Health

Summary

Mrs C complained about the care and treatment provided to her late father (Mr A). Mr A suffered from advanced dementia, and was cared for at home by his daughters, with support provided by community mental health services and district nurses. Mrs C was concerned that Mr A was over-sedated and did not receive enough stimulation. Mrs C raised concerns that a decision was made to continue a three week trial of diazepam without a review by the psychiatrist. Mrs C complained that the decision to prescribe diazepam was inappropriate. Mrs C was also concerned that staff recommended continuous bed rest for Mr A, which meant that he was no longer able to get up or sit in his chair. Mrs C did not agree that Mr A could no longer mobilise and did not feel that he was at risk of falling, aside from being over-sedated from the diazepam. She complained that the decision to recommend Mr A remain on bed rest was inappropriate. Mrs C also complained that mental health services failed to appropriately assess Mr A's mental health problems. She felt that staff failed to address environmental factors that were contributing to his distress, such as poor personal care and lack of stimulation.

The board provided two written responses to Mrs C’s complaints, responding separately to her concerns about the district nurses and about the mental health services. The board considered that the care and treatment provided was appropriate. Staff from the board also met with Mrs C to talk through the issues. Mrs C was not satisfied with the board’s response and she brought her complaints to us.

After taking independent psychiatric, mental health and nursing advice, we upheld Mrs C’s complaint about the assessment of Mr A's mental heath problems. We found that there was an individual mental health care plan in place for Mr A. However, we found that this should have been a multi-disciplinary care plan, in view of Mr A’s challenging symptoms and the involvement of a number of health professionals. We also found the mental health care plan was not reviewed timeously. We did not uphold Mrs C’s other complaints as we found the decisions made regarding bed rest and diazepam to be reasonable. However, we found that Mr A's mobility and falls risk was not appropriately assessed and we made recommendations to address this.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failings in mobility and falls assessment, and in multi-disciplinary care planning. 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:

• Where a patient’s mobility is deteriorating, a Moving and Handling Assessment should be carried out to benchmark, and keep under review, how the patient might best be supported.
• Where there are concerns about a patient’s falls risk, a falls assessment should be arranged.
• For patients with distressing symptoms or challenging behaviour, where a number of health services are involved, a single multi-disciplinary care plan should be put in place and reviewed every six months.

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 father (Mr A) by his medical practice. Mr A suffered from advanced dementia and was cared for at home by his daughters. Mrs C was concerned that a GP from the practice prescribed Mr A pain relief without consulting his welfare power of attorney (Mrs C’s sister), even though they had agreed to consult her on any medication decisions. Mrs C also felt the medication prescribed resulted in Mr A being over-sedated and contributed to his deterioration in health.

The practice acknowledged that the GP had prescribed some medication without consulting the welfare power of attorney. The GP apologised for this and the practice said that the GP had reflected on the case and had undertaken reading on the Adult with Incapacity (Scotland) Act. The practice said the GP understood that the role of the welfare power of attorney is to act in the best interests of the patient and that they can consent to or decline any treatment, and must be involved in decisions. However, the practice considered the medication prescribed was appropriate.

After taking independent medical advice, we did not uphold Mrs C’s complaints. We found that the medications prescribed by the GP were reasonable and the effects of the medication were appropriately monitored with regular visits and feedback from carers and district nurses. In relation to the GP’s failure to consult the welfare power of attorney, we noted that the GP had apologised for this and had taken appropriate steps to improve.

Summary

Mrs C complained that, at an emergency dental appointment, the dentist did not communicate adequately with her. Mrs C said that the dentist told her that previous treatment carried out had not been done correctly and that corrective work would be required. Mrs C said that no explanation was given to her of the work required or costs.

We took independent dental advice. The adviser said that the dental records showed that the dentist was unhappy with the previous work carried out on Mrs C's teeth, but that it was not clear whether these concerns were communicated to Mrs C. We found that the records showed that the dentist communicated to Mrs C that the appointment in question was only to deal with the pain she was suffering from at that point and not to decide on future treatment. Whilst we considered the dental records could have been clearer in showing what was communicated to Mrs C, we were satisfied that the dentist adequately explained that the emergency appointment was only to treat the tooth that was causing pain, and not to create a treatment plan for the future. We did not uphold Mrs C's complaint.

Summary

Mrs C was diagnosed with jak2+VE primary polycythaemia (a cancer where the bone marrow makes an excess of red blood cells). Mrs C complained that staff at Beatson Cancer Centre failed to take appropriate action to establish the cause of abnormal blood tests, and that if they had taken action, a diagnosis could have been made earlier.

We obtained independent advice from a clinical adviser who noted that, in the year prior to Mrs C's diagnosis, a doctor at the oncology clinic at Beatson Cancer Centre had ordered a full blood count inadvertently, which was not part of the usual practice from an oncology perspective. The full blood result revealed a high haemoglobin level and, according to the relevant guidance, further action should have been considered to determine the cause of the high haemoglobin level. However, as the oncology doctor was unaware that a full blood count had been ordered, there was no reason for the doctor to establish the result of the full blood test. It was noted that Mrs C already had a long previous medical history of high haemoglobin levels, which the clinicians were aware of, and she was not displaying symptoms of polycythaemia when she attended for clinical review in the year prior to her diagnosis. We found that Mrs C's high haemoglobin level at that time was of minimal clinical significance and Mrs C did not appear to have suffered any complications as a result.

We also reviewed the process where, in addition to the electronic reporting of the abnormal result, the laboratory would phone the clinician to highlight the abnormal result. We found that the criteria was not met in Mrs C's case, and that, according to the standard operating procedure, a phone call to alert the clinician was not required in this case. As such, we found that there had not been a failure in the reporting process. We did not uphold the complaint.

