Health

Summary

Mr C complained that the prison health centre unreasonably decided to discontinue his medication when he failed a medication check. Mr C said the prison health centre failed to take account of the fact that he had reported to them that he was being bullied for his medication.

The prison health centre considered that Mr C had not been taking the medication as prescribed and therefore the medication was stopped to maintain his safety. The decision was reviewed by a multi-disciplinary team who assessed that there was no significant clinical risk to Mr C ceasing to receive the medication.

Before we reached a decision on Mr C's complaint, he requested to withdraw his complaint. Therefore, we closed the complaint without reaching a decision.

Summary

Mr C underwent an operation at Ninewells Hospital to remove a skin tag on his penis. He was concerned about the outcome of the operation and the appearance of the resulting scar, and he said that he was left with some disfigurement. Mr C complained that the consultant urological surgeon told him before the operation that the appearance of his penis would improve with surgery and that he was not warned that there was any risk of disfigurement. Mr C also had concerns about the standard of the operation itself, and follow-up care.

We took independent advice from an adviser who specialises in urological surgery. We found failings in the consent process. We found that there was no evidence that Mr C had been warned of the risk of scarring and that the outcome of the surgery may not meet his expectations until the day of the operation. This meant that he had not been given enough time and appropriate information to make an informed decision, particularly in light of his additional needs. We found no evidence to suggest that the standard of the operation was not reasonable and while there were failings in relation to a follow-up appointment, this was addressed by the board.

Recommendations

We recommended that the board:

• apologise to Mr C for the failings identified in this investigation;
• bring the failings identified in this investigation to the attention of relevant staff; and
• review the consent process and related documentation to ensure that clinicians properly obtain, and document, consent for procedures.

Summary

Miss C said her mother (Mrs A) had a complex medical history and was admitted to the Royal Victoria Hospital with reduced mobility and delirium (a temporary state of mental confusion arising from, amongst other things, infection). Mrs A was discharged to a nursing home eight days later. Miss C complained that Mrs A was not medically fit to be discharged from the hospital. Mrs A died several weeks after her discharge.

We took independent medical advice. We found that Mrs A was medically fit to be discharged and that the care package was reasonable. We therefore did not uphold Miss C's complaint. However, there were shortcomings in the way in which Mrs A was discharged. This included communication about Mrs A approaching the end of her life, meaning that Miss C was unprepared for Mrs A's death. We therefore made recommendations in relation to this.

Recommendations

We recommended that the board:

• review the discharge policy and communication with relatives in light of the failings identified;
• raise the failings identified with relevant staff; and
• apologise for the failings this investigation has identified.

Summary

Mrs C complained to the board about the care and treatment provided to her mother (Mrs A) by her GP practice. In particular, Mrs C felt that the practice failed to arrange appropriate investigations in view of the symptoms Mrs A presented with.

Mrs A attended the practice on a number of occasions over a two year period, and presented with symptoms including abdominal pain, vomiting and weight loss. After Mrs A's condition did not improve following an out-of-hours GP assessment, she was admitted to hospital. Several tests were performed during this admission and further tests were carried out in the months following discharge. Following these investigations, Mrs A was diagnosed with gastric cancer and she died a number of months following this diagnosis.

In response to our enquiries, the board provided a copy of a review that they had undertaken. Within the review, the board noted that Mrs A had complained of a number of symptoms, yet on each occasion Mrs A's symptoms could have been explained by non-cancer related causes. The board also noted that Mrs A's weight was relatively stable and various blood tests did not suggest anything sinister, with no evidence of anaemia or other worrying findings. The board concluded that the recorded symptoms did not suggest that a referral for gastroenterology investigation was indicated in accordance with local protocols.

We took independent advice on the case from a GP adviser. Having reviewed the records, the adviser did not consider that the practice had failed to take appropriate action in view of Mrs A's symptoms, and did not find that Mrs A's symptoms should have alerted the practice to a likely diagnosis of gastric cancer. The adviser concluded that the practice provided Mrs A with reasonable care. We accepted the adviser's comments, and for this reason we did not uphold this complaint.

Summary

Mr C complained about delays and communication in relation to his wife (Mrs A)'s hip-replacement surgery at Ninewells Hospital.

