Health

Summary

Mr C said that until the age of 14 months, his son (child A) attended A&E at the Royal Hospital for Sick Children on several occasions. Mr C said that staff unreasonably failed to investigate child A's symptoms at these attendances and did not provide a correct diagnosis. Mr C believed that child A had had a lung infection since birth until the point at which he began to recover.

We took independent advice from a medical adviser who specialises in paediatrics. We found that there was no indication that either a chest x-ray or the prescribing of antibiotics during child A's attendances were necessary and that the care and treatment given to child A was reasonable. The adviser noted that children under one often have symptoms of viral upper respiratory tract infection during nearly half of their first year, and that the diagnosis and treatment decisions at each attendance at hospital were reasonable. We therefore did not uphold Mr C's complaint. However, we found that there were shortcomings in relation to assessment of risk factors and made a recommendation to address this. We noted these did not have an effect on the outcome of the standard of care received.

Recommendations

We recommended that the board:

• ensure the shortcomings identified in this investigation are addressed with relevant staff through training and supervision (where appropriate) and through audits.

Summary

Ms C complained about the care and treatment provided by the physiotherapy service at Stonehouse Hospital, and that a scan had not been recommended despite her severe back pain.

We took independent physiotherapy advice and found that the initial assessment carried out was inadequate and had not followed the board's local guidance on lower back pain. We upheld this aspect of the complaint and made a number of recommendations to address these failings.

Whilst we found that a scan would not have been appropriate, we were critical that the reasons for this were not clearly explained to Ms C. We did not uphold this aspect of the complaint, but made a recommendation to address the lack of record-keeping in this respect.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failings identified in this investigation.

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

• The physiotherapist should be reminded about the importance of good record-keeping which should include a detailed history and comprehensive discussions with the patient.
• Conduct a review of current local physiotherapy assessment management of chronic low back pain alongside the board's local low back pain guidance and national guidance.
• Draw the findings of this report to the attention of the physiotherapist involved.

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 that staff at Hairmyres Hospital failed to provide him with appropriate care and treatment.

Mr C became unwell with sepsis (an infection of the blood) following an operation to treat an abscess on his abdominal wall. He was discharged with arrangements to have his wound cared for by district nurses. Mr C was later readmitted with symptoms of pain, swelling and wound discharge and was discharged the same day. Mr C then went on to develop a hernia some months later.

Mr C raised specific concerns that the operation to treat his abscess was carried out too late in the evening. He said the surgeon did not take into account information relayed concerning a scan that he had undergone. Mr C also said a surgeon opened his wound with a scalpel to further drain it while he was on the ward. Mr C attributed his subsequent health problems to the way the board handled his condition. The board said Mr C's condition was identified accurately, and that he received appropriate surgery. They considered Mr C's subsequent problems were not due to any deficit in care.

We took independent advice from a surgeon. We found that overall, the board had provided appropriate treatment. In particular, we found that the surgeon carried out the correct operation, including taking into account Mr C's scan, and that this was not carried out at an inappropriate time. However, we did find that there was an unreasonable delay in Mr C receiving surgery, as this occurred several days into his admission. We found that the board should have made a decision and operated on Mr C at an earlier stage. We therefore upheld Mr C's complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for the delay in surgery identified in this investigation; and
• consider steps they can take to reduce the impact of avoidable delays on treatment in the future.

Summary

Mr C complained about the treatment his wife (Mrs A) received at Raigmore Hospital. Mrs A had ongoing problems with both of her knees and underwent physiotherapy treatment and surgery. Due to post-operative complications and continuing problems with her right knee, Mrs A had to undergo further treatment.

Mr C complained that there had been unreasonable delays in providing Mrs A with appropriate treatment and that Mrs A's surgical treatment was not of a reasonable standard. Mr C was also dissatisfied with the way that the board dealt with his complaint.

We obtained independent medical advice and we found that the time Mrs A waited for knee surgery exceeded national standards with no exceptional circumstances to justify this. We upheld this part of the complaint.

We found that the surgical treatment Mrs A received was appropriate and of a reasonable standard, and that the orthopaedic treatment was within the range of accepted good practice. We did not uphold this aspect of the complaint.

We found that the board took an unreasonable amount of time to respond to Mr C's complaint, and that they did not address all of his concerns. We upheld this aspect of the complaint.

