Health

Summary

Mr C complained that there was an avoidable delay in a diagnosis of lung cancer after he was referred to Wishaw General Hospital.

We took independent advice from a consultant in general respiratory medicine. The advice we received was that there had been no avoidable delay in making a diagnosis of cancer. Mr C's initial CT scan was abnormal but did not show the typical appearances of lung cancer. The adviser found that the doctors took appropriate steps to ensure the possibility of cancer was not missed. We found that when a further CT scan showed clearer signs of cancer, appropriate management (surgery) was undertaken. We therefore did not uphold Mr C's complaint.

Summary

Ms C, an advocacy and support worker, complained on behalf of Mr A. Mr A was referred by his GP to orthopaedics for a knee problem from which he was suffering. He waited around 13 weeks to be seen and was told he required a replacement knee. Mr A also had an active skin condition which the orthopaedic consultant said would need to be controlled as it increased the risk of infection following surgery.

Mr A was not added to the surgery waiting list. His GP was asked to make a dermatology referral. After a further 12-week wait, Mr A saw a dermatologist and was referred on to a more local facility for phototherapy for his skin condition. The phototherapy was successful but the good effects were short-lasting. Mr A had still not been placed on the waiting list and had to undergo a further pre-assessment and round of dermatology treatment before his surgery took place, meaning that he had to wait 15 months from the time he was referred until he received treatment. We upheld Ms C's complaint.

We found that more could have been done in the chain of communication, and that a degree of difficulty in scheduling surgery around such a skin condition might have been predicted.

We also found a letter between two departments had not been sent to a named consultant and there was no evidence it had been actioned.

Recommendations

We recommended that the board:

• apologise to Mr A for the breakdowns in communication and lack of forward planning.

Summary

Mrs C, an advocacy and support worker, complained on behalf of Mrs A that the clinical treatment received by Mrs A at Raigmore Hospital had been of an inadequate standard.

Mrs A had suffered an injury to her calf while on holiday. She had received some treatment, including an MRI scan, but had been told that she did not have an Achilles injury. Mrs A had continued to experience significant pain and discomfort on her return home and attended A&E. Mrs A said she had been examined and told she must walk normally. Mrs A's symptoms did not improve and she attended A&E again on the advice of her physiotherapist. Mrs A was told that she had suffered a calf tear and she was discharged without further treatment.

Mrs A subsequently arranged for her MRI scan to be reviewed privately. This found a tear of her Achilles tendon. When Mrs A returned again to A&E, she was supplied with a protective boot. Mrs A was subsequently seen by an orthopaedic specialist and a complete tear of the Achilles tendon was diagnosed. Her leg was placed in a plaster cast. Mrs C said Mrs A believed that she should have been diagnosed much sooner, that staff had failed to appropriately review the MRI scan results and that they had been unsympathetic to her condition.

The board said they did not believe staff had acted inappropriately towards Mrs A. They said that she had been examined using the standard techniques and that these had not indicated damage to the the Achilles tendon. The board provided information on the reliability of the test, accepting that it was not infallible. They noted the information Mrs A provided about the MRI scan results suggested that she did not have an Achilles tendon injury, which appeared to have been confirmed by her physical examination. The board said that they did not agree with Mrs A's recollections of the attitude of staff towards her.

We took independent advice from a consultant in emergency medicine. The advice we received said there was no clinical reason for staff to question Mrs A's description of the findings from the MRI scan, as this was consistent with the findings from her physical examination. They said that it would not be appropriate for A&E staff to attempt to interpret MRI images as this is a specialist skill. Although the diagnosis had not been accurate, Mrs A's care and treatment had been reasonable.

On the basis of the advice received, we found there were no grounds for upholding Mrs C's complaint. Although the board had failed to identify Mrs A's injury, this was not due to failings on the part of their staff, rather a combination of the original inaccurate interpretation of Mrs A's MRI scan and Mrs A's atypical presentation at the physical examination.

When it was originally published on 15 February 2017, this case referred to a medical practice in the Highland NHS Board area. This was incorrect, and should have read a medical practice in the Grampian NHS Board area. This was due to an administrative error which we have now corrected, and we apologise for any inconvenience that this has caused.

We have put measures in place to help avoid recurrence of this issue.

Summary

Mrs C complained about the care and treatment provided to her father (Mr A) by the practice. She said that the care had been poorly organised and gave specific examples of what she believed was a substandard examination of Mr A by a GP and a failure to follow up on blood test results. Mrs C also said the practice had insisted on some care being provided by the practice nurse, whom she said was not competent. Mrs C felt the practice's response to her complaint had also been inaccurate. Mrs C believed that had the care Mr A received been of a higher standard, he may have been able to undergo treatment before his cancer became terminal.

