Health

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.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of Mrs A about care provided by a dentist. Mrs A attended with a painful front tooth and it was decided that root canal treatment was needed to save it. Mrs A had this treatment over two appointments. However, the tooth later broke while she was eating. Mrs A saw the dentist and emergency treatment was provided. Mrs A experienced pain and swelling following this and saw the dentist about this a few days later. At this meeting, there was a breakdown in the dentist/patient relationship. The dentist completed the treatment and Mrs A later registered with a new dentist.

Ms C complained that Mrs A had not been offered options for treatment and that the risks had not been properly explained. She also raised concerns about the dentist's attitude towards Mrs A, and that the dentist had not followed the proper process as they had threatened to deregister Mrs A. Ms C's final complaint was that the handling of Mrs A's concerns had not been reasonable.

We took independent dental advice. The advice we received was that the treatment provided was appropriate and was the only option to save the tooth. However, the adviser highlighted that there was no evidence that the risks of the treatment had been properly explained to Mrs A. There was also a lack of records for one of her consultations. We therefore upheld Ms C's complaint.

The adviser noted that there was no evidence that steps had been taken to deregister Mrs A and we therefore did not uphold this aspect of Ms C's complaint.

We found that the dentist had not included all appropriate information in the response to the complaint and that there were inconsistencies between the complaints handling procedure and the associated staff guidance document. We therefore upheld Ms C's complaint in relation to this.

Recommendations

We recommended that the dentist:

• apologise for the failings identified in this investigation;
• take steps to ensure that patients are appropriately informed of the risks and benefits of procedures;
• ensure that patient dental records are kept in line with the General Dental Council standard; and
• review the complaints handling procedures for staff and patients for consistency.

Summary

Mr C complained that his prison healthcare centre stopped prescribing medication he had been taking for physical and mental problems. Mr C also complained that the board ignored his complaint, which resulted in his health worsening.

We took independent medical advice and found that the healthcare centre had discussed Mr C's medications with him. We considered that the decision to stop Mr C's medications was appropriate and in line with guidance issued by the General Medical Council and the National Institute of Excellence.

We considered that it would have been helpful for the board, in their written reponse to Mr C's complaints, to have given more detailed information about why some of his medications were not being prescribed. However, we found overall that their comments were reasonable.

Summary

Mrs C complained about the care and treatment provided to her husband (Mr A) by the board. She complained that there was an unreasonable delay in the board diagnosing Mr A with lymphoma (cancer of the lymph nodes). She also complained that a doctor had refused to sign a Personal Independence Payment (PIP) form for Mr A when he became ill. (Personal Independence Payment is a benefit that can be awarded to those with long-term ill-health or a disability to help cover the additional costs of their illness.) Lastly, she complained that the board did not provide a reasonable standard of palliative care to Mr A.

We took independent advice on the complaint from a nursing adviser, a GP and a surgical consultant. We found that the board carried out reasonable investigations into Mr A's presenting symptoms over a period of several years and there were no signs of lymphoma that were unreasonably missed. We found that there was no evidence to suggest that a doctor had refused to sign a PIP form. We also found that whilst there was some delay in Mr A receiving appropriate medication before his death, the standard of palliative care provided to him was reasonable.

Summary

Mr C complained that although he suffered from mental health issues, the diagnosis of Asperger's Syndrome he had been given was incorrect.

Mr C said that he had not been listened to by medical staff and that his opinion and symptoms had been ignored. Mr C believed that medical staff had chosen to inaccurately record his symptoms, in order to protect their colleagues who had given him the original diagnosis of Asperger's Syndrome. Mr C said his assessments had not been properly carried out and the appropriate diagnostic tools and techniques had not been used. Mr C said the board were unreasonably refusing to provide him with a second opinion.

We took independent medical advice and found that Mr C had been diagnosed following a period of observation and assessment. This included a detailed history as well as information supplied by other mental health professionals and direct observation of Mr C. The diagnostic process was reasonable and in keeping with the current guidelines and had taken place over four separate assessments. The adviser said it was reasonable for further assessments to be refused by the board, as Mr C had had a number of assessments by different doctors, which had all reached the same conclusion. Additionally, Mr C's focus on his diagnosis was preventing him from following his treatment programme. As another assessment was unlikely to reach a different conclusion, it would not be helpful for Mr C. We found Mr C was assessed reasonably by the board, who were able to demonstrate they had followed the appropriate guidance. We therefore did not uphold Mr C's complaint.

Summary

Miss C complained that her medical practice failed to fit her intrauterine contraceptive device (IUCD) appropriately and that it had perforated her uterus. She complained to the practice but it was their view that it had been fitted reasonably.

We took independent medical advice and found that prior to the procedure to fit the device, in accordance with national guidance, Miss C had been fully informed about its risks and benefits, including that the IUCD could perforate the uterus. There was no evidence to suggest that the IUCD had been fitted inappropriately and the complaint was not upheld.

Summary

Ms C complained about the care and treatment in hospital of her daughter (Miss A) who suffers from complex regional pain syndrome (a painful condition normally treated with desensitisation and physiotherapy). Miss A was admitted to the hospital where she has remained for over a year without improvement to her condition. Ms C raised concerns that Miss A was not receiving appropriate specialist input as staff at the hospital did not have experience with Miss A's condition. Ms C also said Miss A was not able to get quality sleep due to her position on the ward, which Ms C considered was impacting on her rehabilitation and exacerbating her pain.

The board said Miss A had received appropriate care from an experienced team but she had not felt able to participate with the physiotherapy and desensitisation program, so her condition had not improved. The board explained that the decision to keep Miss A in a central location was due to her high falls risk. While they agreed that lack of sleep was not desirable, they did not consider that this was impacting on Miss A's rehabilitation.

After taking independent advice from a consultant in pain management and a nurse, we did not uphold Ms C's complaint. We found Miss A's care involved appropriate input from a multi-disciplinary team. The medical adviser considered that the team were appropriately experienced and qualified to manage this case and noted that the team had also discussed the case with clinicians both within and outside the UK. In relation to Miss A's position on the ward, both advisers considered this was appropriate in view of the risk assessments carried out by staff.

Summary

Mr C complained that the prison health centre unreasonably opened mail that was addressed to him.

The board were unable to identify who opened Mr C's mail, but they acknowledged that it appeared to have arrived at the health centre unopened. They accepted that the item should not have been opened by staff and that an apology should have been issued to Mr C as soon as it was identified that it had been opened in error. We therefore upheld Mr C's complaint.

Recommendations

We recommended that the board:

• issue appropriate staff guidance on the handling of prisoner mail by healthcare staff.