Health

Summary

Miss C complained that staff at the Assisted Conception Service at Glasgow Royal Infirmary failed to provide her with appropriate in vitro fertilisation treatment (IVF) and failed to communicate appropriately with her. IVF is where an egg is removed from the woman's ovaries and fertilised with sperm in a laboratory. The fertilised egg is then returned to the woman's womb to grow and develop.

Miss C's concerns included that during four referrals she was not once told that she was ineligible for treatment because she was a smoker. Miss C said she also attended various appointments at the service with an egg donor, only to be told at the last appointment that the donor was unsuitable because she was also a smoker.

We obtained independent medical advice from a consultant in reproductive medicine and surgery. The adviser said the IVF treatment provided to Miss C by the board was reasonable. However, the new Scottish Government Access Criteria for NHS-funded treatment for all NHS boards had already been introduced and this set out that smokers were no longer eligible for treatment. Miss C and her partner attended three appointments at the service over a nine-month period before they were finally advised that they were ineligible for treatment because they were both smokers. We were critical of the board in this regard.

The evidence also suggested that Miss C and her partner attended an appointment at the service in which a proposed donor was put forward but the eligibility of the donor under the new access criteria was not discussed.

Recommendations

We recommended that the board:

• take steps to ensure that relevant staff and patients attending the clinic are fully aware of the new Access Criteria;
• provide us with a copy of their revised patient leaflet on egg donor treatment which includes information on the Access Criteria; and
• provide Miss C and her partner with a written apology for failing to advise them of the new Access Criteria at a specific appointment.

Summary

Mrs C complained to us about the care and treatment that her mother (Mrs A) had received from her medical practice before her death. Mrs C considered that Mrs A should have been admitted to hospital earlier and that her death could have been prevented.

We took independent advice from a GP adviser. We found that the examinations carried out by the GPs and the treatment plan put in place for Mrs A had been reasonable. A urine infection had been treated appropriately with antibiotics and it had been reasonable to delay a blood test until she finished the antibiotics. The clinical entries in her records were of a reasonable standard and were in line with guidance from the General Medical Council.

We also found that on the final occasion Mrs A was seen by the GPs, the treatment given to her in relation to her chest symptoms had been reasonable and in line with the relevant guidance. However, her condition deteriorated later that day. She was admitted to hospital and died on the following day. There was no evidence that Mrs A's death was caused by or hastened by the GPs' actions or that it could have been prevented. When Mrs A saw the GPs, there had been no indication that she should be admitted to hospital.

We found that the care and treatment provided to Mrs A had been of a reasonable standard and we did not uphold Mrs C's complaint.

Summary

Mr C complained about the medical practice after they removed his family from the practice list for being outwith the practice boundary. Following a home visit to Mr C's father-in-law, the practice had advised that they felt the distance they had to travel presented a potential safety risk. This had led them to audit the practice list and they had decided to remove all patients outwith their boundary.

Mr C advised that, although his family was outwith the practice boundary, they had been registered there for many years following a complaint against their previous practice. He considered that this meant they should be allowed to remain on the practice list.

We found that the practice had clearly explained the reasons for their decision and given reasonable notice of the removal of services. We sought independent advice from a GP adviser, who was satisfied that the practice had complied with the provisions set out in the General Medical Services Contract for the removal of patients from the practice list, and that it was within their discretion to remove patients who were outwith their practice boundary. We accepted this advice and did not uphold Mr C's complaint.

Summary

Mr C complained about the care and treatment provided to him at Grampian Royal Infirmary following his diagnosis of prostate cancer. Mr C said that he had not been provided with all the information necessary for him to give informed consent for the prostate surgery he had undergone. Mr C said that the board had failed to provide him with a test result which showed that the indicator used to measure the cancer's activity had declined.

The board said that Mr C had been managed and advised appropriately. They accepted that he had not been provided with the test result, but said this was not required for him to have given his informed consent. Additionally the board noted that Mr C had had a number of detailed discussions with his clinicians about his treatment options.

We took independent medical advice on the treatment provided to Mr C. The adviser said that Mr C's management and treatment were in line with the appropriate clinical guidelines. It noted that Mr C had delayed his treatment as he had wished to travel abroad during it. During this trip, a test of his cancer indicators had shown a marked rise. The advice noted that the test Mr C was not informed about showed a lower level of this indicator. The medical decision to operate on Mr C was based on the assessment of a scan of his prostate, and a subsequent examination of the cancer showed it to be more serious than previously thought. The advice said this supported the decisions made by medical staff.

We found that the test level was not the determining factor in deciding whether Mr C should have undergone surgery. We found that for informed consent, Mr C needed to be provided with sufficient information to understand the reason for his surgery, the risks and benefits of the proposed treatment and the alternatives available to him. The evidence showed that this had been done and that the treatment Mr C was provided with was the appropriate one. We did not uphold Mr C's complaint.

