Health

Summary

Mr C complained that a GP at the medical practice failed to refer him to hospital for a specialist opinion when he reported symptoms of feeling a severe crack in his chest and had severe coughing and difficulty in breathing. He showed the GP bruising on his chest and the GP prescribed antibiotics and painkillers, took blood tests and referred Mr C to hospital for an x-ray.

Four months later, Mr C continued to have health problems and was told by the hospital that an x-ray showed he had three broken ribs. Mr C said the GP should have referred him for a specialist opinion when he reported his symptoms at the consultation.

We took independent advice from a GP adviser and concluded that the GP had taken Mr C's symptoms into account and that it was appropriate at that time to reach a diagnosis of pneumonia and prescribe antibiotics and refer for an x-ray. There was no indication that a specialist referral was required.

We therefore did not uphold Mr C's complaint.

Summary

Ms C complained to us about the way NHS 24 handled calls she made to them on two separate occasions. We took independent medical advice and found that when Ms C made her first call to NHS 24 to report symptoms she was experiencing, they failed to deal with her call in line with the appropriate protocol. The protocol said that staff should speak to a doctor as soon as possible. However, in Ms C's case, staff said that they would arrange for a nurse to call Ms C back within a three-hour timescale. Though Ms C was called by a nurse within that timescale, we found that it was likely that this delayed Ms C's admission to hospital. Although we upheld this aspect of Ms C's complaint, we were satisfied that NHS 24 has apologised for this and shared the learning from Ms C's complaint with staff.

Ms C also complained about the handling of two calls she made to NHS 24 almost a year later regarding symptoms she was experiencing. Staff initially said that someone would call her back within two hours. However, Ms C had to call them again, as she had not been called back within two hours and her symptoms had deteriorated. She was then referred to an out-of-hours service to be assessed by a GP. NHS 24 had accepted that the handling of the calls was not of the standard they expect from staff and that some of Ms C's symptoms should have been explored further. We therefore upheld this aspect of Ms C's complaint. The board had apologised to Ms C for this and had taken action to prevent similar problems occurring.

In view of the action already taken by NHS 24, we did not make recommendations.

Summary

Mr C complained about the treatment he received for his wrist injury at the Royal Infirmary of Edinburgh, including that there was a delay in referring him for a surgical opinion.

During our investigation we took independent advice from a specialist in trauma and orthopaedics. The adviser felt there was evidence to favour both surgery and non-surgical treatment for Mr C's injury. They considered that Mr C was reviewed in a timely manner and the decisions taken at those reviews were in keeping with good practice. The adviser did not consider there was a delay in referring Mr C for a surgical opinion. We therefore did not uphold Mr C's complaint.

Summary

Mr C complained that he had not been provided with appropriate clinical treatment in relation to his diabetic neuropathy (nerve damage) and a slipped disc in his back. However, during the course of our investigation, Mr C withdrew his complaint.

Summary

Mrs C was referred to St John's Hospital for her first maternity appointment. Mrs C complained that during her pregnancy, community midwives failed to provide her with a reasonable level of care and that she was not given antenatal blood screening as she said she required. Mrs C's baby was stillborn.

We took independent advice from a specialist in haemostatis and thrombosis and from a midwife. We found that as Mrs C had a family history of deep veinous thrombosis, she was correctly referred to a specialist clinic for tests. These tests showed no evidence of personal risk for Mrs C and as such no further blood testing was required. However, it was agreed to offer her blood thinning medication after the baby's birth. While Mrs C believed that if further blood screening tests had been carried out she may not have lost her baby, we found no evidence of this. We found that the midwifery care and treatment given to Mrs C had been of a reasonable standard. We therefore did not uphold these aspects of Mrs C's complaint.

Mrs C said that her placenta was lost when it was sent for testing. We found that when the placenta was sent to the laboratory, it was not accompanied by the appropriate paperwork and for this reason it was destroyed. We upheld this element of Mrs C's complaint. The board apologised for this and put new procedures in place to prevent the same happening again.

Summary

Mr C complained about the prison health centre's decision not to prescribe him sleeping medication that he had previously been prescribed by his community GP.

The information available confirmed that the prison health centre had checked the medications prescribed to Mr C by his community GP. This confirmed that he had been given a two-week supply of the sleeping medication to take as needed.

We took independent clinical advice. The adviser noted that the sleeping medication should only be prescribed for short periods and long-term use was to be avoided. They also noted that Mr C had been prescribed an appropriate detox whilst in prison and that because of this, the decision to not prescribe the sleeping medication was reasonable. Our adviser also confirmed that Mr C was being prescribed appropriate medications for the symptoms he had reported. We did not uphold Mr C's complaint.

Summary

Following a private hernia operation, Mr C was referred to the Royal Infirmary of Edinburgh for pain management. Mr C had various appointments with a consultant over a nine-month period, and required further surgery. Mr C later complained that the consultant had failed to complete appropriate clinical records which fully explained why he needed further treatment. Mr C told us the lack of records had caused him a problem when he went to get insurance when travelling abroad for work.

We took independent clinical advice. We found Mr C's medical records were of the standard, and in the detail, expected of NHS clinical records. We were satisfied the reason Mr C required surgery was appropriately documented. We did not uphold Mr C's complaint.

Summary

Ms C, an advocacy and support worker, complained on behalf of Ms A about the care and treatment given to Ms A after she was diagnosed with breast cancer.

