Health

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of Ms A that Borders General Hospital failed to identify that Ms A had fractured a bone in her foot after she attended A&E on two separate occasions and failed to provide adequate treatment. Ms A's pain persisted for months and her GP referred her to an orthopaedic specialist. A scan identified the fracture.

In responding to the complaint, the board said that the initial x-rays were reported appropriately. However, in a late stage of our investigation the board reviewed the x-ray images and acknowledged there were failings in the fracture being identified by radiology and that the A&E department failed to review the radiology reports, which had shown abnormalities.

We took independent medical advice. We found that there had been failings by the A&E locum doctors who had reviewed Ms A. Specifically, their record-keeping and assessments were below a reasonable standard given the background to Ms A's injury and inability to bear weight. We were critical that the A&E department had not reviewed the radiology reports, which were abnormal. Furthermore, we found that both x-rays did show the fracture. We also considered that it was unreasonable that on each occasion she attended A&E, Ms A was not provided with crutches or given a follow-up appointment to check that her symptoms were resolving, given her inability to bear weight. We therefore upheld Ms C's complaint.

Recommendations

We recommended that the board:

• contact the first locum doctor in order that they may reflect on their practice at their annual appraisal for personal learning and practice improvement;
• provide evidence of the action taken in relation to the second locum doctor and the radiologist, discussing this case at their annual appraisals and ensuring the findings of this investigation are shared with them, including their assessments and record-keeping;
• provide evidence of the review they carried out into the patient management system and process for reviewing imaging reports requested by the A&E team to ensure it is effective and in line with national guidelines;
• apologise to Ms A for the failings identified; and
• consider issuing guidance for the A&E team regarding the necessity for follow-up of patients who are unable to weight bear following an injury.

Summary

Mrs C complained on behalf of her husband (Mr A) about the way a consultant at Ninewells Hospital managed his care and treatment following the discovery of a nodule (a growth of abnormal tissue) in his lung. Mr A was reviewed over three years and then received a letter discharging him from the clinic because the nodule appeared stable. At Mrs C's persistence, the consultant reviewed Mr A again and further investigation identified that the nodule was a slow growth tumour.

We took independent medical advice and found that Mr A had been appropriately managed up until being discharged from the clinic. However, we considered that Mr A's latest scan results should have been discussed at a multi-disciplinary team meeting prior to taking the decision to discharge him as it showed other lung changes. We also found it unreasonable that the consultant had referred to these lung changes in the discharge letter rather than discussing them in person with Mr A.

Recommendations

We recommended that the board:

• apologise to Mr A for unreasonably discharging him from the service; and
• draw these findings to the attention of the consultant to discuss at their next appraisal.

Summary

Mr C complained that the dentist carrying out work on his teeth over a number of appointments acted unreasonably by treating what Mr C considered to be a healthy tooth.

We took independent advice from a dental surgeon. They noted that no unnecessary work had been carried out on Mr C's teeth and that his dental records confirmed that treatment had been carried out on teeth needing treatment.

Mr C does not speak English as a first language and during the course of our investigation we found that an interpreter was not present at every appointment. Mr C may not have understood fully the treatment that was being carried out. We therefore made a recommendation to address this.

Recommendations

We recommended that the dentist:

• take steps to ensure that an interpreter is present for appointments where a patient's understanding of English is not adequate to ensure informed consent for treatment is obtained.

Summary

Mr C complained about the care and treatment he received during his admissions to the Royal Infirmary of Edinburgh, in particular that the board failed to diagnose a brain injury and that they transferred him to another hospital for rehabilitation too quickly.

During our investigation we took independent advice from a consultant cardiothoracic surgeon and a consultant neurosurgeon.

Both advisers felt that the board did not fail to diagnose a brain injury and that there was no evidence of suspicion of a brain injury. In particular, the neurosurgery adviser having reviewed Mr C's brain scan carried out in November 2013 was satisfied that there was no evidence of head injury. They also added that a further scan of Mr C's brain carried out in 2015 showed no evidence of a previous head injury.

The board accepted that Mr C had been transferred from the Royal Infirmary of Edinburgh too quickly and that he was discharged without the necessary aids. We found that the action taken by the board in response to these failings was reasonable and appropriate and would ensure there was no recurrence in the future.

Summary

Mrs C complained to us about the medical care and treatment provided to her late father (Mr A) at the Western General Hospital before his death. Mr A had previously been diagnosed with rheumatoid arthritis associated interstitial lung disease (a group of disorders characterized by inflammation and scarring of the lung tissue). He was admitted to hospital and a CT scan showed that he had inflammation and a possible infection in his chest. He was given steroids and antibiotics to treat this and was then discharged. Mr A was then admitted to hospital again with increased breathlessness. He was again treated with antibiotics and discharged after physiotherapy. Mr A was subsequently admitted to hospital again with increased shortness of breath. A chest x-ray showed that this was most likely pneumonia. His condition deteriorated in the hospital and Mr A died there several days later.

We took independent medical advice from a consultant in respiratory medicine. We found that the care and treatment provided to Mr A had been reasonable. However, when he was discharged from hospital on the second occasion it was decided that he could be reassessed for portable home oxygen at his respiratory clinic appointment which the staff thought was two or three weeks later. However, they did not check the date of the clinic appointment and it was in fact nearly six weeks after Mr A was discharged. We found that this was too long to wait to assess Mr A and for this reason we upheld this aspect of Mrs C's complaint.

Mrs C also complained about the nursing care Mr A received. We took independent nursing advice. We found that there had been a number of failings but we were satisfied that the board had apologised and had taken action to try to prevent similar problems recurring.

