Health

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.

Summary

Mr C complained about the orthopaedic treatment he had received from the board. In particular, he complained that he had undergone a number of operations on his shoulder and had contracted an infection.

We took independent advice from a consultant orthopaedic surgeon. The advice we received was that the orthopaedic treatment Mr C received was reasonable and that, while his care pathway had resulted in a poor outcome for him, there was nothing the board could have done differently to achieve a better outcome for him. The advice we also received was that there was no way of knowing when the persistent infection Mr C contracted had developed. In the circumstances we did not uphold the complaint.

Summary

Mr C had been taking warfarin (a blood-thinning medication). Following a review at an out-patient cardiology clinic, his International Normalised Ratio (INR, a blood test that checks how long it takes for blood to clot) target range was changed to between 2 and 3. Previously, it had been 2.5 to 3.5. Mr C's GP practice did not update the change on their systems and Mr C only became aware of the change 18 months later. Mr C complained to the practice and was dissatisfied with their handling of his complaint.

Whilst the practice accepted that they failed to update Mr C's INR target, the advice we received was that this failing was not significant. The adviser said the change in Mr C's INR target was not clearly communicated by the cardiologist to the practice as it did not contain a sufficient alert to notify the change in his INR target level. Furthermore, the practice could not be expected to be aware of national changes. We accepted this advice. The adviser also commented that as Mr C's INR target was to be reduced rather than increased, there was no significant clinical risk resulting from the failure of the practice to update the target. Taking account of this advice, we did not uphold this aspect of the complaint.

We accepted that the practice had provided Mr C with an apology and an explanation for the error but they had delayed in doing so. While we accepted the delay was due to difficulty in obtaining information that they needed from the cardiology department, we considered the practice could have made Mr C aware of this. We also found that the practice's response to Mr C's complaint did not contain details for this office. We upheld this aspect of the complaints.

Recommendations

We recommended that the practice:

• apologise to Mr C for the failings in complaints handling identified in this investigation; and
• review their complaints handling procedures to ensure that they are in line with NHS Scotland's 'Can I Help You?' guidance.

Summary

Mr C received treatment from the board over a two-year period for urinary incontinence and erectile dysfunction, which he developed following surgery at the Western General Hospital for prostate cancer. After communicating with the board about his dissatisfaction with his treatment, Mr C obtained penile implant surgery privately abroad and asked the board to reimburse him for the cost of his treatment. The board refused.

Mr C complained that the board acted unreasonably when assessing his request for reimbursement, because they failed to take into account that, despite being aware of his concerns about the delay and his intention to seek treatment privately, they did not properly inform him of the alternative options that were available within the NHS.

We obtained independent advice from a consultant urologist. The adviser said that where a patient raises concerns about delays in treatment and their intention to look for treatment elsewhere, the board should advise the patient of the options to obtain treatment elsewhere in the NHS or the European Union. It was clear that Mr C made the board aware of his concerns about the delays in investigation and treatment of his conditions. However, Mr C advised the board that he had already agreed private treatment with a urologist outwith the UK, that he would be pursuing that course of action and that he did not expect a response from the board on this matter.

The adviser noted that the board said Mr C should have had a full assessment of his urinary incontinence and agreed treatment plan (which had yet to be completed), prior to undertaking any surgery for erectile dysfunction. The adviser said this was entirely reasonable. While we acknowledged the delays in Mr C's treatment, we considered that the board's assessment of Mr C's request for reimbursement was reasonable, as the equivalent treatment in the UK or EU at that time would have been to continue to treat his urinary incontinence rather than perform implant surgery. We therefore did not uphold Mr C's complaint. However, we found that the board did not respond to one of Mr C's letters to them and made a recommendation regarding this.

Recommendations

We recommended that the board:

• apologise to Mr C for failing to respond to a letter during their handling of his complaint.

Summary

Mrs C complained on behalf of her brother (Mr A), that staff at the Royal Infirmary of Edinburgh failed to ensure he was safely transferred to a trolley. In addition, Mrs C raised concern that the incident was not properly investigated, that Mr A was not reviewed following the incident, and that the complaints handling by the board was poor.