Summary

Mr C complained to us about the decision to stop his medication in prison. He said that he had been wrongly accused of concealing it in his mouth when it was given to him under supervision by nurses. He complained to us about the way in which he was supervised when taking the medication. We took independent medical advice on Mr C's complaint. We found that the way in which he had been supervised was reasonable. The decision by medical staff to stop the medication was also reasonable given their concerns that Mr C was not using the medication in line with his needs. We did not uphold these aspects of Mr C's complaint.

Mr C also complained to us about the response he had received from the board to his complaint. He said that this incorrectly stated that he had concealed medication four times in four months. Mr C's medical records showed that he had been caught concealing medication on three occasions. We upheld this aspect of his complaint.

Finally, Mr C complained to us that the board had failed to treat his ongoing pain effectively. We found that the care provided to Mr C in relation to pain after the medication was stopped had been reasonable. We did not uphold this aspect of Mr C's complaint.

Summary

Ms C's partner (Mr A) was admitted to the A&E department at Forth Valley Royal Hospital, where he died. Mr A's mobile phone was not listed among his valuables and could not be found. Ms C made a formal complaint to the board but the phone could not be located. Ms C said that the phone contained images of her late partner and their child that could not be recovered.

Our investigation focused on the efforts made to locate the phone and/or to find out where and when it had gone missing. We were satisfied that, although ultimately unsuccessful, the board took reasonable actions to try to locate the phone.

Summary

Mr C complained about the care and treatment of his late mother (Mrs A). Mrs A had multiple health problems and was admitted to Victoria Hospital with back pain. She was subsequently transferred to Queen Margaret Hospital but became unwell a few weeks later and was transferred back to Victoria Hospital. She deteriorated quickly due to sepsis (an infection of the blood) and died the following morning. Mr C complained about various aspects of the nursing care provided to Mrs A.

We took independent advice from a consultant physician and a nurse. We noted that there was a failure to correctly label a urine sample, resulting in the laboratory being unable to process it and a subsequent delay in obtaining a repeat sample. This resulted in a two-day delay in Mrs A receiving antibiotics. The medical adviser considered that had there been no delay, Mrs A may have had a better chance of survival, although they could not be certain that this would have been the case. We also noted a failure to assess and document Mrs A's leg wound upon admission, leading to a delay in appropriate treatment.

Mr C had alleged that a nurse's physical handling of Mrs A amounted to assault and, although the nursing adviser considered that this complaint was taken seriously and dealt with sensitively, they advised that consideration should have been given to handling this more formally through the relevant incident-reporting system.

Mr C also complained about a delay in responding to the family's request for the toilet to be cleaned and while we could find no evidence of a delay, we noted that the board had not directly addressed this concern. While we noted that the board had already acknowledged many of the identified failings and taken appropriate remedial steps, we upheld this complaint.

Mr C also complained about the communication with his family, in particular a lack of opportunity to speak with medical staff about Mrs A's care. The medical adviser agreed that there was minimal evidence of good communication between medical staff and the family. They considered that an 'Adults with Incapacity' form should have been completed earlier in the admission and discussed with the family.

We found no evidence of inadequacies in relation to the communication surrounding Mrs A's transfer back to Victoria Hospital or when a DNACPR decision was taken (a decision that means a healthcare professional is not required to resuscitate the patient if their heart or breathing stops). In addition, we were also unable to evidence specific occasions where Mr C described inappropriate communication and attitude of particular members of nursing staff. However, we upheld the complaint. We noted that the board had acknowledged and acted upon failings but we made some recommendations for further remedial action.

Finally, Mr C complained about the board's handling of his complaint and in particular the time it took to respond. We noted that his complaint was very detailed and asked a significant number of specific questions. We were satisfied that the board's response was reasonable and proportionate in the circumstances. We were also satisfied that they took appropriate steps to keep Mr C updated regularly throughout their investigation. However, we considered that the investigation was not concluded in a timely manner and that there was an unreasonable failure to set a revised target response date when it became clear that the response would be delayed beyond the standard time frame. Therefore we upheld the complaint. While the board had already provided an explanation and apology for the delay, we made a further recommendation.

Recommendations

We recommended that the board:

• take steps to ensure that allegations of the nature of those raised by Mr C are handled in line with their formal incident reporting system;
• highlight to relevant staff the family's concerns about the failure to respond to their request for the toilet to be cleaned, and remind them of the importance of responding promptly to such requests;
• review the use of 'Adults with Incapacity' forms in the relevant ward/department to ensure that the appropriate processes are being followed and that the actions being taken are in keeping with Health Improvement Scotland visit standards;
• remind nursing staff of their responsibility to facilitate good communication between families and medical staff; and
• highlight to complaints handling staff the importance of aiming to provide complainants with a revised response timescale when it becomes clear that the 20-working-day target will not be met.

Summary

Mr C complained about the care and treatment he received for abdominal symptoms. He said that he did not receive treatment until he was admitted as an emergency for an operation to remove his gallbladder, over a year after first experiencing symptoms.

