Health

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Ms A) about the care and treatment she had received at Wishaw General Hospital. Ms A suffered a stroke-like episode and was taken to hospital by ambulance. Following medical investigation, Ms A was discharged a few days later with a probable diagnosis of multiple sclerosis (MS). Although her discharge documents detailed this probable diagnosis, Ms A complained that a doctor had made a specific diagnosis of MS and that this was not in line with national guidance which states that MS should not be diagnosed in a general hospital setting. Ms A was also concerned that the medical investigations that were carried out and the delay in referring her to neurology were unreasonable. We also considered whether the handling of and response to the complaint was reasonable.

After taking independent advice from a consultant physician, we did not uphold the complaints regarding medical investigations or neurology referral. We found that the investigations were timely and appropriate for the symptoms that Ms A presented with. We found that board staff had a different recollection of Ms A being advised of the outcome of the medical investigations and that while Ms A was certain that a definitive diagnosis had been provided, staff maintained that this had been probable only. We were unable to determine what had been said at the time in question but found that the medical records made reference to a probable diagnosis of MS. The advice highlighted that Ms A was referred to neurology following discussion with the neurology department which is based at another NHS board. No delay in referral was identified and the board had no control over waiting times for appointments, given that the service is provided out with their area. We did make a recommendation around communication as we found that there were a number of differences between the board's and Ms A's understanding.

Although we found that the board's response to Ms A's complaint addressed the points raised, a failing in the board's investigation was identified. We found that a member of staff that had been present when Ms A was advised of the outcome of the medical investigations had not provided comments before the final decision was issued. While this did not affect the outcome in this case, we considered that the board should have ensured all necessary comments were obtained before reaching a conclusion on the complaints.

Recommendations

We recommended that the board:

• use this case to highlight the importance of clear, effective communication with patients.

Summary

Mrs C, who works for an advocacy and support agency, complained on behalf of Ms A about a GP home visit when Ms A reported severe dizziness and staggering. Ms A was diagnosed with labyrinthitis (an inflammation of the inner ear), but it was later discovered that she had suffered two minor strokes. Mrs C said that the GP should have considered the possibility of a stroke and admitted Ms A to hospital by ambulance. Mrs C also said that it was unreasonable for the GPs at the practice to prescribe statins (medication used to lower cholesterol in the blood) to Ms A.

We took independent advice and found that the care and treatment provided to Ms A at the home visit was reasonable. It was appropriate to diagnose labyrinthitis and there was no clinical evidence at this point to suggest that Ms A had had a stroke. However, there was an unreasonable delay in making a referral to a stroke unit, and there was a failure to carry out a particular examination which would have been reasonable in light of Ms A's symptoms, which included hypertension. In relation to the prescription of statins, we found that this was reasonable in the circumstances.

Recommendations

We recommended that the practice:

• ensure their systems for sending hospital referrals are such that referrals are sent within a reasonable time, and there is no recurrence of unreasonable delays;
• ensure the relevant GP familiarises themselves with guidelines for the management of hypertension; and
• apologise for the failings identified in this investigation.

Summary

Mrs C complained about the care that her late husband (Mr A) received at Monklands Hospital after attending the emergency department. Mr A was to be admitted to a private room but none was available. He remained in A&E until a suitable room was found. Mr A was later moved to a different area in the hospital, where he fell while in the toilet.

Mrs C complained that Mr A waited in A&E for too long. She was also concerned that the toilet where he fell was not properly equipped and that staff had not taken reasonable steps to help him afterwards. Mrs C also considered that his risk of falls had not been assessed and that the recording and investigation of the incident had not been carried out properly. Finally, Mrs C complained that Mr A's bed was not adjusted for his height quickly enough.

After taking independent advice from a consultant in emergency care, we upheld the complaint about Mr A's wait in A&E. We found that he had waited longer than was reasonable in the circumstances and that the board had already apologised for this. We recommended a review of their policy for escalating cases like Mr A's.

We took independent advice from a registered nurse in relation to Mrs C's other concerns. We did not uphold the complaint regarding a falls assessment as the advice we received was that this had been carried out in A&E with no risk identified. We also did not uphold Mrs C's concerns about the toilet facilities as we received advice that these were reasonable. We found that there were two different accounts of events around Mr A's fall and we were unable to determine exactly what had happened within the scope of our investigation, therefore we did not uphold this element of the complaint. We did, however, uphold the complaint about the initial investigation of the fall. The advice we received was that although it was appropriately recorded, there were missed opportunities to resolve Mrs C's concerns locally. We made two recommendations to address this.

Finally, we upheld Mrs C's complaint about the failure to adjust Mr A's bed. The advice we received was that this was unreasonable in the circumstances and the adjustment can be made easily. We made two recommendations to the board in light of this.

Recommendations

We recommended that the board:

• review the escalation procedure for individual patients awaiting specific beds, taking into account the adviser's comments;
• review the training they have in place for early resolution of concerns and complaints;
• ensure mechanisms are in place for staff to access support from more senior colleagues in the ongoing resolution of complaints;
• apologise for the failure to take the falls assessment into account and adjust the bed in a timely manner; and
• ensure staff are aware of the appropriate considerations when making adjustments to beds.

Summary

Ms C, an advice and support worker, complained on behalf of Ms A. Ms A had developed mobility problems and, after an episode of severe dizziness, was admitted to Hairmyres Hospital and discharged a week later. She then attended the movement disorder clinic for further tests and investigations.

