Health

Summary

Ms C had surgery for breast cancer in her right breast. She reported a lump in her breast 11 years later. Further tests were carried out at Forth Valley Royal Hospital but did not show evidence of cancer. Ms C was followed up with repeat tests which identified a local recurrence of cancer. Ms C then had a mastectomy (an operation to remove the breast), which showed no evidence of cancer. Later, a marker clip (a small titanium clip used to mark the site) initially placed at the time of the biopsy was removed along with surrounding tissue, which also did not show evidence of cancer.

Ms C complained that she should have undergone more tests and should have been reviewed every four weeks after the lump was identified. She also complained that the mastectomy may not have been required and had concerns about the lack of action taken in response to the marker clip that had not been removed at the time of the mastectomy.

We took independent medical advice from a consultant breast surgeon and a consultant radiologist. We did not find failings in Ms C's care and treatment before or after the mastectomy. We considered that she received appropriate tests and was reviewed within a reasonable timescale. In addition, given there was evidence of invasive cancer identified from a biopsy and Ms C's history of previous radiotherapy for breast cancer, we considered that the mastectomy was warranted. In terms of the marker clip, we found that there were no failings in relation to mastectomy technique and that reasonable steps were taken to remove it and check the surrounding tissue. We did not uphold Mrs C's complaint.

Summary

Mr C complained about an endoscopy procedure that he had undergone at Forth Valley Royal Hospital which he found painful. Mr C died while our investigation was ongoing. Mr C's death was not connected to the endoscopy procedure about which he complained.

After making further enquiries, we decided that the most appropriate course of action was to discontinue our investigation.

Summary

Mrs C was required to travel outwith the board area for treatment of a rare condition from which she suffers. She complained that the board's policy of reimbursing after travel, rather than paying upfront, caused her financial hardship. The board confirmed that it was their policy only to reimburse on production of receipts and Mrs C's request for upfront payment was refused. We were satisfied that the board acted in line with their documented procedure and we did not uphold the complaint.

However, the board acknowledged a need to consider exceptional circumstances on a case-by-case basis. They subsequently reviewed their procedure and established that other health boards have an ability to make payment in advance. They updated their procedure to include a provision for making upfront payments where exceptional circumstances are deemed to exist. We considered this action reasonable and had no further recommendations to make.

Mrs C raised further concerns that the board had refused to pay her the associated costs of travel, such as the cost of meals and childcare. We did not take this forward as the board's procedure clearly set out that only the costs of travel and accommodation are eligible for reimbursement. In addition, Mrs C complained that the board had communicated poorly with her and, while we noted there were occasions where they delayed in responding to her requests for information, we were satisfied that they had already explained, and apologised for, these delays.

Summary

An arrangement was in place whereby Mr C received his meals in his prison cell. This was as a result of the anxiety Mr C experienced in attending the prison dining hall due to post-traumatic stress disorder (PTSD). However, the board advised the Scottish Prison Service (SPS) that Mr C could return to the dining hall to have his meals. Mr C complained about the board's decision that he was fit to do so.

We took independent medical advice from a consultant forensic psychiatrist who noted that the in-cell dining arrangement did not appear to have been a significant feature of Mr C's historic clinical assessments. They also noted that there was no indication that PTSD was felt to have been a major ongoing issue for Mr C. They considered that Mr C was appropriately reviewed by clinicians before deciding that he was fit to attend the dining hall and that this decision was reasonable. We did not uphold the complaint.

However, the adviser considered that the psychiatrist who reviewed Mr C's fitness to attend the dining hall should have provided clearer and more definitive advice to the SPS. As they were still in training, they should have discussed the situation with their supervising consultant if they were unclear on what to advise. There was no evidence that this happened. We noted that the psychiatrist had indicated they would leave it for the SPS to make the final decision, rather than focusing on providing clear and specific advice upon which they could base their decision. We considered that the board's role in such decision-making could benefit from being clarified through the provision of guidance to mental health staff and we made recommendations accordingly.