We took independent medical advice. We found that Mr C's symptoms of lower abdominal pain were different to those he later developed (upper abdominal pain), and in each case appropriate tests were carried out, with further follow-up planned. We therefore did not uphold this aspect of Mr C's complaint.

We concluded that the overall treatment pathway was reasonable, although we were concerned that there was a six-month waiting period for one of Mr C's non-urgent follow-up appointments and made a recommendation to address this.

Mr C also complained that, when he called out-of-hours with severe pain, the board's operator gave him an appointment at a hospital that was not the closest to his house and that this cost him about £100 in taxi fares. Mr C was also concerned that at this appointment he was reviewed by a nurse and discharged, before being admitted to hospital as an emergency the next day.

After taking independent nursing advice, we did not uphold this complaint. The recording of the out-of-hours call showed the operator offered Mr C a closer appointment first, but that he chose to travel to the more distant hospital for a slightly earlier appointment. We found the nurse practitioner carried out a reasonable assessment of Mr C's symptoms and consulted with the GP, and that it was reasonable for the board to have discharged Mr C in the circumstances.

Mr C also complained that the board failed to the take action they had agreed with him in response to an earlier complaint. In particular, the board agreed to put a note on his medical records to alert staff to a childhood trauma, so that he would not have to keep explaining this at medical appointments. While the board put a written note on Mr C's physical health records, we found this was unlikely to be effective as clinicians would not normally look at his entire record prior to an appointment. We upheld this complaint. However, the board explained that they are currently updating their electronic system and would be willing to discuss the possibility of an electronic update with Mr C.

Recommendations

We recommended that the board:

• review their waiting times for routine or repeat general surgery out-patients and take action to address any significant delays;
• apologise to Mr C for failing to adequately implement the complaint outcome discussed (or explain why this would not be possible);
• explain to Mr C what steps they have taken to ensure that patients are not issued appointments with a clinician they have asked not to see; and
• discuss with Mr C the possibility of including a general case alert on his electronic health records (once this facility becomes available).

Summary

Mrs C said her son (Mr A) had bilateral gynaecomastia (swelling of male breast tissue) and was to have surgery at Dumfries and Galloway Royal Infirmary to remove the excess tissue from both breasts. Mrs C complained that on the day of the operation, the board changed the procedure Mr A was to have by operating on one breast instead of both and failed to communicate this to Mr A appropriately. She also said that the operation was not carried out to a reasonable standard and that the board did not reasonably respond to her complaint about the surgery.

We obtained independent advice from a consultant breast surgeon. The adviser said it was unreasonable that the decision to operate on Mr A's right breast only was made immediately pre-operatively. We were also concerned that the board did not obtain Mr A's signed consent for the revised procedure and that Mr A did not appear to have been shown photographs of other patients who had had the procedure carried out by the board or been provided with written information on the procedure for him to consider in advance of surgery. Therefore, we upheld this part of Mrs C's complaint.

The adviser said it was not possible for them to determine whether Mr A's surgery had been carried out to a reasonable standard or whether the decision to change the surgery had been reasonable as there were no photographs of Mr A's chest before and after surgery and no notes of the surgeon's rationale for making this decision. We therefore did not uphold this part of Mrs C's complaint.

The evidence showed that it took the board nearly 11 months to successfully make contact with the surgeon, who had since left their employment, and that when Mrs C first raised issues about Mr A's surgery, the board logged this as a concern rather than a complaint. We upheld this part of Mrs C's complaint.

Recommendations

We recommended that the board:

• feed back the failings identified to the staff involved, including the surgeon, for future learning;
• ensure that in future cases of this type patients are provided with appropriate written and photographic information in advance of surgery and photographic records are made of patients pre- and post-surgery;
• provide Mrs C and Mr A with a written apology for the failings identified;
• provide this office with a copy of their process for ensuring complaints are shared with staff who have left employment with the board;
• remind relevant staff of the need to properly record complaints when they are received; and
• provide Mrs C with a written apology for failing to respond reasonably to her complaint.

Summary

Mr C complained on behalf of his wife (Mrs A). He said that she had suffered from a complex series of health complaints for a number of years. He also said that despite the significant impact this had had on Mrs A and her family, the board had failed to provide a satisfactory diagnosis or a reasonable standard of care and treatment. Mr C said that Mrs A's orthopaedic, neurological and rheumatology care had all been of an unacceptable standard.

We took independent medical advice on Mrs A's care and treatment. The adviser said that Mrs A had presented with a complex set of symptoms which could not be explained by a single diagnosis from any of the specialists who reviewed her. Mrs A had been reasonably diagnosed with a neurological condition but had been unwilling to accept this diagnosis as she felt it reflected on her mental health. Mrs A was referred for further specialist review which provided a diagnosis of arthritis. The adviser said there had not been sufficient evidence available previously to make this diagnosis.

Overall we found Mrs A had been provided with a reasonable standard of care and treatment. Although a diagnosis was subsequently made, it did not explain the majority of her symptoms and there was no evidence that it should have been made earlier by the board. We therefore did not uphold Mr C's complaint.