Health

Summary

Ms C complained about the treatment she received for an eye infection from the out-of-hours service at Dumfries and Galloway Royal Infirmary. In particular, Ms C complained that a GP wrongly tried to dissuade her from attending the primary care clinic and that when she did attend, she did not receive treatment and was told she needed to give the antibiotics already prescribed more time to work. Ms C also complained about the board's complaints handling.

During our investigation we took independent medical advice from a GP. The adviser considered it was reasonable Ms C was told to allow more time for the antibiotics her own GP had given her to work. The adviser did not consider the care provided to be inadequate. We therefore did not uphold Ms C's complaints about the care she received.

As we considered there were some errors in the board's complaints handling, we upheld this aspect of Ms C's complaint. The board acknowledged that they were not always efficient in responding to and progressing Ms C's wider concerns and said that they were in the process of making improvements to their complaints handling practices.

Recommendations

We recommended that the board:

• apologise to Ms C for the errors made in the handling of her complaints.

Summary

Mrs C complained about the medical practice with regards to the care and treatment provided to her husband (Mr A). Mrs C said that the GP failed to ensure that Mr A's diagnosis of a rare type of cancer was followed up and that had the GP acted differently, Mr A would have been offered earlier treatment.

We took independent medical advice from a GP. We found that the practice had not been told that the diagnosis of cancer was definitive, but rather that it had been communicated as a 'suspicion of diagnosis'. We found that there was no obligation for the practice to record this if it was not definitive. Additionally, we found that it was not the practice's responsibility to ensure that further tests and reviews were being carried out as this was the responsibility of secondary care. Therefore we did not uphold Mrs C's complaint.

Summary

Mrs C complained that staff at University Hospital Crosshouse failed to provide her father (Mr A) with appropriate clinical treatment following his admission with abdominal pain. Mr A was diagnosed with cholangitis (an infection of the tube connecting the liver to the duodenum, the first part of the small intestine immediately beyond the stomach) and an ERCP (endoscopic retrograde cholangiopancreatography, a procedure where a flexible tube is passed into the small intestine) was performed on Mr A four days later. Mr A suffered a retroperitoneal perforation (a small tear in the upper bowel) during the ERCP. Mr A's condition deteriorated and he died.

We obtained independent advice from a consultant gastroenterologist and a consultant general surgeon.

The consultant gastroenterologist explained that an ERCP was the appropriate procedure in Mr A's case, as verified by the British Society of Gastroenterology and National Institute for Health and Care Excellence guidelines. They explained that the procedure was carried out appropriately, was documented as being relatively straightforward and was well tolerated by Mr A. However, they said Mr A suffered a recognised complication of an ERCP. Both advisers said that although Mr A's perforation was not detected as soon as it could have been, the management of Mr A's condition would not have changed with an earlier diagnosis. The consultant general surgeon confirmed that the time taken to diagnose the perforation was not due to poor practice. We therefore did not uphold Mrs C's complaint.

Summary

Mr C complained about the care received by his sister (Miss A) at University Hospital Ayr, in particular that there was a delay in her being scanned and a delay in transferring her to the Beatson West of Scotland Cancer Centre, which is in another board area. Miss A had a history of Crohn's disease (a long-term condition that causes inflammation of the lining of the digestive system) and became unwell. Further tests showed that Miss A had tumours in her liver and bone marrow. She died two days after being transferred to the centre.

We took independent medical advice and found that Miss A had been reviewed urgently when abnormalities were identified. We found that she was offered admission to hospital to undergo further tests including a specialist scan. However, it appears Miss A opted to wait for an out-patient appointment. Whilst cancer was not initially suspected we found that the time taken to carry out a specialist scan was reasonable. We concluded that Miss A's care was reasonable and did not uphold Mr C's complaint.

However, we were critical of the board's communication about Miss A's transfer to the centre, which caused Miss A and her family additional distress. The board apologised for this and we made a recommendation to identify any further learning and improvement.

Recommendations

We recommended that the board:

• evidence that they have liaised with Greater Glasgow and Clyde NHS Board to identify any possible learning and improvements in relation to the delayed transfer to the centre.

Summary

Mr C complained to us that when he took his son (child A) to the emergency out-of-hours service, he was not satisfied with the treatment given for child A's swollen eye and temple by the attending GP. The GP diagnosed child A was suffering from a chest infection.

Child A subsequently underwent neurosurgery to remove an abscess (a swollen area within the body tissue, containing an accumulation of pus) from the eye socket and was admitted for over six weeks.