In addition, Mrs C complained about the communication with Mr A and her family. We found that this had been inadequate and upheld this aspect of the complaint.

Recommendations

We recommended that the board:

• confirm that relevant staff are now working in line with the NHS quality standard on assessment for oxygen therapy.

Summary

Mr C complained on behalf of his late sister (Miss A) about the care that she received at the Western General Hospital, in particular that she was prescribed methotrexate (a drug to suppress the immune system) for Crohn's disease (a long-term condition that causes inflammation of the lining of the digestive system). Miss A was diagnosed with tumours in her liver and bone marrow and died around a week later. Mr C understood that Miss A had refused methotrexate in the past and was concerned that it had been given to her without her knowledge.

We took independent medical advice and found that the prescribing of methotrexate in Miss A's case was reasonable and in keeping with national guidance on the management of Crohn's disease. Miss A's Crohn's disease was complex and had been difficult to control with medication. We did not identify evidence to show that Miss A had refused methotrexate but that surgery had been offered as an alternative which she declined.

Summary

Ms C complained about a decision to reduce her thyroid medication following the results of a blood test.

We sought independent medical advice. The adviser said the change in medication dosage was reasonable and in line with guidance for managing thyroid disease.

We accepted this advice and did not uphold the complaint.

Summary

Mrs C complained that her mother (Mrs A) was left sitting in a chair for nine hours without access to a bed, whilst waiting to be moved to a new ward. Mrs C said that Mrs A had asked to go to bed during this time. The board told us that Mrs A had chosen to sit in her chair and was offered access to a bed in a side room if she wanted to lie down. We found that nursing records had not been kept on the day in question and we upheld the complaint because there was a lack of evidence of proper nursing care on the day in question.

Recommendations

We recommended that the board:

• offer an apology to Mrs A which recognises that she has a different account of what happened to that of the staff nurse, and which acknowledges the failure to keep reliable nursing records, and outline the steps taken to address the issues with ward staff.

Summary

Ms C's late mother (Mrs A) had a history of bladder cancer and following surgery, self-catheterised through a stoma (a surgically-made opening from the inside of an organ to the outside) in her stomach. She was admitted to Monklands Hospital in February 2014 complaining of severe abdominal pain and a number of tests were carried out. Mrs A was discharged and continued to see hospital specialists as an out-patient but was readmitted several months later for an operation to remove her right kidney. When the operation was carried out, recurrent bladder cancer was found. Ms C said that following this operation Mrs A's dementia worsensed. After several weeks, Mrs A was discharged again. She was readmitted the following month when she continued to deteriorate and she died several weeks later. Ms C raised concerns about the standard of medical care and treatment during Mrs A's three admissions to hospital and, in particular, said that the decision to carry out the operation was not reasonable and that medical staff failed to manage her pain and dementia in a reasonable way. Ms C also said that nursing staff failed to properly care for Mrs A's catheter and ensure that she had sufficient food and fluids and that the family had to provide personal care. Finally, Ms C raised concerns about the standard of communication.

We took independent advice from an urology adviser and a nursing adviser. We found that the medical care and treatment was reasonable including the decision to operate (although there was a record-keeping shortcoming). However, we also found that there were failings in relation to the standard of nursing care and treatment provided and communication. The overall assessment and care concerning Mrs A's dementia was below a reasonable standard and nursing staff failed to assess her capacity during two of her admissions to hospital. There were further shortcomings in relation to monitoring and recording fluid and nutritional intake. However, we were satisfied that clinicians did assist with Mrs A's catheter. In relation to communication, there was evidence that communication was challenging at times and no evidence that the family was as involved as they should have been in the wider care planning process.

Recommendations

We recommended that the board:

• ensure patients' capacity to consent to treatment on the ward is assessed and recorded in line with relevant guidelines and legislation and provide evidence of this;
• bring the nursing adviser's comments about shortcomings in communication to the attention of relevant staff and carry out audits to ensure compliance;
• bring the nursing adviser's comments about shortcomings in implementing the relevant standards in relation to dementia and nutrition, and the related record-keeping failings, to the attention of relevant staff and carry out audits to ensure compliance;
• apologise for the failings we identified; and
• ensure that sedation and/or analgesia prescribed in the ward before being taken for procedures out with the ward is fully and properly recorded in the medical records.

Summary

Mrs C was referred for a colonoscopy for bowel cancer screening and was asked to contact the hospital to book this in. Mrs C contacted the board to raise concerns that there were no arrangements for her to see a consultant beforehand. She was also concerned to discover the procedure was booked with a nurse rather than a consultant. After further correspondence, the board arranged an appointment for Mrs C with a consultant to discuss the procedure. While Mrs C was dissatisfied that this delayed the procedure for three weeks, she attended the appointment and chose to go ahead with the procedure with the consultant. After the procedure Mrs C complained to the board about the attitude of the male nurse who prepared her for the procedure, the procedure itself, and the board's communication about this.

The board issued two written responses to Mrs C's complaint and met with her and her MSP to discuss the outstanding issues. The board apologised for some aspects of the procedure, including that the male nurse had touched Mrs C when demonstrating the procedure and that another member of staff had entered the room during the procedure to access a storeroom.

After taking independent medical and nursing advice we did not uphold Mrs C's complaints. The advice we received was that the board's care, treatment and communication were reasonable and they had apologised where appropriate. We were concerned that the steps taken by the board may not be sufficient to address the privacy issues raised and we made a further recommendation about this. While we considered some aspects of the board's complaints handling could have been improved, we found their response was reasonable and in line with Scottish Government guidance.

Recommendations

We recommended that the board:

• consider whether there is a recurring problem with staff entering the endoscopy suite to access the storeroom during procedures and take steps to address this.