Health

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.

Summary

Mrs C complained about the management of her husband (Mr A)'s cardiology care by staff at the Victoria Hospital. Mr A suffered a heart attack and later developed heart failure. Mrs C was also concerned about how staff had communicated with the family and the standard of the nursing care Mr A received. In addition, Mrs C felt that her complaint had not been dealt with appropriately.

As Mr A had a number of attendances at the emergency department, we took independent advice from a consultant in emergency care, a consultant cardiologist and a nursing adviser.

The advice we received was that the management of Mr A's cardiac problems was reasonable, although the cardiology adviser highlighted that the co-ordination of Mr A's care could have been better, an issue that the board themselves had identified during their consideration of Mrs C's complaint. We made recommendations to the board in this regard but did not uphold this part of Mrs C's complaint.

We upheld Mrs C's complaint about communication. We found that the board had already identified and apologised for some communication issues. The advice we received was that there was a lack of evidence that Mr A and his family had been provided with information about his initial signs of heart failure. We made recommendations to address the failings identified.

We upheld Mrs C's complaint about nursing care as we found that a number of failings in the care provided had already been identified. The nursing adviser was critical of an incident where there was failure to maintain Mr A's dignity. We made a number of recommendations in relation to this part of Mrs C's concerns.

Finally, we upheld Mrs C's concerns about the handling of her complaint by the board. The board acknowledged that they had not dealt with the complaint in line with their timescales and had not kept Mrs C updated. They advised that this had been addressed going forwards.

Recommendations

We recommended that the board:

• consider how this case could be used to promote learning on the importance of co-ordination of care;
• provide an update on the co-ordination of care since the time of this complaint;
• apologise for the failure to provide information on heart failure at the relevant time;
• take steps to ensure that appropriate information is provided to patients and their families about medical conditions and that this communication is clearly recorded in the notes;
• consider using this case for staff learning and development to highlight the importance of maintaining patient dignity;
• ensure that staff involved in the failure to maintain patient dignity reflect on this complaint at appraisal;
• provide evidence that action has been taken to address the issues identified during their investigation of the complaints raised in this case; and
• provide supporting evidence that steps have been taken to prevent future communication and complaints handling failings.

Summary

Mrs C complained to us that the medical practice failed to provide her mother (Mrs A) with appropriate clinical treatment for her reported symptoms. Mrs C said that by the time Mrs A had been referred to hospital, she was found to have severe sepsis (blood infection). Mrs C said the GPs did not examine Mrs A fully and failed to admit her to hospital sooner.

We obtained independent GP advice. We found that the GPs who visited Mrs A had on a number of occasions said to Mrs A that her blood tests and presentation were concerning and that hospital admission or further investigation was advised. However, we found that Mrs A declined the offer of a hospital admission on three occasions.

Summary

Mrs C complained about the care and treatment provided to her father (Mr A) by staff at Ayr Hospital. She complained that full diagnostic tests had not been carried out when Mr A was in hospital on two occasions, and that signs of heart failure had been missed by staff. Mrs C also complained that Mr A had been prescribed with medication for his previously diagnosed Parkinson's disease (a progressive neurological condition in which part of the brain becomes more damaged over many years) without a full examination and consultation, and that the medication he was given caused adverse side effects. Mr A was discharged with a full care package and died shortly afterwards.

During our investigation we took independent medical advice from a consultant physician and a specialist Parkinson's disease nurse. We found that whilst the clinical treatment provided to Mr A had generally been reasonable, the board failed to consider a diagnosis of pulmonary embolism (blood clot in the lungs) and carry out the diagnostic test for this. Therefore we upheld this aspect of Mrs C's complaint.

We also found that when Mr A was prescribed with medication for Parkinson's disease, he was not appropriately assessed by the Parkinson's nurse and that there was no documented justification for the prescription. We also found that side effects were not appropriately discussed with Mr A or his family, and that prescribing guidelines were not appropriately followed. Given this, we upheld this aspect of Mrs C's complaint.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failures identified by this investigation;
• draw the adviser's comments regarding the alternative diagnosis of pulmonary embolism, and the carrying out of the diagnostic test, to the attention of the relevant staff;
• apologise to Mrs C for the failings identified by this investigation;
• consider implementing in-patient guidelines for staff regarding the care of people with Parkinson's disease in an acute setting, in order to provide a framework to help with assessment and drug choice; and
• consider implementing assessment and prescribing competencies to support nurses working in this setting, to ensure they have the correct knowledge.

Summary

Mr C complained about the medical practice on behalf of his mother (Mrs A). Mrs A was discharged from hospital and given three new medications. On learning of these new medications, the practice decided to carry out a review of Mrs A's prescriptions, as this would result in her being prescribed 18 different medications a day.

Mrs A's GP phoned Mrs A's daughter (Mrs B) to discuss the medications as they considered that these new medications were not necessary and may cause side effects that would exacerbate Mrs A's existing conditions. Mrs B felt that the GP's manner was callous and uncaring and that the content of the call was inappropriate. Following the call, the practice decided to prescribe the medications in line with the request from Mrs A's respiratory consultant.

However, this call led Mrs A's family to decide that they would change GP practices. Mrs A died before the new practice was able to arrange Mrs A's medications.

On investigation we found that there was some discrepancy in the information available to the practice, caused by a delay in the hospital sending them Mrs A's full discharge letter. This meant that they were not in possession of the consultant's rationale for providing the new medication and had to carry out the review based on the medical history they were aware of.

Our adviser considered the relevant medical records and concluded that it was reasonable for the practice to carry out a review of Mrs A's medications in the circumstances. They also considered the conclusions reached in the review to be reasonable, based on the information available to them at that time.

On reviewing the records we were unable to see any evidence that the content or manner of the call in question was unreasonable. For these reasons, we did not uphold Mr C's complaint.

Summary

Mrs C complained on behalf of her son (Mr A). Mr A was admitted to A&E at University Hospital Crosshouse with a three-day history of stomach cramps, diarrhoea and vomiting. It was suspected that he had gastroenteritis and after his symptoms settled he was to be discharged. However, Mrs C said she spoke with the consultant gastroenterologist responsible for Mr A's care and told them that this had been an ongoing problem. Mr A was kept in hospital for a further six days and then discharged with plans to follow up. Prior to the follow-up, Mr A was admitted to hospital as an emergency and diagnosed with Crohn's disease (a long-term condition that causes inflammation of the lining of the digestive system). Mrs C complained that during his initial admission, Mr A was not given appropriate care and treatment.

We took independent advice from a consultant in gastroenterology. We found that on Mr A's admission to hospital, a clear history was documented in the emergency department notes of several weeks of recurrent episodes of abdominal pain associated with significant and unintentional weight loss. This history was later repeated by Mrs C. We found that in the circumstances, this should have raised suspicion of a diagnosis other than that of food poisoning, such as Crohn's disease. The adviser said they would have expected a scan of the abdomen or of the small bowel to have been undertaken during the admission or shortly afterwards. Had this happened, Mr A would have been diagnosed sooner. We therefore upheld Mrs C's complaint.

Recommendations

We recommended that the board:

• apologise to Mr A for the failures identified during this investigation;
• ensure that the consultant gastroenterologist concerned with Mr A's care during this admission is made aware of the results of this investigation and that this case is discussed at their next formal appraisal;
• satisfy themselves that the consultant gastroenterologist is made aware of the guidance relevant to this case; and
• ensure that information about Crohn's disease is readily available to patients on diagnosis.