Health

Summary

Mr C complained about a lack of treatment during an admission to the Royal Alexandra Hospital. He had been admitted following fracture of his hip and femur. Mr C said that he vomited throughout one night and now suffers from throat discomfort. He said that although staff changed his basin on occasions he now feels that the lack of treatment for his vomiting caused this.

We took independent medical advice. We found that nursing staff reported the vomiting. The adviser noted that Mr C was stable and that anti-sickness medication was prescribed and that an appropriate treatment plan was put in place. We therefore did not uphold Mr C's complaint.

Summary

Miss C complained that her medical practice unreasonably removed her from the practice patient list because of comments which had been made on her social media site. The practice said that they would not tolerate such comments and that there had been a breakdown in the doctor/patient relationship which meant that it was not possible for them to treat Miss C. They considered the tone of the comments to be both threatening and bereft of any respect for the practice.

We took independent advice from an adviser in general practice and concluded that the comments which were made could be reasonably interpreted as threatening to the practice and as such it was not unreasonable that Miss C was removed without a preceding warning. We found the practice had adhered to their contractual specifications in this regard and their actions were reasonable. We did not uphold Miss C's complaint.

Summary

Mr C asked the prison health centre to prescribe him a medicine used in the treatment of opiate addiction. The prison health centre refused and explained to Mr C that he did not meet the relevant criteria.

We took independent medical advice. We found that the decision to refuse to prescribe Mr C the medicine he requested was taken following a thorough clinical assessment and that the care and treatment given to him was reasonable. We therefore did not uphold Mr C's complaint.

Summary

Mr C complained that the prison health centre unreasonably reduced his medication for nerve pain. He said the decision had affected his wellbeing and he wanted to have the dose increased.

The information available confirmed Mr C was reviewed and assessed by a number of clinicians and they did not feel there was any clinical need to increase his medication. We took independent medical advice. The adviser found that the health centre's decision appeared to be reasonable and in line with appropriate guidance. We therefore did not uphold Mr C's complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mr A) that there had been an unreasonable delay in the GP practice referring Mr A for further assessment and advice when he attended with on-going abdominal pain and diarrhoea. Mr A had undergone a colonoscopy (an examination of the bowel with a camera on a flexible tube) in hospital several months earlier and had been diagnosed with diverticulosis (small pouches that stick out from the wall of the gut). He had then had a bowel screening test, which showed blood in his bowel motion and his health board had written to him to say that they would arrange another colonoscopy.

Mr A then attended the practice with abdominal pains and diarrhoea. He was prescribed medication and it was recorded that he was hoping to have a repeat colonoscopy from the board. He attended the practice again four weeks later and they sent a routine referral to the board asking for advice about whether he needed further investigation. Mr A was subsequently diagnosed with bowel cancer, which had spread to his liver and lungs.

We took independent advice from a GP. We found that the practice had provided a reasonable standard of care to Mr A when he attended with abdominal pains and diarrhoea. The on-going investigation by the board into Mr A's bowel problems fell outwith the practice's remit. It was also reasonable for the practice to send a routine referral to the board asking for advice. We did not uphold Ms C's complaint.

Summary

Mrs C complained that there was an unreasonable delay by the board in diagnosing her breast cancer.

We took independent advice from a consultant clinical oncologist, who said that there had been an unreasonable delay in diagnosing and treating Mrs C's breast cancer. We also found that it was not possible to know what the outcome would have been had Mrs C been diagnosed with earlier with breast cancer.

The board accepted that they had failed to meet the 12-week guarantee time for referrals and outlined the action they had taken to minimise delays to appointments and subsequent treatment, including managing out-patient referrals. We upheld Mrs C's complaint.

Recommendations

We recommended that the board:

• provide an update on the review being carried out of the management of out-patient referrals.

Summary

Ms C, a GP, complained on behalf of her patient (Mrs B) about the care and treatment received by Mrs B's husband (Mr A) whilst he was in Queen Elizabeth University Hospital. Ms C complained that the board did not provide Mr A with a reasonable standard of medical treatment, that they did not provide a reasonable standard of nursing care, and that the board failed to communicate with Mr A's family about his condition and prognosis and provide a palliative care plan.

We took independent advice from a consultant physician and a nursing adviser. We found that whilst many aspects of Mr A's medical treatment had been reasonable, the palliative care team should have been involved in his care earlier, and that there was a lack of discharge planning. We upheld this aspect of Ms C's complaint.

