Health

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.

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.