Health

Summary

Mrs C's mother (Mrs A) was admitted to Queen Elizabeth University Hospital. Mrs A had a number of health conditions and had recently been treated with antibiotics for infected leg ulcers and had chronic leg swelling.

Mrs A spent two months in the hospital and was discharged after clinical staff considered that she was medically stable. Shortly after discharge, Mrs A had a fall at home and was re-admitted to hospital.

Mrs C complained that the board did not provide appropriate pressure ulcer care for Mrs A. In particular, Mrs C said that staff left wounds on Mrs A's legs undressed for a number of hours and failed to appropriately elevate Mrs A's legs to promote healing.

We took independent nursing advice. We found no evidence in the records that failings in care had occurred. For this reason, we did not uphold this aspect of Mrs C's complaint.

Mrs C also complained that staff inappropriately discharged Mrs A from hospital. Mrs C specifically raised concerns about the level of physiotherapy input, Mrs A's nutritional status, that a home visit was not carried out prior to discharge and the medication with which Mrs A was prescribed on her discharge.

We took independent advice from an specialist in geriatric medicine. The adviser considered that Mrs A had received an appropriate level of therapy from a range of specialties before discharge and considered that the decision to discharge was reasonable. The adviser had no concern about the medication prescribed at discharge and was satisfied that the board's considerations in relation to a home visit were reasonable.

In relation to nutrition, the adviser considered that Mrs A had received appropriate care from dieticians, but noted that the board had mischaracterised Mrs A's nutritional status in their complaint response. We did not uphold this aspect of Mrs C's complaint, but we made a recommendation in respect of their complaints handling.

Recommendations

We recommended that the board:

• apologise to Mrs A's family for the inaccuracy in the board's complaint response letter.

Summary

Ms C, an advocacy and support worker, complained on behalf of Ms B. Ms B's concerns related to the medical and nursing care received by her mother (Mrs A) at Southern General Hospital. Mrs A had been diagnosed with lung cancer that had spread to her liver. She was admitted to hospital as she was suffering from pain, shortness of breath and confusion. A plan was made for Mrs A's transfer to a special cancer treatment centre but she suffered a fall and fractured her hip before this could take place. An incapacity certificate was completed and after assessment, surgery was carried out to Mrs A's hip, but her condition worsened. Mrs A was transferred to a hospice, where she died.

We took independent advice from a consultant in acute and respiratory medicine. We did not uphold Ms C's complaint about the standard of medical care. We found that the decision to proceed with surgery was reasonable in the circumstances of the case and that whilst pain had been poorly controlled for Mrs A, this was despite the best efforts of the team caring for her.

We also took independent nursing advice. The advice we received highlighted issues with the assessment of Mrs A's risk of falling. We found that Mrs A's cognitive difficulties and other factors had not been properly taken into account, resulting in an inadequate falls prevention care plan at the time of her fall. The advice we received also highlighted issues with the assessment of Mrs A's mobility. We therefore upheld this aspect of Ms C's complaint.

Recommendations

We recommended that the board:

• apologise for the failings identified in this investigation;
• ensure that all relevant issues, including documented cognitive difficulties, are properly accounted for during the falls risk-assessment process;
• ensure that mobility assessment documentation is appropriately completed and reviewed; and
• ensure that completed incapacity certificates are accompanied by a treatment plan when appropriate.

Summary

Ms C complained that the board failed to provide her with appropriate orthopaedic surgery. She also complained that they did not provide her with appropriate clinical treatment when she reported health problems following the surgery.

Ms C had an initial operation to treat a bunion affecting her right foot. The operation was not successful and she elected to undergo further (revision) surgery. Following this surgery, Ms C's condition appeared to improve. However, over the subsequent years she experienced further problems with her foot, including pain and discomfort. Ms C also felt that this triggered other health problems. During this time, the board attempted to treat these problems with orthotics (supports) and also referred Ms C to their pain management clinic.

Ms C raised concerns about the revision surgery, including that the surgeon had left a bone in her big toe too short. Ms C also said the surgeon did not provide appropriate care when the problems arose with her foot, that they were unresponsive, and did not communicate with her about her situation. The board said that the shortening of the bone in Ms C's foot was inevitable as a result of the two operations, and within reasonable limits. They considered the surgery had been performed appropriately. The board also said they considered the follow-up care was reasonable.

After receiving independent advice from an orthopaedic surgeon, we did not uphold Ms C's complaints. We found that the evidence did not suggest there had been a failure in the operation. We also found that the medical records suggested timely care with appropriate review from the clinicians involved in Ms C's care. We noted the difficulty of judging communication from paper records, but considered that there were no failings evident in respect of this aspect of Ms C's care.