We took independent medical advice. We found that Mr A's examination had failed to identify a condition which merited urgent referral. We therefore upheld this aspect of Mrs C's complaint. This failure had not, however, had any impact on Mr A's prognosis as the condition was unrelated to Mr A's cancer. The other aspects of Mr A's care were, however, reasonable.

We also took independent nursing advice. The adviser said that the actions of the practice nurse were adequately documented and there was no evidence of incompetency.

We found that while Mr A did not receive a reasonable standard of examination from the practice on one occasion, in other respects his care, including his nursing care, was reasonable. The practice's complaint response was detailed and provided a full explanation of Mr A's care and showed the practice had reflected carefully on the actions they had taken. We therefore did not uphold these aspects of Mrs C's complaint.

Recommendations

We recommended that the practice:

• apologise to Mrs C for the failings identified during this investigation.

Summary

Mrs C complained about a delay by clinicians at the Victoria Infirmary in diagnosing that her husband (Mr A) had a cancerous tumour at the site of a previous operation.

Mr A was under two-yearly surveillance following his original surgery. Several years after his original surgery, Mr A reported new symptoms to clinicians and his GP. However, it took six months for a diagnosis of a colonic tumour to be made. Mrs C felt that the diagnosis should have been reached at an earlier stage.

We obtained independent medical advice. We found that Mr A should have been on yearly rather than two-yearly surveillance, in accordance with British Society of Gastroenterology guidelines. Arrangements were made for a procedure to be performed five months after Mr A began to report symptoms, but in the meantime he reported further symptoms. An appointment with a consultant was cancelled due to a change in the consultant's work patterns and this led to Mr A having to attend A&E with deteriorating symptoms.

We found that the clinicians should have arranged further investigations into the cause of Mr A's reported symptoms at an earlier stage. We therefore upheld Mrs C's complaint.

Recommendations

We recommended that the board:

• share the findings of this investigation with relevant staff and ask them to reflect on their actions; and
• apologise to Mr A and Mrs C for the delay in arranging a medical review for Mr A.

Summary

Miss C complained to us about the failure of the board's radiology department to manage their waiting list in a reasonable manner. She had phoned to cancel an appointment at the Royal Alexandra Hospital for a procedure and was told that as a result she would be placed at the bottom of the waiting list.

Miss C complained to the board that this was not in line with national guidance on waiting times, which stated that the patient should only be placed at the bottom of the waiting list if a reasonable offer (an offer of two or more appointment dates) was declined. In Miss C's case, the board had placed Miss C at the bottom of the waiting list after only one offer and she felt that the board were treating her unfairly.

We found that in terms of national guidance, this was a reasonable approach as long as staff were acting in the spirit of the guidance and provided reasonable explanation for not following part of the guidance.

We found that the board were acting in the spirit of the guidance and that the reason for not making a reasonable offer was reasonable in view of the short timescales for carrying out the procedure. We therefore did not uphold Miss C's complaint.

Summary

Mrs C complained about the treatment provided to her at Glasgow Royal Infirmary when she sustained a left distal radius fracture (fracture of a bone in the forearm, close to the wrist). Mrs C said that the splint provided for her injury was too big, and that the delay in this being rectified resulted in her having to have an operation to correct the fracture when it displaced. She also felt that her medical history had not been taken into account when treatment was being provided for her arm injury.

During our investigation, we obtained independent advice from two clinicians, an A&E consultant and an orthopaedics consultant. We found that providing a splint for Mrs C's injury was reasonable, and there was evidence that suggested attempts were made in A&E to make sure it fitted as well as possible. We were advised that an injury such as Mrs C's should not be fully immobilised and that the splint being too big, whilst it may have been uncomfortable, would not have had an effect on the fracture position. We also found that Mrs C's medical history was noted in the clinical records and was reasonably taken into account. We did find that at Mrs C's follow-up appointment, as her fracture had minimally displaced, she should not have been discharged and we made a recommendation related to this. However, we found that this did not cause any significant injustice to Mrs C, and therefore we did not uphold Mrs C's complaint.

Recommendations

We recommended that the board:

• feed back the findings of this investigation to relevant staff, in particular the adviser's comments on the appropriateness of discharge when there is a change in fracture position.