We noted that the consent form Mrs A signed for her surgery should be updated to reflect current guidance on obtaining consent in relation to ensuring there is an appropriate section to document risk. We made a recommendation to address this.

Recommendations

What we asked the organisation to do in this case:

• The board should issue a written apology to Mrs A for failing to provide treatment for her within the appropriate timescale.
• The board should issue a written apology for the failings in their response to Mr C's complaint.

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

• The board should take action to meet the 18 weeks referral to treatment time standard for knee replacement surgery for at least 90 percent of patients.
• The board should ensure that consent forms signed by patients comply with current guidance on obtaining consent in relation to ensuring that there is an appropriate section to document risk.

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). She complained that when Mrs A had been admitted to Queen Elizabeth University Hospital with shortness of breath and chest pain, she was not provided with proper care. Ms C also complained that Mrs A was inappropriately discharged from the hospital, as three weeks after Mrs A's admission, she was diagnosed with interstitial lung disease (thickening of the tissue between the air sacs of the lungs).

During our investigation, we took independent advice from a consultant physician and found that whilst appropriate tests were carried out when Mrs A was in hospital, there was a delay in her chest x-ray being formally reported. The adviser said that had the chest x-ray been reported sooner, the clinician may have arranged further investigations which could have led to an earlier diagnosis of interstitial lung disease. We therefore upheld this aspect of Ms C's complaint. However, we found that the decision to discharge Mrs A had been reasonable as there was nothing to suggest at that time that she had serious health problems.

Recommendations

What we asked the organisation to do in this case:

• The board should apologise to Mrs A.

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

• The board should ensure that formal reports should be more readily available, particularly for acute or unscheduled patients.

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 complained about the care and treatment provided to her late mother (Mrs A) by her GP practice. Mrs A had hypertension (high blood pressure) and was prescribed multiple medications for this. Ms C expressed concern that this medication was not reviewed, despite it failing to control Mrs A's blood pressure. Ms C felt that this contributed to Mrs A suffering kidney failure and heart problems.

We took independent GP advice and found that Mrs A had multiple health conditions, and that her treatment and blood pressure control were complex. The adviser noted that some of her medication was serving a dual purpose, such as controlling her blood pressure and fluid overload. The adviser considered that the practice took appropriate steps to monitor Mrs A, including active assessment of her hypertension and regular blood tests. They explained that the number of underlying conditions made it difficult to control Mrs A's blood pressure, but were satisfied that the difficulties were not due to a lack of care on the part of the practice. We accepted this advice and did not uphold the complaint.

Summary

Ms C complained that the board incorrectly diagnosed her as suffering from bi-polar disorder when she was admitted to hospital in 2004. She was also unhappy that they prescribed sodium valproate which she did not consider should be prescribed to someone of childbearing age.

Although this complaint related to issues which occurred some years ago and would usually be considered to be time-barred in terms of a complaint to our office, as the board had reviewed the medical records last year and advised Ms C that the treatment provided was appropriate, we agreed to look at the diagnosis and decision to prescribe.

We obtained independent advice from two advisers, one of whom reviewed the records for the period of Ms C's admission. We were satisfied that a reasonable diagnosis was made in 2004 and the decision to prescribe sodium valproate to Ms C was reasonable. As a result, we did not uphold the complaints.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of Mrs B about the care and treatment of her late husband (Mr A). Mr A was admitted to Queen Elizabeth University Hospital with symptoms including severe abdominal pain and weight loss. He underwent tests, including a CT scan, but nothing was found to explain his symptoms. His GP later contacted the hospital as they remained concerned about Mr A's pain, and the CT scan was reviewed. Abnormalities in Mr A's liver and abdomen were suspected, and a further CT scan and liver biopsy confirmed that he had secondary liver cancer. He was referred to oncology and died after two sessions of chemotherapy. Ms C complained that Mr A's cancer was not diagnosed earlier and that there were signs on the first CT scan that were initially overlooked.

The board accepted that there was a delay in diagnosing Mr A's cancer but said the original CT scan report was falsely reassuring. They did not consider that this delay had any bearing on Mr A's prognosis, as Mr A's cancer was advanced and would have been regarded as terminal at the time of the first scan. They noted that the missed diagnosis on the first scan had been discussed at a radiology review meeting and also fed back to the radiologist concerned.