Two months later, Ms A was readmitted to Hairmyres Hospital before being discharged the following week. She was referred to community physiotherapy and visited by them on a number of occasions. She was then referred to out-patient physiotherapy.

Ms C said that had Ms A been allowed to stay as an in-patient for longer and been provided with sufficient support and treatment (as both an in-patient and out-patient), she would have recovered her ability to walk.

We took independent advice from specialists in physiotherapy and in care of the elderly. We found that the standard of physiotherapy provided during both Ms A's admissions to hospital was reasonable, and that the follow-up care was reasonably provided for the second admission. However, there was an unreasonable failure to refer her for appropriate physiotherapy services when she was first discharged from hospital. We found that while the decision to discharge her was reasonable, there were failings in the discharge planning in relation to the provision of physiotherapy in the community. We also were satisfied that the decision to discharge Ms A from her second admission to hospital was reasonable.

Recommendations

We recommended that the board:

• take steps to ensure that all in-patients receiving physiotherapy are appropriately reviewed by the service and, where appropriate, referred for community physiotherapy prior to discharge home;
• bring the failings identified to the attention of the relevant physiotherapy and medical staff involved; and
• apologise for the failings identified.

Summary

Mrs C complained that her dentist had failed to provide her with appropriate treatment for an infection in her gum. Mrs C said that this had caused her stress and anxiety as she felt she had not been diagnosed correctly.

We took independent dental advice and found that both the examination and the treatment Mrs C received were reasonable and appropriate. We did not uphold the complaint.

Summary

Mrs C complained that her dentist had failed to provide her with appropriate treatment for an infection in her gum. Mrs C said that this had caused her stress and anxiety as she felt she had not been diagnosed correctly.

We took independent dental advice and found that both the examination and the treatment Mrs C received were reasonable and appropriate. We did not uphold the complaint.

Summary

Mrs C complained that her dentist had failed to provide her with appropriate treatment for an infection in her gum. Mrs C said that this had caused her stress and anxiety as she felt she had not been diagnosed correctly.

We took independent dental advice and found that both the examination and the treatment Mrs C received were reasonable and appropriate. We did not uphold the complaint.

Summary

Mrs C, who works for an advice and support agency, complained on behalf of her client (Ms A) that her medical practice had failed to investigate, diagnose and treat her symptoms. We took independent medical advice and found that Ms A had previously been referred to a number of specialists. She had no new symptoms that warranted further investigation and it was reasonable not to refer her back to the specialists. We found that the care provided by the practice had been of a reasonable standard and we did not uphold this aspect of Mrs C's complaint.

Ms A considered that she was suffering from Jarisch Herxheimer's reaction (a physical reaction within the body during antibiotic treatment). Mrs C complained that the practice had unreasonably stated that this was not the cause of Ms A's symptoms. We found that this had already been investigated in hospital and there was no evidence that this was the diagnosis. We considered that the practice's comments in relation to this matter had been reasonable and we did not uphold the complaint.

Mrs C also complained that it was unreasonable for the practice to suggest in their diagnosis that that there were psychological or psychiatric factors which were worsening Ms A's physical symptoms. We found that the practice's clinical assessment and opinion on this matter had been reasonable and we did not uphold this aspect of the complaint.

Summary

Mrs C complained about the care and treatment provided to her by her medical practice in relation to her ongoing ankle pain.

During our investigation we took independent advice from a GP adviser. The advice we received was that the care and treatment provided by the practice in relation to the ongoing management of Mrs C's ankle injury was of a reasonable standard and no failings were identified. We did not uphold the complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of Mrs B about the care and treatment given to Mrs B's husband (Mr A) after he had two wisdom teeth extracted under general anaesthetic at Raigmore Hospital. Ms C said that on his return home after discharge, Mr A became very unwell. Mrs B twice phoned the hospital for advice but it was only after her second call that he was asked to return. When Mr A returned to the hospital, no record was found of the calls made.

After examination and a scan, Mr A was diagnosed with sepsis and was admitted to intensive care where he stayed for about a week. Ms C said that information about Mr A's discharge failed to reach his GP and dentist in a timely way. Mrs B made a formal complaint to the board about these matters. Ms C complained that they failed to properly address Mrs B's concerns.

The board were of the view that they had treated Mr A reasonably although they recognised a number of shortcomings (namely that records of phone calls to the hospital were not properly recorded and that letters and discharge information were delayed).

We took independent advice from a consultant in oral and maxillofacial surgery and found that there was no record of phone conversations prior to Mr A's admission. However, after his re-admission Mr A's care had been reasonable. We also found that there had been delays in issuing discharge letters and that addresses had been omitted. Furthermore, Mrs B's complaint had not been properly addressed in that although these shortcomings had already been identified by the board, they had put no plan in place to prevent the same thing happening again. We therefore upheld Ms C's complaint.

Recommendations

We recommended that the board:

• advise of the action taken in the interim to prevent the same thing happening again (in relation to information not being recorded in the clinical notes) and if no action has been taken, they should advise of their proposals;
• advise what they have done to address communications concerns since they were brought to their attention and failing any action, they should undertake an audit of the clinics and ward concerned to establish the extent of any continuing problem and provide their solution should problems remain; and
• make a formal apology for their oversights to Mr A and Mrs B.