Summary

Mrs C complained about the care and treatment given to her father (Mr A) after his referral to Glasgow Royal Infirmary. Mr A underwent a colonoscopy (his bowel was examined with a camera on a flexible tube), a number of polyps were removed and a likely cancer of the rectum was biopsied. He was discharged home but began to feel unwell and was later admitted to hospital as an emergency. He had a perforated bowel which required repair.

Mrs C complained that Mr A was not given appropriate advice about the risks of his initial surgery or about what to do if his health deteriorated after being discharged. She further complained that Mr A had not been fully advised of his state of health by the clinician who was treating him. In particular, she complained that he had not been told that his cancer had returned, for which he would be given no treatment as agreed by a multi-disciplinary team who discussed his case. Mrs C said that as a result, the family was not prepared when Mr C died, seven months after his initial referral to the hospital.

We took independent advice from a consultant general and colorectal surgeon. We found that before his operation, Mr C had been given clear information about the possible risks, including of the possibility of a perforation. Although Mr C became unwell following the procedure, we found that he had been given written advice about what to do in such circumstances. We therefore did not uphold this aspect of Mrs C's complaint.

We found that while Mr C had been told that his cancer had been removed and that, unlike most colorectal cancers, showed no further involvement in his liver, lungs or abdomen, he had not been told that, unusually, it had spread to his bones. In their reponse to Mrs C's complaint, the board said it was difficult to achieve the right balance in terms of how much information to give to patients and their families. In this case, Mr A had already undergone multiple surgeries and the multi-disciplinary team decided not to provide Mr A with chemotherapy because of his very weak and frail condition. However, we established that he and his family should have been told that the cancer had spread. This would have been in line with the General Medical Council guidance on effective communication. We therefore upheld this aspect of Mrs C's complaint.

Recommendations

We recommended that the board:

• make the relevant staff aware of the outcome of this investigation;
• apologise for the failure to inform Mr C and his family of a multi-disciplinary team meeting and the decision it reached; and
• remind the clinician concerned of the relevant General Medical Council guidance.

Summary

Mrs C complained that the board failed to provide her husband (Mr A) with appropriate wound care following his vascular surgery at Queen Elizabeth University Hospital, both at the hospital and after he was discharged home. She said the board failed to respond appropriately when she and Mr A reported concerns about the way Mr A's wound was dressed. She said Mr A should have been referred to doctors to assess his wound and the possibility of re-suturing prior to his discharge from hospital.

We obtained independent nursing advice. The adviser said that the medical records indicated that Mr A's wound was healing well on discharge from hospital and when seen at home by the district nurse and it appeared that after this point, his wound began to dehisce (a surgical complication when the edges of a wound no longer meet).

The adviser considered that the board responded appropriately when Mr A and Mrs C reported concerns about the way Mr A's wound was dressed and that Mr A should not have been referred to doctors to assess his wound and the possibility of re-suturing prior to his discharge from hospital. The adviser said the nursing notes indicated that Mr A's wound was clean and dry on discharge from hospital and therefore there was no need for further review or suturing. We concluded that the board did not fail to provide Mr A with appropriate wound care following his vascular surgery. We therefore did not uphold Mrs C's complaint.

Summary

Mrs C complained about the cataract surgery she underwent at Gartnavel General Hospital. Mrs C received cataract surgery from a trainee ophthalmologist, under the supervision of a consultant ophthalmologist. She said that her eye was painful after the operation, and appeared smaller than the other eye. Mrs C subsequently attended her optometrist, and the consultant ophthalmologist for a follow-up some weeks later. She received an ultrasound and subsequently received a further examination from a second consultant ophthalmologist.

Mrs C raised a number of concerns about the surgery. She also said she felt the operation was performed by a doctor with insufficient experience. The board said the cataract surgery had been performed appropriately. They considered Mrs C had an abrasion that had resolved, and that the drooping appearance of Mrs C's eye was due to the lid speculum (the instrument that allowed the surgeons to hold her eye open). They said both consultant ophthalmologists found no evidence of significant complications.

We took independent advice from a consultant ophthalmologist. We found the evidence suggested the board provided appropriate cataract surgery. We considered the board's explanations of the problems Mrs C had encountered after surgery were reasonable and accurate, and did not evidence any failings on the part of the board. We also found the surgical trainee had an appropriate level of experience to perform the operation. While we did not uphold Mrs C's complaints, we made a recommendation relating to informing patients that operations may be performed by a trainee.

Recommendations

We recommended that the board:

• consider changes to their standard consent form to note that operations may be performed by a trainee.