We took independent advice from a consultant radiologist who noted that interpreting the first scan was not straightforward and that the abnormalities were subtle. Nonetheless, they confirmed that these were overlooked, leading to delay in diagnosis. We also took advice from a consultant clinical oncologist, who confirmed that the delayed diagnosis would not have altered Mr A's life expectancy but acknowledged that it would have delayed his access to palliative care services. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• The board should issue a written apology to Mrs B regarding the delay in diagnosing Mr A's cancer, and consequently the delay in him accessing palliative care services.

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 that there was a failure to carry out a proper range of diagnostic tests into the possible cause of blood in his late wife (Mrs A's) urine when she was admitted to Southern General Hospital. Mrs A underwent a change of catheter and a urinary tract ultrasound. A cystoscopy (a medical procedure used to examine the inside of the bladder) was also planned, but was not carried out.

We took independent advice from a urological surgeon. We found that the treatment Mrs A received was reasonable. We also found that an ultrasound and a cystoscopy would normally be the first wave of investigations to investigate blood in urine, and in doing so investigate the possibility of cancer. While an ultrasound was carried out when Mrs A was admitted to hospital, we found that the decision not to carry out the cystoscopy at that time was reasonable. However, we found that the subsequent delay in carrying out a cystoscopy was unreasonable. While the advice we received was that an earlier cystoscopy and diagnosis of bladder cancer may not have changed Mrs A's outcome, we were concerned that the uncertainty caused Mrs A, Mr C and their family considerable distress during a very difficult time. Given the delay in carrying out the cystoscopy we upheld this aspect of the complaint.

Mr C also raised a concern that Mrs A was unreasonably discharged from the Victoria Infirmary following an emergency admission due to side effects from opiate pain relief that had been prescribed to her. Following this discharge Mrs A had to return to the hospital and was admitted a few hours later. We took independent medical advice from a consultant physician. We found that it was unreasonable that Mrs A was discharged and that, while relevant examinations were carried out, the relevant investigations were not. In particular, we found that the medical staff caring for Mrs A should have predicted the potential requirement for further naloxone (a medication used to block and reverse the effects of opiates) after the naloxone given by ambulance crew had worn off. Our adviser said that, according to the medical records, Mrs A was discharged after approximately two hours, which they considered to be too short a period in the circumstances. The adviser also considered that inadequate investigations into Mrs A's home circumstances were carried out before discharge. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• The board should issue a written apology to Mr C for the unreasonable delay in carrying out the cystoscopy.
• The board should issue a written apology to Mr C for unreasonably discharging Mrs A from the Victoria Infirmary.

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

• The board should ensure that patients with visible blood in their urine are investigated in a timely manner.
• The board should ensure that, where a patient with renal impairment or multiple medical problems has overdosed on long acting opiates, relevant investigations are carried out.
• The board should ensure that relevant guidelines are prepared on the use of naloxone in adult patients with renal impairment who have overdosed on long acting opiates.
• The board should ensure that a patient's home circumstances are adequately investigated when notification is received from a family member that they are struggling to cope at home.

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 husband (Mr A). Over the course of a number of years Mr A attended the practice with anxiety and depression. During this time, the practice treated Mr A in primary care, and did not refer him to mental health services. Subsequently, Mr A did not attend the practice with these problems for approximately 18 months. Mr A then contacted the practice and reported persistent thoughts about suicide to the GP who saw him. The GP developed a plan of management, including referring Mr A to psychiatric services. However, the referral was not processed. Mr A committed suicide approximately ten days after his attendance at the practice. Mrs C complained that the practice failed to appropriately refer Mr A to mental health services in view of his presenting symptoms.

The practice said they provided appropriate treatment based on Mr A's symptoms during his earlier attendances. They did not consider a referral was appropriate at that stage. When Mr A returned and described persistent thoughts about suicide, they said a referral was appropriate. The practice acknowledged there was an error in processing the referral, although they noted that it was unlikely Mr A would have received an appointment before his death.

After receiving independent advice from a GP, we upheld Mrs C's complaint. We found there was an administrative failing in not making the referral (as the practice acknowledged). We also found the practice should have scheduled an earlier review when Mr A re-attended the practice. However, we did not consider the practice should have made a referral at any of Mr A's earlier attendances, and we found that the care and treatment provided during this time had been reasonable.

Recommendations

We recommended that the practice:

• confirm that the GP will review the relevant National Institute for Health and Care Excellence guidance and consider identifying this as a learning need in their personal development plan;
• confirm the GP will discuss this case as part of their annual appraisal; and
• apologise for the failings identified in this investigation.