We took independent GP advice and concluded that the GP had provided a reasonable level of care. The GP had noted a history of upper respiratory symptoms for two days (suggestive of viral/cold symptoms) and that both parents had similar symptoms. The GP examined child A's chest, breathing rate and temperature. The GP found that child A was likely to have a chest infection. Child A was given treatment and the family was told to return should they have further concerns. We found that this was a reasonable management plan.

The adviser noted that swollen/puffy eyelids can be common in children with viral illness due to them rubbing their eyes. If there was no evidence of a pus collection, then it was reasonable for the GP to adopt a 'watch and wait' management plan. We found that as the symptoms described could be consistent with a viral illness, it was not unreasonable that the GP did not diagnose the abscess during the visit. We therefore did not uphold Mr C's complaint.

Summary

Mrs C complained about the care and treatment she received at Ninewells Hospital after having her jaw joint replaced with an artificial joint. Prior to then, Mrs C had been under the care of an oral medicine consultant who had tried a range of non-surgical methods to manage the pain she was having in her jaw joint. Mrs C was then referred to a specialist surgeon, who recommended surgical replacement of the joint. Mrs C proceeded with the surgery but suffered complications that resulted in the artificial joint being removed for several months and replaced with a different type.

Mrs C was concerned that the risks of surgery had not been properly explained to her, about the sourcing of the artificial joint, that special equipment to detect nerves was not used during the surgery, and that there was a delay in identifying problems with the replacement joint.

We took independent advice from an oral and maxillofacial (the speciality concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck) surgeon. We found no failings with the standard of surgery performed or the type of artificial joint used. We also considered that Mrs C's ongoing problems were reasonably reviewed with no undue delay in providing treatment.

However, we considered it unreasonable that there was no evidence to show that a discussion took place with Mrs C at any out-patient appointment with regard to all the benefits and recognised risks associated with the surgery. The only records of such discussions were during a phone call, where not all the risks were documented, and on the day of Mrs C's surgery, where it was unclear what had been explained to her. We therefore upheld Mrs C's complaint.

Recommendations

We recommended that the board:

• apologise in relation to the failings identified in the consent process;
• review the service's process for obtaining informed consent to ensure it is in line with General Medical Council consent guidance; and
• consider providing written patient information on the jaw joint surgery.

Summary

Mr C complained that the Scottish Ambulance Service (the ambulance service) did not ensure that someone attended his home to make sure he was safe after he took an overdose of paracetamol. When the ambulance crew arrived, they could not or did not gain access and left the house without taking further action. Mr C was later helped by a neighbour to attend A&E. Mr C said he was in a vulnerable situation and that the failings by the ambulance service were potentially life-threatening.

Mr C also complained about the way the ambulance service handled his complaint, including the time it took them to respond.

We took independent advice from a specialist in the training and supervision of healthcare professionals including paramedics. We found inconsistencies in the accounts of the staff involved and it is not clear why contact was not made with Mr C. The ambulance service failed to record their findings and action taken at the time. The evidence indicated a communication breakdown between the ambulance crew and ambulance control centre. We found that the ambulance service should have escalated the situation to the police in order to gain more information and access to the property.

In relation to the handling of Mr C's complaint, we found evidence indicating confusion amongst staff about who should deal with the complaint and how it should be dealt with. We were critical that Mr C's complaint to the ambulance service was initially managed as a concern and that it took over three months for the ambulance service to start an investigation. We also found that complaint staff did not reasonably inform Mr C about the delays and the reasons for these.

Recommendations

We recommended that the ambulance service:

• raise the failings identified with relevant staff;
• confirm that the guidelines being developed for dealing with similar incidents have been implemented and communicated to all staff;
• ensure ambulance crews record adequate information on patient report forms;
• provide an update on the actions taken to improve complaints handling; and
• apologise to Mr C for the complaints handling failures.

Summary

Miss C complained about the care and treatment she received at St John's Hospital. She had been diagnosed with skin cancer and had an operation in the hospital to remove the cancer. She said that, after the operation, the anaesthetist refused to give her further pain relief without having seen her when she asked for this.

We took independent advice from an anaesthetist. We found that Miss C had been seen by the anaesthetist when she requested additional pain relief and that their decision that she had already received appropriate and adequate pain relief was reasonable. We did not uphold this complaint.

Miss C also complained that there was an unreasonable delay by nurses in providing her with pain relief she had requested later that day. We found that there had been an unreasonable delay in providing the pain relief and upheld the complaint. However, we were satisfied that the board had apologised for this and had taken action to prevent such delays occurring in the future.