Ms A was treated with surgery followed by chemotherapy and radiotherapy at the Western General Hospital, from which she appeared to be recovering well. However, part way through her course of chemotherapy, Ms A was not given a review appointment to establish how she was progressing, as per a local protocol. Ms A maintained that she had been 'lost to the system' and received inadequate care. Ms C also said that the board failed to respond reasonably to Ms A's complaint.

We took independent advice from a consultant oncologist. We found that Mrs A's treatment had been given in terms of national guidelines and had been reasonable and appropriate. While it had been intended to review her part way through her chemotherapy, Ms A was seen a few weeks later and her treatment continued. We did not uphold this aspect of Ms C's complaint.

However, we noted that the board failed to deal with Ms A's concerns about her treatment in a timely manner and we therefore upheld this aspect of Ms C's complaint.

Recommendations

We recommended that the board:

• remind the staff involved in this case of the necessity of adhering to their stated complaints procedure.

Summary

Ms C was referred to the sleep clinic at the Royal Infirmary of Edinburgh. She attended on a number of occasions over the following four years but her symptoms did not improve. She said that a consultant physician contacted her clinical psychologist but provided inaccurate and misleading information which detrimentally affected her future treatment. Ms C also complained about the way the board responded to her complaint.

We took independent advice from a consultant respiratory and general physician. We found that while Ms C's consultant physician provided her professional opinion to other health professionals, she did not provide incorrect or misleading information. We therefore did not uphold this aspect of Ms C's complaint. We noted, however, that the information could have been written more sympathetically and that the board had already spoken to the consultant physician about this. We also found that after Ms C complained, the board took too long to reply to her and their letter provided little explanation. We therefore upheld this aspect of Ms C's complaint.

Recommendations

We recommended that the board:

• emphasise to staff the necessity of providing reasoned responses to complaints made; and
• emphasise to staff the necessity of replying to complaints within the time-frames specified.

Summary

Miss C complained about the care received by her brother (Mr A) at the Royal Infirmary of Edinburgh following a suspected drug overdose. During his admission, Mr A was drowsy and had slurred speech. Mr A was moved to the acute medical unit and received treatment for a chest infection. He also had a scan to check for a blood clot on the lung. No blood clot was found and Mr A was to be discharged. On the morning of his discharge, he experienced a cardiac arrest and died.

We took independent nursing and medical advice. The nursing adviser was satisfied that nursing staff had noted Mr A's condition but raised concerns that Mr A's oxygen saturation (the relative measure of the amount of oxygen in the blood) was abnormally low during the admission. Whilst nursing staff had noted this, they had not informed medical staff.

The medical adviser considered that Mr A had received appropriate care and treatment for the first two days of his admission, but that Mr A's low oxygen saturation should have resulted in a medical review on the evening before discharge. They noted that a possible explanation for the omission of a review was that staff considered his oxygen levels to be low as a result of drug use, rather than his chest infection. The medical adviser noted that staff could have considered administering a medication which temporarily reverses the sedative effects of drugs to help them determine the reason for low oxygen levels. The adviser could not say whether better care at this time would have prevented Mr A's death. However, they considered that the treatment provided to Mr A was unreasonable. We upheld this aspect of Miss C's complaint.

Miss C also complained that staff had failed to respond reasonably to concerns raised by Mr A's family. The medical adviser noted that Miss C had spoken to a doctor on the evening before the planned discharge. The adviser was critical that the doctor had informed Miss C that Mr A was well enough for discharge, when the evidence available at that time did not support this. They considered that there was evidence that staff had shown a lack of appreciation for the family's concerns, and we therefore upheld this aspect of the complaint.

Miss C also complained about the board's handling of her complaint. We noted that the board had met with Miss C and Mr A's family and had also taken steps to investigate the concerns raised by Miss C. We were critical that the board delayed interviewing staff regarding Miss C's complaints and that the board did not update Miss C about the delay in arranging a second meeting. While we noted that the board had responded in writing to aspects of Miss C's complaints, we were critical that they did not conclude their investigation with a definitive final response or inform Miss C in writing of what to do were she not happy with their response. We also noted that Miss C had not received a copy of a substance misuse leaflet that the board had agreed to provide. We upheld this aspect of Miss C's complaint.

Miss C also complained that Mr A's medical records inaccurately stated that his family had given him drugs. We found that the discharge letter did not explicitly state this, but that staff did have concerns that Mr A's family had brought him drugs. The medical adviser noted that there was no suggestion in the letter that any additional drugs caused Mr A harm, and no indication that the letter was directly critical of the family. However, they found that the letter contained a statement that was not supported by the clinical notes and that there was no clear evidence in the records of specific additional drug use, or evidence of involvement of the family related to the drug use. The adviser considered that the statement was unreasonable. We therefore upheld this complaint.

Recommendations

We recommended that the board:

• feed back the comments of the advisers to medical and nursing staff in the acute medical unit;
• issue a written apology to Mr A's family for the failings in nursing and medical care identified by the advisers;
• provide evidence that the learning from this complaint has been implemented;
• issue a written apology to Mr A's family for failing to respond reasonably to the concerns that were raised;
• issue a written apology to Miss C for the complaints handling failings identified in this investigation;
• feed back to staff the importance of interviewing staff within good time of events, of concluding a complaint investigation with a written report and of updating complainants with the progress of the investigation where delays occur;
• provide Miss C with a copy of the substance misuse leaflet and details of the steps taken to improve communication;
• feed back the comments of the adviser to the member of staff who wrote the discharge letter;
• make an addendum to the records, which notes that the statement about the family in the letter was not reflected in the clinical notes, and send a copy of this addendum to Practitioner Services to be filed with Mr A's GP records; and
• issue a written apology to Mr A's family for the inaccurate statement in the records.