Health

Summary

Miss C complained to us that the medical practice had unreasonably notified the Driver and Vehicle Licensing Agency (DVLA) that she had alcohol issues. She said that she had to surrender her driving licence for a period and that she had suffered financially as a result. The practice explained that they had acted in accordance with their policy about advising patients to inform DVLA about alcohol problems and the circumstances where the practice could contact DVLA themselves.

We took independent advice from an a GP adviser and concluded that the practice policy in force was reasonable and that the practice were entitled to notify DVLA in this instance. We did not uphold the complaint.

Summary

Mrs C complained that her late mother (Mrs A)'s medical practice did not take urgent action and advise Mrs A to attend hospital after she reported symptoms related to deep vein thrombosis (DVT, a blood clot). Mrs A collapsed at the entrance of the main health centre at the practice and was taken to hospital. She died shortly after of a pulmonary embolus (a blockage of an artery in the lungs), which is a side effect of DVT. Mrs C was also unhappy that the medical practice had not told her about the incident.

We took independent medical advice and found that the practice acted reasonably in advising Mrs A to attend the practice for assessment rather than going immediately to her local emergency department. We considered that the practice provided a timely appointment for Mrs A to be reviewed. In addition, we considered it was reasonable that practice staff had not contacted Mrs C regarding the incident because Mrs A had collapsed outwith the premises of the medical practice and staff there were unaware of what had happened. In view of these findings, we did not uphold the complaint.

Summary

Mr C complained that the board had unreasonably delayed in providing treatment for his eye condition at Hairmyres Hospital.

We took independent advice from a consultant who specialises in the medical and surgical treatment of eye disease. The advice we received was that there had been no unreasonable delay in the treatment provided to Mr C, but that there had been an unreasonable delay in the following up of Mr C's eye condition. However, we found that this delay had not resulted in deterioration of Mr C's vision. Taking account of the evidence and the advice we received that Mr C should have been followed up more closely, we upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failure to follow-up his eye condition.

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 to us about the care and treatment provided to her late father (Mr A) at Wishaw General Hospital after he was diagnosed with cancer of the oesophagus (the tube that carries food from the throat to the stomach). Mr A had been admitted to hospital for an operation. During the operation a hole in one of his air passages was identified and he was transferred to another hospital outwith the board area. It was decided there that his cancer had spread and was inoperable. Mr A died four days later.

Mrs C complained that there had been delays in carrying out tests and in providing treatment to Mr A. We took independent advice from a consultant upper gastrointestinal surgeon and from a consultant radiologist. We found that, in general, the board had provided reasonable care and treatment to Mr A. However, there had been delays in carrying out two scans that Mr A needed. The board did not have the facilities to carry out these scans and had referred Mr A to another board. There was no evidence that the board had taken any action to escalate the matter when there were delays in carrying out the scans. In view of this, we upheld Mrs C’s complaint, although we did not consider that the delays in carrying out the scans would have influenced the ultimate clinical outcome for Mr A.

Mrs C also complained that the board did not take reasonable action to investigate the possibility of Mr A’s cancer spreading before the operation. We found that the investigations the board had carried out before the operation were appropriate and in line with standard practice. It had also been reasonable for them to carry out the operation. We did not uphold this aspect of Mrs C’s complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failure to act on the delays in the scans being carried out. 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:

• Ensure that there are adequate mechanisms in place to prevent delays in having scans carried out outwith the board.

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 events following an incident when he became ill at home and was taken by ambulance to Monklands Hospital. He said that the board incorrectly recorded that he underwent a loss of consciousness at home and then unreasonably assessed that he was unfit to drive. He said they failed to follow health guidelines on loss of consciousness in over 16s and that their actions resulted in an unnecessary ban on driving for him. Mr C also said that the board unreasonably failed to respond to his complaint.

Mr C said the board failed to communicate the basis of their diagnosis of his illness to him and how this affected his fitness to drive. He said they also provided him with incorrect information regarding the relevant Driver and Vehicle Licensing Agency (DVLA) regulations and his future prospects of driving. Mr C subsequently saw a cardiac consultant who said there was nothing clinically wrong with his heart and that he had undergone a simple faint and was fit to drive.

We took independent medical advice from a consultant in general medicine, who said it was not clear from the records whether Mr C did or did not lose consciousness. However, the adviser noted that there was no evidence that staff had asked for any witness accounts of what occurred from Mr C’s wife or daughter, which they considered to be crucial in such cases. The failure by staff to gather this information before assessing that Mr C was unfit to drive meant that their decision was based on incomplete information. We upheld this part of Mr C’s complaint.

We also found that the evidence available did not demonstrate that staff gave Mr C reasonable information about the basis for his diagnosis and how this affected his ability to drive. We upheld this part of the complaint. We asked the board to provide evidence of remedial action that they said they had taken and also made recommendations to address the remaining failings. We did not have sufficient evidence to say with certainty that Mr C was incorrectly advised of the relevant DVLA regulations and his future prospects of driving. Therefore, we did not uphold this part of his complaint.

We also found failings in the board’s handling of Mr C’s complaint and, therefore, upheld this part of his complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to follow National Institute for Health and Care Excellence guidelines, the failings in communication about the assessment that he was unfit to drive and the failings in their complaint responses. 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 transient loss of consciousness (TLoc) is suspected, staff should question the person involved and any witnesses, and use this information in determining whether the person had TLoC.
• Patients found to be unfit to drive should be given clear information about the basis for this.

In relation to complaints handling, we recommended:

• Complaint responses should address the issues raised, clearly explain any areas of disagreement and give adequate apologies where things have gone wrong.

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). 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.