Miss C also complained that the surgeons had not discussed her concerns with her at an appointment, as the board's response to her complaint said they would. We found that the board had written to Miss C to say that they had shared her concerns with the surgeons and they would discuss the matter at her next appointment. However, Miss C's concerns were not discussed at the appointment, as they had not been shared with the surgeons. We also upheld this aspect of Miss C's complaint. However, we were satisfied that the board had apologised to Miss C for this and had offered to arrange a further meeting.

Finally, Miss C complained about the board's handling of her complaint. We also upheld this complaint, as we found that there had been an unreasonable delay in responding, although the board had apologised for this and had provided us with evidence that they had taken action to prevent such delays in the future.

Summary

Following a fall, Mrs C attended the A&E department at St John's Hospital with a painful and swollen left arm. X-rays were taken and Mrs C was diagnosed with a dislocated left elbow. Mrs C's elbow was moved back into position (reduced), she was given a plaster cast and further x-rays were taken. An emergency medicine consultant reviewed the x-rays and did not identify any fractures. Mrs C was discharged the same day.

Mrs C's records and x-rays were later reviewed by an orthopaedic and trauma surgeon at the hospital's virtual trauma triage clinic. The surgeon agreed there were no evident fractures. Mrs C was issued with a follow-up appointment to attend the fracture clinic.

In the interim, Mrs C returned to A&E as her cast had become loose and she was in continual pain. An x-ray was taken which showed the elbow had dislocated again and she had a displaced radial head fracture (a fracture of the bone at the top of the forearm). Mrs C was referred the same day to the Royal Infirmary of Edinburgh for surgery.

Mrs C complained that there was an avoidable delay in staff diagnosing she had suffered a fractured arm.

We took independent advice from advisers in emergency medicine and orthopaedics. We found that Mrs C's injury was managed correctly when she first attended A&E and she was appropriately referred to the virtual clinic for review. We also found that the x-rays taken before Mrs C's elbow was reduced showed a fracture which was missed on review. We noted that the x-rays taken after Mrs C's elbow was reduced were not of sufficient quality to rely upon for a diagnosis and that further x-rays should have been obtained. While the problems Mrs C experienced in terms of her outcome were due to the severity of her injury and not her treatment, if further x-rays had been ordered, it is likely the severity of the injury could have been diagnosed and the injury treated sooner. We therefore upheld Mrs C's complaint.

We accepted the advice we received that the board should give consideration to the implementation of hot reporting (where a report of an x-ray of a suspected fracture is delivered by a radiographer before the patient is discharged from the emergency department). This would be in-keeping with the National Institute for Health and Care Excellence (NICE) guidelines on the assessment and management of non-complex fractures. We also considered the board should review the relevant patient advice sheet given at discharge and the process of scheduling fracture clinic appointments to minimise the risk of administrative errors which we found had occurred in this case. We therefore made recommendations to address this.

Recommendations

We recommended that the board:

• apologise to Mrs C for the delay in diagnosing her fractured arm;
• ensure that the advisers' comments on the failure to observe the x-ray abnormalities in this case and to order further x-rays of a diagnostic quality are brought to the attention of relevant staff and report back on the action taken;
• give consideration to the implementation of hot reporting as per the NICE guideline (NG38) on the assessment and management of (non-complex) fractures;
• review the relevant patient advice sheet given at discharge to ensure it sets out the process for orthopaedic follow-up and contains appropriate contact details for any concerns the patient may have and provide us with evidence of this; and
• review the process of scheduling fracture clinic appointments to minimise the risk of administrative errors as occurred in this case.

Summary

Mr C complained to us about a delay in the medical practice referring him for a scan. The scan showed a diagnosis of testicular cancer. He had attended the practice on three occasions and it was only on the last attendance that he was referred for the scan. Mr C believed that the scan should have been arranged at either the first or second consultation.

We took independent GP advice. At the first consultation there was a report of a tender right testicle which had been present for two to three days. There was no lump and antibiotic medication was provided with a review the following week if the condition did not settle. A diagnosis of orchitis (inflammation of one or both testicles) was made. Mr C then reattended the practice some 12 weeks later with a report of right testicular discomfort again and repeat medication was provided. Mr C then attended again after a further five weeks and reported right testicular discomfort and a lump. The ultrasound referral was then made, in line with national guidance, which led to the diagnosis of testicular cancer.

We found that the practice had provided a reasonable level of care and that the referral was made at an appropriate time in view of Mr C's reported symptoms. We therefore did not uphold Mr C's complaint.