Health

Summary

Mrs C sustained a broken hip following an accident at work and underwent hip replacement surgery at Wishaw General Hospital the next day. She complained that she had been left in pain and walking with a limp since her surgery. In particular, she raised concern over the surgeon's indication that her ongoing symptoms were due to the type of prosthetic joint that he was required to use, due to non-availability of his preferred joint type.

We took independent advice from a consultant orthopaedic surgeon who advised that the type of prosthetic joint used in Mrs C's surgery was in keeping with relevant guidelines and best practice. They reviewed Mrs C's post-operative x-rays and considered that her surgery was carried out appropriately. On balance, they did not consider that her surgery was the cause of her ongoing symptoms and they were of the view that the use of an alternative joint would not have given a better outcome. They considered that there were alternative causes that were more likely explanations for the type of symptoms Mrs C experienced, including referred pain from the lower spine and/or inflammation of the soft tissues overlying the hip. As we found no evidence to suggest that Mrs C's surgery was not carried out appropriately, we did not uphold this complaint.

Mrs C also complained that appropriate follow-up action was not taken to address her ongoing symptoms. However, the adviser considered that she was appropriately followed up, including a second orthopaedic opinion having been sought. In addition, they did not consider that there was an unreasonable delay in referring Mrs C for pain management. We therefore did not uphold this aspect of Mrs C's complaint.

Summary

Mr C complained to us about the care and treatment he had received from an opticians practice he attended with a problem in his left eye. He was examined by two optometrists at the practice. When he then phoned the practice again about the matter, they referred him to hospital, where a retinal detachment was diagnosed and surgery performed. Retinal detachment occurs when the thin lining at the back of the eye called the retina begins to pull away from the blood vessels that supply it with oxygen and nutrients. Without prompt treatment, it will lead to blindness in the affected eye. Mr C said that the sight loss he suffered in his left eye would not have been as severe had the optometrists referred him to hospital earlier.

We took independent optometry advice. We were unable to say for certain whether the retinal detachment was present on the two occasions Mr C attended the opticians. However, we found that the initial examination carried out when he attended the opticians was reasonable and appropriate according to the relevant guidelines. This would have offered a reasonable chance to detect whether retinal detachment was present at that time. When Mr C attended the opticians on the second occasion, his pupils were not dilated and the full set of relevant tests was not carried out. However, we found that this was reasonable as there was no evidence of increasing symptoms.

We did not uphold Mr C's complaint, as there was no clear evidence that he should have been referred to hospital earlier. However, there was no evidence that he was given an information leaflet about retinal detachment in line with both local and national guidance and we made a recommendation to the opticians in relation to this.

Recommendations

We recommended that the opticians:

• take steps to ensure that in appropriate cases, patients are provided with a retinal detachment warning leaflet.

When it was originally published on 25 January 2017, this case referred to a pharmacy in the Lanarkshire NHS Board area. This was incorrect, and should have read a pharmacy in the Greater Glasgow and Clyde 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.

Summary

Mrs C contacted a pharmacy by phone for an emergency supply of her prescribed medication. She told us the pharmacist refused her request a number of times and that she was treated rudely and asked unreasonable and irrelevant questions. Mrs C complained to us that the pharmacy had not responded reasonably to her complaint. We were satisfied that the pharmacy had investigated her complaint in a reasonable manner. Their response was made within a reasonable timescale and contained a reasonable level of detail. We did not uphold this aspect of Mrs C's complaint.

Mrs C also complained about the lack of a suitable response to the issues she raised during the complaints process. We upheld this complaint because the pharmacy did not signpost Mrs C to this office at the end of their complaints process. They also caused confusion in setting out Mrs C's options for escalating the complaint and continued to correspond with her after they said their complaint process was at an end.

Recommendations

We recommended that the pharmacy:

• review their complaints process demonstrating compliance with the requirements which apply to NHS complaints in Scotland, and which will ensure the correct escalation advice is given to complainants, and provide us with a copy of the written process and evidence of its circulation to relevant staff.

Summary

Mrs C, who works for an advocacy and support agency, complained on behalf of her client (Ms A). Mrs C said that staff had failed to diagnose that Ms A had suffered a fracture to her right tibia and broken bones in her right knee when she attended A&E at Raigmore Hospital. Ms A was given painkillers and discharged home. She continued to suffer pain and two weeks later an x-ray revealed the fracture and broken bones. Ms A felt the staff should have arranged an x-ray when she attended A&E.