After taking independent advice from a consultant orthopaedic surgeon, we did not uphold Mr C's complaints. The advice we received was that while Mrs A's patient journey had been a long one, there were no unreasonable delays in her orthopaedic treatment. After reviewing all the available evidence, no issues were found with the standard of communication.

Summary

Mr C complained on behalf of his wife (Mrs A) about the clinical treatment she received when she attended A&E at the Gilbert Bain Hospital. We took independent advice from a consultant in emergency medicine. The advice we received was that the assessment and treatment of Mrs A was reasonable and that appropriate investigations were carried out, and that Mrs A did not require hospital admission. We therefore did not uphold this complaint.

However, the advice we received said that while written notes made by the doctor caring for Mrs A were of a high standard, one thing that could have been improved was the inclusion of vital signs and we made a recommendation to the board regarding this.

Mr C also raised his concern that the doctor had failed to reasonably interpret Mrs A's chest x-ray. The board accepted that the doctor had failed to appreciate the significance of the radiographic appearance on the base of Mrs A's left lung on the x-ray. They apologised for this and explained that the issue of x-ray interpretation had been discussed with the doctor. The advice we received was that the action taken by the board was reasonable. While we upheld the complaint, given the action taken by the board we made no further recommendations.

Mr C complained that the board inappropriately discharged Mrs A when she attended the hospital, particularly as she had had to re-attend the following day. The advice we received was that Mrs A did not require hospital admission. We did not uphold the complaint.

Recommendations

We recommended that the board:

• draw the importance of including vital signs in written notes to the attention of relevant staff as part of their professional supervision.

Summary

Mr C complained to us that the medical practice had failed to provide appropriate care and treatment to his son (Mr A). He said that a GP had prescribed oxycodone (opiate medication) over the phone to Mr A on the morning that he died from a medication overdose. Mr C was also concerned that there had been an entry in Mr A's clinical records from his previous GP surgery noting that Mr A was not to be prescribed opiates.

The practice said that practitioners are aware of the need to balance the potential benefits of a drug against any possible harm. The practice were aware of the previous GP surgery concerns that Mr A used illicit drugs and that care should be taken about the strength of any opiates prescribed. Mr A had recently undergone significant surgery and he reported that his pain control was ineffective. It was also noted that Mr A was attending orthopaedics and the pain clinic.

We took independent medical advice from a GP who noted that Mr A had been referred to orthopaedics and the pain clinic and that he was regularly reviewed in either face-to-face consultations or phone contact. When required, his pain relief was increased and this was considered reasonable care. The adviser had no concerns about the actions of the GP who prescribed the oxycodone, as they had taken note of the previous GP practice's concerns about drug misuse and made a reasonable clinical judgement based on the recorded evidence available. We did not uphold the complaint.

While we did not uphold the complaint, we noted that the practice and the previous GP practice operated different electronic record recording systems and that there was a failure of the first practice to transfer all relevant information over when Mr A joined the new practice. We made a suggestion to both practices which may have allowed more clarity, although it may not have altered the GP's decision to prescribe the oxycodone.

Summary

Mr C complained that his wife (Mrs A) was inappropriately diagnosed as having suffered a miscarriage and that she was not provided with appropriate and timely treatment.

Mrs A was in the early stages of pregnancy when she experienced bleeding. During the night, Mr C and Mrs A attended the gynaecology out-of-hours service at the Royal Infirmary of Edinburgh. After waiting, they were seen by a doctor, who examined Mrs A. A procedure was offered and it was noted that this would not harm the baby should the pregnancy still be viable. Miscarriage was recorded as being very likely and the couple were sent away to return the following morning for a scan.

The scan confirmed that the pregnancy was ongoing and that the bleeding had been caused by a haematoma (a collection of blood outside the blood vessels).

Mr C felt that the lack of scanning facilities at night time meant they had an unnecessary wait to find this out. Mr C also said that the doctor they had seen told them that Mrs A had miscarried and that he was concerned about the procedure that was offered.

