease of the lining of the stomach). After further tests, she was diagnosed with peritoneal mesothelioma (cancer that attacks the lining of the abdomen).

Ms C complained that Mrs A's GP had ignored the symptoms about which she had been complaining and that had she been referred to hospital sooner, she may have had an earlier diagnosis and her life expectancy may have improved. Mrs A complained to her medical practice, who said that she had not been a regular attendee at the practice and the majority of her symptoms had been respiratory for which she had received appropriate treatment. They added that when she presented with a hernia, she was immediately referred to hospital and that none of her symptoms had given any indication of her final diagnosis.

We took independent GP advice and found that all of Mrs A's symptoms had been investigated and treated appropriately. There had been no delay in referring her to hospital and there had been no suspicion of a cancer diagnosis to which a reasonable GP would have been alerted. We did not uphold the complaint.

Summary

Mrs C complained about her transvaginal tape (TVT) surgery not being performed appropriately at St John's Hospital, as she suffered heavy post-operative bleeding. Mrs C also complained that her post-operative bleeding was not treated appropriately at the Royal Infirmary of Edinburgh. In particular, Mrs C complained that she was given painful vaginal packing (an emergency treatment for excessive bleeding of the vagina) before she was referred for surgery to stop the bleeding.

During our investigation we took independent advice from a consultant gynaecologist. We found that Mrs C had suffered a rare but well-recognised complication of surgery, which did not evidence that the TVT surgery was carried out improperly. The adviser considered that Mrs C was given appropriate treatment for her post-operative bleeding as it was reasonable to try conservative management to try to stop the bleeding before referring Mrs C for surgery. We did not uphold the complaint. However, the adviser considered that the consent form should have documented the risks of TVT surgery so we made a recommendation in light of our findings.

Recommendations

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

• 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

Mrs C complained on behalf of her late husband (Mr A) who was being treated for a brain tumour at Dumfries and Galloway Royal Infirmary. Mrs C enquired with the board about the methylated status of Mr A's brain tumour as she had learned that it was useful to know this in deciding whether to accept chemotherapy. (Methylation is a chemical change which alters the MGMT gene, making treatment more effective.) The board told Mrs C that this information was not available at the time she enquired. Mrs C complained that the board failed to perform a test to confirm the methylated status of Mr A's brain tumour. She also complained that the board failed to respond to her queries within a reasonable timescale. The board responded and advised that the test was not available in the board area at the time.

In investigating Mrs C's complaint, the board carried out the test and it was found that the tumour was unmethylated. The board also confirmed that the methylation test is now carried out in all grade 3 and 4 gliomas (malignant tumours of the glial tissue of the nervous system) in the board area. We took independent advice from a consultant neurosurgeon. The adviser noted that knowing the methylation status of the tumour would have some bearing on the likelihood of the chemotherapy being effective. Our investigation found that even though the test was not routinely carried out by the board at the time Mr A was receiving treatment, the test could have been requested from another department. We also found the board failed to deal with Mrs C's complaints within the required timescale and they failed to advise her of their need to extend their response time. We upheld both of Mrs C's complaints and recommended that the board provide Mrs C with a written apology.

Recommendations

What we asked the organisation to do in this case:

• The board should provide Mrs C with a written apology, acknowledging that they failed to perform the test and failed to respond to her queries within a reasonable timescale.

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 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.