During the course of this investigation, we noted that the board's consent documentation, while appropriate by the standards of the time, would not comply with contemporary practice. We also noted some limitations in record-keeping by the board. We made recommendations to address this.

Recommendations

We recommended that the board:

• remind staff of the importance of adequate record-keeping; and
• review the relevant consent form to ensure it is appropriate.

Summary

Ms C's mother (Mrs A), who was diabetic, injured her toe. Mrs A attended A&E at the Royal Alexandra Hospital a few days later. Mrs A's toe was found to be broken and there was evidence of infection. At that time, Mrs A was keen to avoid admission and she was sent home with antibiotics. After initial improvements in her condition, Mrs A had to re-attend at A&E and was admitted for around two weeks. During this admission, Mrs A became unwell and had to be resuscitated. On her discharge, Mrs A's injured toe was noted to be necrotic (where the cells or tissue are dead). Mrs A was readmitted to the hospital later that month after being seen at the diabetic foot clinic.

Ms C complained about the A&E care provided to Mrs A, the medical care and treatment provided to Mrs A while she was an in-patient, the nursing care, the standard of communication and the approach in the Coronary Care Unit (CCU) to visiting.

After taking independent advice from a consultant in emergency care, we upheld Ms C's complaint about the initial A&E attendance. We found that due to Mrs A's diabetes, a referral should have been made to a specialist foot team. Although the advice we received was that this did not affect the outcome for Mrs A, we considered this to be a failing. The board identified this during their own investigation and we considered that they had taken reasonable steps to address the issue.

In relation to Ms C's concerns about the standard of in-patient medical care and treatment, we took independent medical advice. The adviser found that Mrs A received optimal care and treatment. We therefore did not uphold this part of Ms C's complaint.

After taking independent nursing advice, we upheld Ms C's complaint about nursing. The advice we received was that there were failings in obtaining an appropriate mattress for Mrs A and that there had been some issues around wound dressings. The board had already apologised for this and for an occasion where fluids were administered more quickly than intended. The nursing adviser also noted that a fluid balance chart had not been properly completed. We made a recommendation to address this.

We found that the approach of some of the staff regarding Mrs A's family visiting her in the CCU was not reasonable. The board had identified failings in communication with Mrs A's family and apologised for these. We therefore upheld this aspect of Ms C's complaint.

Recommendations

We recommended that the board:

• ensure that fluid balance charts are appropriately completed for patients;
• make all relevant staff in the CCU aware of the nursing adviser's comments on visiting; and
• review the approach to visiting in the CCU in light of the nursing adviser's comments.

Summary

Miss C complained about the care and treatment received by her father (Mr A) during an admission to Queen Elizabeth University Hospital. Miss C said it took an unreasonable length time for Mr A to be reviewed by a doctor in the assessment unit, and that he was not treated for his urinary tract infection (UTI) for several days. Miss C was also concerned that Mr A's catheter became blocked on one occasion, and that it took several hours before this was changed. Miss C said that a doctor told her this had resulted in lasting kidney damage. Miss C also raised concerns that in their response to her complaint, the board gave an inaccurate account of what happened.

The board apologised that Mr A had waited so long to be reviewed, and for a lack of communication during the admission. However, the board said Mr A did not have a UTI on admission, but developed this a few days later (which was treated). The board also considered Mr A's blocked catheter was treated appropriately.

After taking independent medical and nursing advice, we upheld Miss C's complaints about medical care and communication. We found that there was no evidence Mr A had a UTI on admission, and that this was treated reasonably when it developed a few days later. We also found the blocked catheter was treated appropriately, and that there was no evidence that this had caused damage to Mr A's kidneys. However, we considered the delay in Mr A being reviewed was unreasonable, and we recommended the board provide more detail on how this is being addressed. We also found failings in communication, although we noted the board had already acknowledged and apologised for this, which we considered appropriate.

In relation to complaints handling, we found a factual inaccuracy in the board's response (describing the position of the blocked catheter). This appeared to be an error, and we did not consider the overall response to have been unreasonable.

Recommendations

We recommended that the board:

• provide evidence of the action being taken to reduce waiting times for patients in the assessment unit.

Summary

Miss C complained about the care and treatment her mother (Mrs A) received from the Victoria Infirmary when Mrs A attended A&E following a fall. Mrs A was found to have a fractured arm and was admitted to the orthopaedic ward. Four days later, Mrs A was noted to be suffering from hip and leg pain and was found to have a hip fracture that required surgery. Mrs A was transferred to the New Victoria Hospital for rehabilitation, but due to concerns about her condition, was transferred back.

Miss C complained about an excessive delay in transferring Mrs A from a trolley in A&E to a ward. She also complained about Mrs A's medical treatment and nursing care, and that communication with Mrs A's family was poor.