The board said that Ms A was appropriately assessed by nursing and clinical staff who diagnosed a soft tissue injury and that an x-ray was not required.

We took independent medical advice from a consultant in emergency medicine and found that the staff had carried out an appropriate assessment based on the presenting symptoms and reached a reasonable diagnosis of soft tissue injury. There was no requirement to have arranged an x-ray at that time, although it was subsequently established that the fracture had occurred. We did not feel that the actions of the staff were unreasonable and therefore we did not uphold Mrs C's complaint.

Summary

Mrs C had attended a series of physiotherapy appointments at the Victoria Integrated Care Centre. However, her symptoms related to a degenerative disc disease in her spine were unresponsive and she was referred back to her GP for further management. She was provided with a home exercise programme and advised of the symptoms of cauda equina syndrome (a spine disorder affecting the nerves).

Mrs C's pain continued and her GP referred her to Queen Elizabeth University Hospital where she had an MRI scan. The scan showed that she had a bulging disc in her lower back which was pressing on the nerves of her leg. Before Mrs C could attend a further specialist consultation which had been arranged, her situation deteriorated. She attended A&E at the Royal Alexandra Hospital with symptoms of cauda equina syndrome and was admitted. The next day Mrs C underwent surgery.

Mrs C complained that the physiotherapist she attended failed to treat her appropriately and that she should have been referred for an MRI scan.

We investigated the complaint and took independent physiotherapy advice. We found that although Mrs C's symptoms were noted to be developing, she was reviewed and her treatment amended accordingly. However, her symptoms did not meet the criteria that would have required her to have an MRI scan and she was given appropriate advice and treatment and referred back to her GP. We therefore did not uphold Mrs C's complaint.

Summary

Miss C complained to us that the practice had failed to provide her with appropriate care and treatment when she developed problems following back surgery. In particular, she felt that her GP should have taken a urine sample as she was having difficulty urinating and that as she was suffering from pain and swelling at the surgery wound site, a referral should have been made to a specialist consultant. Miss C continued to be in pain for a number of days before contacting the out-of-hours service where she was admitted to hospital for further surgery.

The practice said that it was not appropriate to take a urine sample as the urinary symptoms which Miss C reported were consistent with a diagnosis of a urine infection and that appropriate antibiotics were prescribed. In regards to the wound site, it was felt that the problem was a build-up of fluid which would resolve naturally over time.

We took independent advice from a GP and concluded that there was no requirement for her GP to take a urine sample as the diagnosis of a urine infection was reasonable. However, we found that the GP should have referred Miss C for an urgent specialist orthopaedic opinion as she had developed an acute complication following the surgery. Miss C's symptoms of swelling and pain at the wound site had only been present for three days but it had been three weeks since Miss C's original back surgery. We therefore upheld this complaint.

Recommendations

We recommended that the practice:

• apologise to Miss C for not referring her for a specialist opinion for her spinal condition.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her clients (Mr and Ms B) about care their daughter (Miss A) received from her medical practice. They also complained about the response to their complaint.

Miss A attended her medical practice on three occasions over two months. On the third attendance she was seen by a locum doctor who urgently referred her to hospital where she was diagnosed with a brain tumour. Miss A died later that month.

We sought independent medical advice. The adviser's view was that no symptoms were recorded at Miss A's earlier appointments that would have indicated a serious neurological problem and that the treatment given was reasonable. The adviser said the only significant symptom appeared in the last consultation, where Miss A was appropriately referred to hospital. For these reasons, we did not uphold this complaint.

However, we did uphold Ms C's complaint about the practice's response to the complaint as there were unreasonable delays in responding and third-party information was included in the response when it should not have been.

Recommendations

We recommended that the practice:

• provide us with a copy of their complaints handling procedure demonstrating compliance with the Patient Rights Act and government guidance 'Can I Help You?';
• reassure us that they have a robust system for recording and storing complaints documentation; and
• ensure that the GP concerned undergoes relevant appraisal with regard to complaints handling.