After taking independent advice from a consultant gynaecologist, we upheld Mr C's complaints. The board previously acknowledged that there had been an inappropriate diagnosis of miscarriage and had apologised for this. The advice we received was that the doctor had mistaken blood clots that were present during the examination for tissue and that it was inappropriate to make a firm statement about miscarriage without a scan taking place. We noted, however, that the availability of scanning facilities at the hospital was in line with the relevant guidance. We found that there were issues with record-keeping and that the procedure offered by the doctor was not clinically necessary.

Recommendations

We recommended that the board:

• apologise for the offer of a procedure that was not clinically indicated;
• take steps to ensure that all emergency gynaecology referral notes are appropriately completed with timings and an identifiable name and grade of the doctor;
• ensure that the adviser's comments are fed back to the doctor for learning and discussion at their appraisal;
• consider whether further training for doctors working in this area is necessary to improve communication with patients suffering from problems in early pregnancy; and
• consider how electronic records of consultations can be maintained in circumstances such as these in future.

Summary

Mr C complained that the board failed to provide him with appropriate treatment in relation to removal of a fatty lump on his neck/shoulder area and provided him with misleading information regarding waiting times. He also said the board failed to adequately respond to his formal complaints about these matters.

Mr C felt that the removal of the lump could have been carried out under local anaesthetic at a nearby hospital, instead of under general anaesthetic at a hospital further away as planned by the board. He also said that the board failed to consider his request to change his attendance time from 08:00 to 11:00 to accommodate his travel arrangements. We took independent medical advice and found that the expertise required for the procedure was only available at the further away hospital. The adviser also said that the decision to carry out the procedure under general anaesthetic was reasonable, as it reduced the risk of complications. We did not uphold this aspect of the complaint. However, we did make a recommendation in relation to the board's handling of Mr C's request for a different attendance time.

Mr C said that the board unreasonably changed his treatment time guarantee (TTG) date, said that he was unavailable for a two-week period, and unreasonably offered him a re-scheduled appointment at very short notice. We found that it was not reasonable for the board to offer a re-scheduled operation at short notice, at the weekend, at some distance from a patient's home, without taking the lack of public transport into account or offering to provide transport for Mr C. We upheld this aspect of the complaint. Mr C was also concerned that the phone line he was required to use to discuss his appointment was unanswered. However, we found that the board had taken reasonable action to address this issue.

In relation to the handling of Mr C's complaint, we found that the board took six and a half months to provide him with a response, instead of doing so within 20 working days as set out in their complaints handling procedure and NHS Scotland guidance. We found that they did not provide updates, and unreasonably failed to respond to calls and emails from Mr C. We therefore upheld this aspect of the complaint.

Recommendations

We recommended that the board:

• feed back the findings of this investigation to staff involved;
• ensure that exceptional circumstances are appropriately taken into account when deciding patients' hospital attendance times;
• provide Mr C with a written apology for failing to appropriately communicate with him regarding the cancellation of his surgery;
• feed back our decision on Mr C's complaint to the waiting list services booking staff involved;
• ensure that exceptional circumstances are appropriately considered when deciding whether to apply a period of unavailability to a patient's TTG;
• provide Mr C with a written apology for the misleading information given to him about waiting list guarantees;
• feed back our decision on Mr C's complaint to the complaints handling staff involved; and
• provide Mr C with a written apology for failing to provide him with updates on his complaint and failing to respond to his communications about his complaint.

Summary

Mr C complained about the board's decision not to offer him surgical treatment for his condition. The board said that the decision to proceed with surgery was subject to the Adult Exceptional Aesthetic Referral Protocol, which details the limited criteria in which surgery can be provided for a range of conditions. The board said that because Mr C did not meet criteria within this protocol, he did not qualify for surgery for his condition.

We found that Mr C was assessed by a plastic surgery registrar and a clinical psychologist before a multi-disciplinary team made a decision on whether Mr C met the criteria. We took independent advice from a consultant plastic and reconstructive surgeon and a consultant psychiatrist. Based on the advice we received, we concluded that the assessments carried out prior to the decision-making were reasonable. Although we found that the board had not undertaken the assessments in the order specified within the protocol, the advisers did not consider that this would have prejudiced the subsequent decision of the multi-disciplinary team. We concluded that the board's decision not to offer Mr C surgery was reasonable, and for this reason we did not uphold this complaint.