We took independent advice from an A&E consultant, an orthopaedic consultant, a consultant physician, and a nursing adviser. We found that there was an unreasonable delay in Mrs A being transferred from a trolley to the ward, which the board had accepted and apologised for. We also identified an unreasonable delay in Mrs A's hip fracture being diagnosed and that her transfer to the New Victoria Hospital for rehabilitation was unreasonable as there was a lack of evidence to show that she was fit for discharge. We therefore upheld these aspects of Miss C's complaint. However, we found that the nursing care in terms of assessing and monitoring food and fluid intake was reasonable.

Finally, we were critical that there was poor communication with Mrs A's family by both the A&E staff and orthopaedic team, for which the board had apologised. While Mrs A's consent form for the surgery indicated that she was not able to give informed consent, we found no evidence of communication with Mrs A's family in this regard.

Recommendations

We recommended that the board:

• provide information about the action taken to minimise waiting times for patients in A&E before they are admitted to a ward;
• ensure that the A&E doctor involved in Mrs A's care reflects on the adviser's findings at their next appraisal to ensure appropriate clinical assessment takes place;
• ensure that the medical staff responsible for Mrs A's transfer reflect on the adviser's findings regarding fully documenting the reasons supporting a patient's discharge or transfer;
• apologise to Miss C for the failings identified with regard to the diagnosis of Mrs A's hip fracture and the decision to transfer Mrs A;
• remind relevant staff involved in Mrs A's care in A&E and the orthopaedic ward of the importance of communicating effectively with family members and documenting in the clinical records when this has been done; and
• review their consent process for patients who are deemed to lack capacity to ensure where relevant that the views of relatives and carers are effectively taken into account.

Summary

Mr C complained to us that the medical practice had failed to provide appropriate care and treatment to his late teenage daughter (Miss A). He said that Miss A had a lump on the side of her head which, over a couple of years, the doctors had said was a cyst. This turned out to be cancer.

Mr C felt that there had been a delay in reaching the diagnosis and that it was inappropriate that the practice had sent letters directly to his daughter about possibly removing the cyst at an earlier time. He said that he and his wife were not aware of the letters.

The practice responded that the presumption was that Miss A had a cyst, and that the option of removal under local anaesthetic was discussed. Miss A was given the opportunity to consider the excision along with the offer of a second opinion. When the cyst was noted to be increasing in size, Miss A was referred to hospital and cancer was diagnosed.

The practice explained that the diagnosis was unusual for a child of Miss A's age but that their investigation had identified a number of learning points.

We took independent GP advice. We found that based on the recorded evidence, there were no concerns about the way the GPs managed the situation. Initially there were no signs that the lump was sinister and the offer to have it removed was made. Miss A was competent to make the decision whether to have the lump removed at an earlier stage for cosmetic reasons rather than for clinical reasons and she decided not to have it removed. That was a reasonable decision for her and her parents to consider as her parents were involved in Miss A attending the practice at times. It was also reasonable for the practice to write directly to Miss A directly. We did not uphold Mr C's complaint.

Summary

Mrs C complained to us that the medical practice had failed to prescribe her with medication that had been recommended by a private clinician.

Mrs C withdrew her complaint to us and we therefore did not continue our investigation.

Summary

Mr C complained to the board about various aspects of the care and treatment which was provided to his son (Mr A) at the Victoria Hospital. Mr A saw his GP, who sent him to hospital with a diagnosis of viral meningitis. Mr A was discharged after clinicians at the hospital made a diagnosis of a viral infection. He was admitted to intensive care the following day and was diagnosed with meningitis. Mr A died a short time later.

Mr C felt that the clinicians should have acted on the GP's diagnosis and that a lumbar puncture (a medical procedure where a needle is inserted into the lower part of the spine) should have been carried out.

We took independent advice from a consultant in emergency medicine. We concluded that although the GP had made a provisional diagnosis of viral meningitis, the staff involved took full note of Mr A's symptoms, carried out appropriate observations and investigations, and arrived at a reasonable diagnosis before discharging Mr A. Initially some of Mr A's results were abnormal but they improved over the time he was in A&E. We also found that there was no clinical indication to admit Mr A to hospital or carry out further investigations. We therefore did not uphold Mr C's complaint.

Summary

On attending his dentist, Mr C was noted to have dental decay in two of his teeth. It was agreed that this would be removed and his teeth would be filled. Despite this, Mr C remained in pain and he required root canal treatment. The treatment and known risks of such treatment were explained. Mr C experienced one of these risks in that a file broke during treatment and was required to be left in his root canal. Mr C's treatment was completed but he remained in pain.

Mr C complained that he did not receive appropriate or reasonable treatment. We took independent dentistry advice. We found that while it was regrettable that the instrument broke, this was not indicative of poor treatment and was a known risk, as was the possibility of continuing pain. We therefore did not uphold Mr C's complaint.