Summary

Mr C complained that his GP practice failed to provide him with a GP appointment and a medical certificate for sickness absence. Mr C said he could not get a same day appointment when he phoned the practice in the mornings. We found there were other means of getting an appointment, such as booking online or booking an appointment for later in the same week. An audit of the practice’s appointment records showed there were appointments available in the week Mr C phoned the practice. We took independent advice from a GP adviser, and in their view the practice’s appointment system was reasonable.

Mr C said because he could not get an appointment he could not get a medical certificate and, when he spoke to a GP by phone, the GP refused to issue a certificate. We found that the GP asked Mr C to make an appointment for review, given that his circumstances had changed. In the adviser’s view, the GP acted in line with the General Medical Council's guidance, and the care provided to Mr C was of a reasonable standard. We did not uphold Mr C’s complaints.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mr A). Mr A had experienced symptoms of pain and numbness in his left foot. After he attended a number of consultations in the board's podiatry and orthopaedic services, he underwent surgery at Gartnavel General Hospital to fuse one of the joints in a toe. Following the operation, Mr A continued to experience pain and numbness and he attended a number of review appointments in the orthopaedic department before being discharged approximately a year after the procedure.

Ms C complained that the board did not perform appropriate orthopaedic surgery on Mr A, and said that Mr A was not informed of the possible side effects of surgery.

We took independent advice from an orthopaedic surgeon. The adviser was satisfied that Mr A was appropriately informed of the potential side effects of the procedure and that consent was obtained appropriately and in accordance with the board's consent policy. Furthermore, the adviser considered that the records indicated that the operation was carried out to a reasonable standard. In view of this advice, we did not uphold this aspect of Ms C's complaint.

Ms C also raised concern that Mr A did not receive appropriate treatment following surgery when he reported further concerns to the surgeon. We found that Mr A had attended three review appointments in the orthopaedic department following the surgery and that by the point of discharge the surgeon was satisfied that the toe joint had healed well. The adviser did not find evidence of failings in the aftercare provided to Mr A. We did not uphold this aspect of Ms C's complaint.

Summary

Mr C complained on behalf of his wife (Mrs A) that her medical practice failed to refer her to hospital for an audiology review as agreed during an earlier consultation. The practice apologised, but advised that the GP involved had no recollection of this agreement, nor was it recorded in Mrs A's medical notes. As we could find no additional evidence to allow us to conclude whether or not a referral was agreed, we did not uphold the complaint.

Summary

Ms C complained that her late father (Mr A) was wrongly diagnosed with metastatic cancer (a cancer which has spread from a primary site elsewhere in the body) , and then had to wait an unreasonable length of time to be informed of the mistake. Ms C said that Mr A’s mental and physical health suffered as a result.

Mr A was diagnosed with prostate cancer. As part of the diagnostic process he was given a bone scan. As the results were indeterminate, a repeat scan several months later was carried out which showed some changes and was reported by the radiologist as being suggestive of possible metastatic cancer. This was communicated to Mr A at a review appointment by his consultant oncologist. A scan subsequently carried out concluded that Mr A did not have metastatic cancer.

We took independent advice from a consultant oncologist and found that it was reasonable that Mr A was initially assessed as having metastatic cancer, and that it was appropriate based on the evidence available at the time that his oncologist had communicated this to him. We also found that after it was discovered that Mr A did not have metastatic cancer, this was communicated to him within a reasonable time-frame. We did not uphold this aspect of Ms C’s complaint.

Ms C also complained that Mr A was not referred to any specialist cancer support services and he was not offered additional support for pain management. Whilst we acknowledged that the board had accepted this and had apologised to Mr A’s family, we were critical of these failings. We upheld this aspect of Ms C’s complaint.

We also found that the board failed to respond to Ms C’s complaint within a reasonable period of time and we upheld this part of her complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C and her mother for:
• failing to make Mr A aware of specialist cancer support services
• failing to offer Mr A additional support for pain management
• failing to provide an update on Ms C's complaint when it became clear that the 20 day timescale could not be met
• the unreasonable delay in arranging a meeting and providing Ms C with the minutes of this.
• These apologies 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:

• Patients should be informed of the specialist cancer support services that are available to them.
• Patients should be provided with additional support for pain management, where appropriate.

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 accuracy of a report which was written following a meeting attended by his ex-wife, a member of the child and adult mental health services, and staff from his son's school. Mr C felt that the report gave an inaccurate description of his behaviour and he was concerned that his ex-wife might produce the report in legal proceedings and that he would have to defend it.

We took independent advice from an adviser in mental health services and concluded that the report was factually accurate in that the information which was recorded had been discussed during the meeting. However, we could understand that the report could be interpreted differently by its readers as it was not entirely clear that the information discussed in the meeting was the opinions of those involved rather than actual facts. We noted that the board had clarified the issue in their response to Mr C's complaint. We did not uphold the complaint.

Summary

Miss C complained that the board unreasonably refused her breast reduction surgery. She maintained that this should have been done, not for reasons of appearance, but because of her extreme back and neck pain. The board did not agree and said that Miss C failed to meet the criteria necessary for the operation to be carried out.

We took independent advice from a consultant in plastic and reconstructive surgery. We found that in consideration of Miss C's case, the board had followed current Scottish Government advice. We did not uphold her complaint. However, we also found that the board had not told Miss C what to do should she continue to suffer severe back and neck pain, and so we made a recommendation about this.

Recommendations

What we asked the organisation to do in this case:

• Advise Miss C what to do in the event of non-surgical methods failing to improve her back and neck pain.

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.