Recommendations

We recommended that the board:

• take steps to ensure that any non-consultant-grade psychiatric staff providing input to the SPS are appropriately supervised;
• remind prison mental health staff to ensure that they provide clear and specific advice and/or recommendations to the SPS when they receive a reasonable request for clinical input into a decision; and
• consider introducing written guidance for prison mental health staff on dealing with requests from the SPS for clinical input into decisions relating to the management of prisoners, taking account of the psychiatric adviser's comments.

Summary

Ms C complained about care she received from her medical practice. When Ms C received a copy of her medical notes she found that during a previous consultation two years earlier, the GP had noted a mild vaginal prolapse and had not told her about this. Ms C complained that she should have been told about the prolapse and treated for it, and that the practice had not reasonably responded to her complaint.

We sought independent medical advice and found that while the failure to inform Ms C of this incidental finding had not caused significant harm to her, the GP should reflect on this decision further. We upheld this complaint.

However, the adviser's view was that the decision not to provide treatment at the time was reasonable, as was the response to Ms C's complaint. We therefore did not uphold this aspect of Ms C's complaint.

Recommendations

We recommended that the practice:

• reflect on the decision not to inform the patient of an incidental finding.

Summary

Miss C had been experiencing poor health over a number of months and made a suicide attempt by medication overdose. She contacted NHS 24 and was taken to University Hospital Ayr. Miss C's symptoms included slurred speech and problems with walking. Miss C was assessed by nursing, medical and psychiatric staff and was later discharged. The following day, she attended with the same symptoms and was again discharged home. The next day, Miss C's GP arranged for her to attend University Hospital Crosshouse. A scan confirmed Miss C had a brain tumour, which was subsequently operated on. Miss C complained that, despite her presenting symptoms, she was not properly assessed or treated when she attended at University Hospital Ayr.

We took independent advice from a specialist in emergency medicine. We found that at the initial admission, the focus of attention had been on the immediate presenting problems of Miss C's mental health and the effects of the overdose and that the assessment and treatment provided that day were appropriate and reasonable. The adviser said that in normal circumstances, the symptoms Miss C presented with on her second attendance at the hospital should have resulted in further investigation. In this case, however, the adviser noted that the doctors involved had felt it was likely that Miss C's presenting symptoms were related to the overdose the previous day and that it was reasonable that they reached this conclusion. Therefore, we concluded that the assessment was reasonable. We also reviewed Miss C's records and were satisfied that the treatment she received was appropriate. Therefore we did not uphold Miss C's complaint.

Summary

Mr C complained about the care and treatment he received for a diabetic foot ulcer. Mr C had been receiving treatment for diabetes-related foot problems for an extended period. Due to difficulties with recurrent infection and Mr C's difficulty in complying with his treatment programme, he was fitted with a special cast to protect the ulcer on his foot. Mr C complained that the cast had been too tight and had damaged his foot, resulting in the possible amputation of his toe.

The board said no injury had been noted to Mr C's toe prior to the removal of the cast. They suggested that the injury had taken place between the removal of the cast and a subsequent medical review. The board said that the cast had been appropriately applied and reviewed and that the care and treatment had been of a reasonable standard.

We sought independent medical advice and found that Mr C's cast had been an appropriate course of treatment. There was no evidence that it had been incorrectly applied, or that it had damaged Mr C's foot. There was no record of a wound to Mr C's toe when the cast was removed. Mr C's medical review following removal of the foot cast did not attribute the injury to the cast. We also found that Mr C's ulcer had reduced whilst the cast was on his foot, demonstrating that the treatment had worked as planned.

We found that Mr C's care and treatment had been of a reasonable standard. The cast to his foot had been applied and removed by an appropriate specialist and there was no evidence to link the injury to his toe to the cast.