We took independent medical advice. We found that Mr A was not transferred to the trolley in accordance with the moving and handling plan that had been put in place following his mobility assessment. Furthermore, when the incident was reported to a nurse later that evening, we were critical that the nurse did not take appropriate steps to formally record the incident on the hospital's system for reporting adverse events. We considered this would likely have resulted in the incident being investigated in a timely manner, and that Mr A would have been reviewed by a doctor sooner. We were also critical of the board's handling of the complaint. Specifically, that they had inaccurately said that a nurse had been present at the time of the trolley transfer for which they apologised. We also found that the board had not acknowledged that the porter's recollection of the transfer was contrary to the manual handling plan documented in Mr A's clinical records. We therefore upheld the complaint.

Recommendations

We recommended that the board:

• apologise to Mr A for the delay in reviewing him after the incident was reported to the nurse;
• share these additional findings with the nurse involved;
• take steps to ensure that porter staff are made fully aware of patients' mobility limitations and needs prior to carrying out inter-departmental transfers; and ensure that nursing staff are available to provide the necessary support indicated in mobility assessments;
• apologise to Mrs C for the additional failings in the complaints handling identified in this investigation; and
• provide evidence of the steps taken to address the issue related to the complaints handling.

Summary

Mrs C, who works for an advocacy and support agency, complained on behalf of her client (Mrs A). She said that an orthopaedic consultant at Hairmyres Hospital should not have referred Mrs A for a Magnetic Resonance Imaging (MRI) scan because she had metal clips in her head from surgery performed in the past.

We took independent medical advice and found that MRI scanning should not be used in patients with metal clips as this can lead to movement of the clips in the strong magnetic field.

We considered that the orthopaedic consultant had not taken an adequate previous medical history when deciding to refer Mrs A for an urgent MRI scan. However, we noted that further safety checks by radiology staff prevented the scan from going ahead. We acknowledged that the board had apologised for the distress caused to Mrs A in relation to the referral but made two further recommendations.

Recommendations

We recommended that the board:

• apologise to Mrs A for the failure to obtain her previous medical history at the time of the consultation and for inaccurately completing the MRI request form; and
• draw these findings to the attention of the orthopaedic consultant for future learning.

Summary

Mrs C complained that the dental practice failed to deal with her complaints in a reasonable manner. We found that the practice had failed to establish in the first instance what Mrs C's complaint involved and that this resulted in a missed opportunity to resolve the complaint at an early stage. We also found that Mrs C's complaint was not acknowledged by the practice within the three working day timescale set out in the Scottish Government's 'Can I help you?' guidance for handling healthcare complaints, and that the practice did not communicate with Mrs C by her preferred method. Finally, we found that the practice's response to Mrs C's complaint was not sent to her within the 20 working day timescale that is set out in the Scottish Government's 'Can I help you?' guidance. We therefore upheld Mrs C's complaint.

Recommendations

We recommended that the practice:

• apologise to Mrs C for the failings identified by this investigation;
• ensure all staff are familiar with the 'Can I help you?' guidance for handling healthcare complaints;
• ensure their complaints policy is in line with the 'Can I help you?' guidance; and
• ensure that their complaint response letters comply with the 'Can I help you?' guidance, and in particular give details for contacting our office.

Summary

Mrs C complained that she had been given a bill by her dentist which included costs for work which was either corrective or had already been paid for. Mrs C also complained that she was being charged for work that had not been carried out. Additionally, Mrs C complained that the dentist had failed to communicate with her about her treatment needs, in particular that she had once been given a treatment plan with no costs on it.

We took independent dental advice. We found that what Mrs C had believed to be a bill was in fact an estimated treatment plan and therefore she was not being charged for work at the time of her complaint. We did not uphold this aspect of Mrs C's complaint. However, we found that it was unreasonable that she had on one occasion been presented with a treatment plan with no costs on it and therefore we upheld this aspect of Mrs C's complaint.

Recommendations

We recommended that the practice:

• apologise to Mrs C for issuing a treatment plan without any costs on it.