Summary

Mrs C complained about the standard of clinical and nursing care provided to her mother (Mrs A) at Inverclyde Royal Hospital and the Royal Alexandra Hospital. Mrs C said Mrs A was suffering from non-Hodgkin lymphoma and had been unreasonably denied chemotherapy treatment at the Royal Alexandra Hospital, against her clearly stated wishes. Mrs C believed her mother had not been provided with the appropriate antibiotic therapy and that she had been allowed to lie in a position in bed which exacerbated the pneumonia she acquired at Inverclyde Royal Hospital. Overall, Mrs C believed the treatment her mother had received had increased the speed of her decline, causing her unnecessary suffering and denying her family time with her.

We took independent advice from a consultant geriatrician and a nurse. The advice we received was that the clinical and nursing treatment provided to Mrs A was of a reasonable standard overall. It had been a reasonable decision not to proceed with chemotherapy as Mrs A was suffering from repeated and serious infections and was becoming increasingly frail. The advice found that this was explained appropriately as soon as practically possible after the decision had been made.

We noted that while Mrs A had been in hospital, the board had failed to provide her with adequate fluids over a weekend. This had already been recognised by the board during their own investigation and we were advised that the steps the board had taken were adequate to address the issue. The advice noted that overall Mrs A had been in hospital for 44 days and, with the exception of the weekend period, they considered her treatment reasonable.

We found that on balance the overall standard of clinical and nursing care was reasonable and therefore we did not uphold Mrs C's complaint.

Summary

Mrs C complained about the care and treatment provided to her father (Mr A), who had been admitted to Southern General Hospital for surgery for a fractured hip. Mr A was initially found not be to fit for anaesthesia because of a lung condition and as he had pneumonia. However, he improved with treatment and underwent hip surgery. Mr A later dislocated his hip and developed further deterioration in his lung function and an infection. Mr A died in hospital.

Mrs C complained there had been a failure to provide Mr A with appropriate clinical treatment once it was found his condition had deteriorated, and that pain relief had not been put in place appropriately. She also complained there had been a failure to communicate adequately with the family about Mr A's clinical condition and prognosis and to provide him with an appropriate standard of nursing care.

We obtained independent advice from a medical adviser and a nursing adviser.

The advice we received from the medical adviser was that the clinical treatment Mr A had received was reasonable and that the pain relief given by the palliative care team was reasonable. However, they considered that control of Mr A's pain should have been managed better and sooner. We therefore upheld this aspect of Mrs C's complaint.

We also found that the level of communication with Mr A's family about his condition and prognosis was unsatisfactory. Whilst the advice we received was that communication by the nursing staff was reasonable, there were shortcomings in the medical staff's communication with the family, in particular a failure to convey effectively to the family that Mr A was dying. Given this, we upheld this aspect of Mrs C's complaint.

The nursing adviser considered that overall the nursing care provided to Mr A was reasonable and so in this regard we did not uphold Mrs C's complaint.

Recommendations

We recommended that the board:

• issue an apology to Mrs C for the failings identified in Mr A's pain management;
• ensure the comments of the medical adviser regarding the management of Mr A's pain control are brought to the attention of relevant staff;
• issue an apology for the failings identified with regard to communication with Mr A's family; and
• ensure the comments of the medical adviser are fed back to the relevant medical staff concerning communication and that they have been provided with adequate training in communication skills, especially in communicating news of a patient's prognosis to their family.

Summary

Mr C complained about the care and treatment he received at Inverclyde Royal Hospital for arthritis in his thumbs. He said that following initial treatment with steroid injections, the consultant orthopaedic surgeon at the hospital suggested Mr C have surgery on his left thumb. The procedure involved the removal of the trapezium (a small bone at the base of the thumb) and filling the space with a tendon sling. The surgery was carried out by an orthopaedic registrar under the supervision of the consultant and Mr C said it was unsuccessful.

Mr C raised several concerns about his care and treatment. Mr C complained that despite assurance from the consultant that he would be carrying out the procedure, the consultant unreasonably allowed the registrar to perform it. He also said that at the review clinics following surgery, the consultant dismissed Mr C's concerns about his hand getting smaller, muscle wastage, an enlarged vein in his elbow and pain in his shoulder.

We took independent medical advice from a consultant orthopaedic and trauma surgeon and found that there was no evidence in Mr C's records to indicate that the consultant committed to undertaking the surgery. We acknowledged that Mr C said the consultant gave this undertaking, but without documentary evidence it was not possible to determine exactly what had happened. The adviser said it was appropriate for the registrar to carry out the surgery assisted by the consultant.

The adviser found that the care and treatment following Mr C's surgery was appropriate and that his symptoms were not the direct result of the surgery.