Health

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mrs A). Mrs A was referred by her GP to hospital as she had an umbilical hernia. She had tests involving her chest, abdomen and pelvis which led to a suspicion of cancer, and a letter was sent to her GP advising that at the same time as her hernia was repaired, a biopsy would be taken. After these procedures, Mrs A was advised that it was likely that she had cancer. She was reviewed at a subsequent appointment where it was confirmed that she had advanced malignant disease.

Ms C complained about the way in which Mrs A had been told about her diagnosis and that she had not been given full information about the surgical procedures she was to undergo. She also said that the board had delayed in reaching a diagnosis and delayed in responding after Ms C made these complaints to them.

We found that Mrs A had been alone when her diagnosis was given to her and that no effort had been made to try to contact her husband before she was given bad news. We found little evidence that the procedures and the risks had been fully explained to Mrs A, despite the fact that she had signed the consent form as having understood. We upheld these aspects of the complaint. Although Mrs A felt that there had been a delay in diagnosing her, we found no evidence of this. She was seen within a month of referral, and tests were carried out in a timely way. We did not uphold this aspect of the complaint. However, we did find that when the board came to consider Ms C's complaints, they took too long, so we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• The board should send Mrs A a formal letter apologising for failing to attempt to involve her husband or another supporter when she was given bad news.
• The board should send Mrs A a formal letter apologising for failing to discuss the risks of surgery with her.
• The board should send Mrs A a formal letter apologising for the delays in responding to her complaint.

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

• The board should ensure as far as possible that when patients are receiving bad news, they are personally supported by a friend or family member.
• The board should ensure that prior to elective surgery, a full explanation is given to the patient including information about the risks entailed. This conversation should be documented.

In relation to complaints handling, we recommended:

• The board should complaints should be responded to within the stated timeframes. Where this is not possible, the complainant should be updated.

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 by her medical practice for her back pain. She said that she was not appropriately investigated or diagnosed, and that there was a delay in her being referred for a scan.

We took independent advice from a GP. We found that when Mrs C presented with back pain, she was appropriately assessed and examined, and that appropriate action was taken as a result of these assessments. We also found that she was referred for a scan within two and a half weeks of presentation. We found that the care and treatment provided by the practice was reasonable and we did not uphold Mrs C's complaint.

Summary

Mrs C complained about her medical practice, specifically that they failed to recognise or suspect she had whooping cough given her symptoms until a blood test confirmed the condition. Mrs C told us that as a result of the failings, her health needs were not met and she posed an unnecessary risk to her family and other members of the public. Mrs C also raised concerns about the way the board handled her complaint in that a complaints manager had been involved in both supporting her and investigating her complaint.

We took independent advice from a medical adviser. We found that the standard of medical care and treatment provided was reasonable. We also found that, given the review of the investigation and report was undertaken by the head of services and not the complaints manager, the complaints handling was reasonable.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mrs A). She complained that it was unreasonable for Mrs A's GP practice to fail to diagnose her with whooping cough until a blood test confirmed this. She also complained about communication with the GPs and the impact this had on the diagnostic process.

We took independent advice from a medical adviser who specialises in general practice. We found that the standard of medical care and treatment provided to Mrs A was reasonable, and that there was no evidence of any failings. We did not uphold the complaint.

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.