Summary

Mr C complained about the care and treatment he received from his medical practice. He was concerned that the GP inappropriately prescribed him steroid medication for asthma which caused his heart rate to increase, requiring hospital treatment. Mr C felt that his GP dismissed his ongoing concerns about his heart rate and breathlessness.

We took independent advice from a GP adviser and considered that it was appropriate that Mr C's GP diagnosed worsening asthma and prescribed steroid medication in accordance with national guidance. In addition, whilst Mr C had been diagnosed previously with atrial fibrillation (where the heart beats irregularly and faster than normal), the type of steroid prescribed was not specifically associated with this condition. Therefore we considered that it was reasonable practice to prescribe this treatment and did not uphold Mr C's complaint.

Summary

Mrs C complained about the care and treatment given to her mother (Mrs A) at University Hospital Crosshouse prior to Mrs A's death. At the time of her admission, Mrs A had been very unwell with pneumonia and sepsis. Mrs C said that she and her family were not alerted to the seriousness of Mrs A's condition and were not prepared for her death. Mrs C said that Mrs A was not cared for appropriately, specifically that she was left in soiled clothes and bedding, not given medication in a timely manner, that there was a delay in moving Mrs A to the high dependency unit and that fluid was removed from Mrs A's lung in an incorrect way. Mrs C said that it was only after Mrs A's death that it was disclosed that she may have been suffering from leukaemia. Mrs C also complained that the board's response to her complaint was inadequate.

We took independent advice from a nursing adviser and a consultant physician and geriatrician. We found that overall, Mrs A's care had been reasonable. Mrs A had wanted to be independent regarding personal hygiene, with help from family members rather than from staff. Mrs A's medication was administered appropriately and in a timely manner. The procedure to remove fluid from Mrs A's lung was reasonable, as was the timing of moving her to a high dependency unit. We found evidence that Mrs C and her family had been kept updated about Mrs A's condition. We also found that it was only after Mrs A's death that it was determined that she had leukaemia. We did not uphold these aspects of Mrs C's complaint. However, our investigation did raise concerns about the facilities on the ward and we made a recommendation to address this.

We found that the board's response to Mrs C's complaint had been poor in that it failed to provide sufficient detail in a timely manner. We therefore upheld this aspect of Mrs C's complaint.

Recommendations

We recommended that the board:

• confirm that action has been taken to improve the facilities concerned. If nothing has been done, they should provide details of the action they intend to take to remedy the situation;
• apologise to Mrs C for the shortcomings identified in their correspondence to her; and
• emphasise to relevant staff the importance of supplying information to allow a timely response to complaints.

Summary

Mr C, who works for an advocacy and support agency, complained on behalf of his client (Mr A). Mr A attended the A&E department at Glasgow Royal Infirmary where he was assessed as having had a transient ischemic attack (TIA), a condition where the blood supply in part of the brain is temporarily disrupted. After being assessed, Mr A was discharged with aspirin and a referral for an appointment at the TIA clinic. However, Mr A had a stroke the following day and was readmitted to the hospital. Mr C complained that Mr A should not have been discharged and that the doctor who had assessed Mr A on his first admission had failed to note that he had on-going symptoms which would have indicated admission. Mr C said that Mr A was concerned that he could have suffered a more severe stroke as a result of the discharge the day prior to his stroke.

We took independent advice from a consultant in emergency medicine. We found that the doctor performed reasonable observations of Mr A during his attendance at A&E. However, the adviser found that the doctor who assessed Mr A had not recorded the time of onset, or the duration, of Mr A's symptoms. The adviser was critical of this but said that whilst this information may have led to Mr A being admitted rather than discharged, it was not possible to say if admission would have prevented his stroke.

Recommendations

We recommended that the board:

• remind A&E staff of the need to accurately assess and document the nature and duration of TIA symptoms and report back to this office on action taken; and
• apologise to Mr A for the failure to accurately assess and document his TIA symptoms.