We found that the nursing care provided to Mr A was of a reasonable standard and did not uphold this aspect of Ms C's complaint. However, in relation to the communication of Mr A's prognosis and condition, we found that the board did not check to ensure that Mr A's family understood his prognosis, and that a DNACPR form (do not attempt resuscitation form) and DS1500 form (an end of life benefits form) should have been completed as this may have helped the family have a better understanding of Mr A's condition. The board had accepted that the standard of communication with Mr A's family was not reasonable. We upheld this aspect of Ms C's complaint.

Recommendations

We recommended that the board:

• report to us on the action taken to review discharge planning;
• take action to ensure that, in similar cases, the palliative care team are involved at the appropriate time; and
• feed back to staff the adviser's comments in relation to completion of a DNACPR form and DS1500 form.

Summary

Mr C complained on behalf of his constituent (Mr A) about cataract surgery he had undergone in 2014. During cataract surgery on his right eye, Mr A sustained a small corneal abrasion (a scratch on the clear, front part of the eye). He was not told of this at the time of the operation. Following the operation, Mr A suffered from discomfort in his eyes and further deteriorating vision. At an appointment with an ophthalmologist more than a year after the cataract surgery, he was told about the small corneal abrasion he had sustained but was reassured that this was not the cause of his ongoing issues. Mr A complained to the board as he believed his problems with his vision were due to the corneal abrasion sustained at the cataract surgery and that he should have been told of the injury at the time of it happening.

In our investigation we took independent advice from an ophthalmologist. We found that the corneal abrasion sustained to Mr A's right eye during cataract surgery would most likely have healed up within 48 hours. We considered the cataract surgery to have been performed to a reasonable standard. However, we found that Mr A should have been informed of the corneal abrasion at or near the time of surgery. We therefore recommended that the board apologise to Mr A and draw our comments to the attention of the surgeon who performed the cataract surgery.

Recommendations

We recommended that the board:

• apologise for the failure to advise Mr A of the corneal abrasion; and
• draw the comments of the adviser to the attention of the surgeon responsible for Mr A's cataract surgery.

Summary

Ms C had low abdominal and pelvic pain and was referred to a gynaecology clinic. She attended two appointments with the same clinician but complained that she was not treated or cared for appropriately and that she should have had a biopsy due to her family history. She also complained that the examining equipment at each appointment had not been fitted with a protective sleeve. She also complained that communication at the two appointments had been unreasonable.

We took independent advice from a consultant in obstetrics and gynaecology. We found that while an ultrasound scan at Ms C's first appointment had shown a small fibroid in the wall of her uterus, this was not cancerous and she was appropriately advised. She was given medication for her presenting symptoms and was to attend in two months' time. At her second appointment, we established that her treating clinician suggested a laparoscopy as her symptoms remained and while Ms C had not wanted this and wanted a biopsy, this would not have been the appropriate treatment. We found no evidence that a protective sleeve had not been used nor evidence of poor communication. We did not uphold Ms C's complaint.

Summary

Mr C complained on behalf of his constituent (Mrs B). Mrs B was concerned about the care her mother (Mrs A) received from her medical practice.

Mrs A was receiving palliative care in the home from Mrs B and the district nursing service. Mrs B was concerned that the GPs at the practice did not undertake home visits to provide medical and emotional palliative care support for her and her mother. In particular, Mrs B felt that a GP should have visited in the days prior to her mother's death. We took independent advice from a GP adviser. The adviser was satisfied that the GPs visited Mrs A on a reasonable number of occasions. Similarly, they did not find evidence that the GPs unreasonably failed to visit in the days before Mrs A's death and noted that the medical records did not indicate that an urgent home visit was clinically required at this time. Furthermore, the adviser did not consider that the practice had unreasonably failed to provide a reasonable level of support and guidance to Mrs B. We therefore did not uphold this aspect of Mr C's complaint.

Mrs B also expressed concern that the practice had not responded to her complaint in a compassionate manner. We found that the practice had not followed their own complaints procedure in this instance in that they had not adopted as conciliatory and sympathetic a tone as possible when responding to the complaint. We further considered that the practice had failed to respond to the complaint in a person-centred way as required by the Scottish Government's 'Can I help you?' guidance for handling healthcare complaints. For these reasons, we upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the practice:

• apologise for failing to respond reasonably to Mrs B's complaint; and
• feed back the findings of this investigation to staff in the practice responsible for responding to complaints.