Health

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.

Summary

Mr C complained that the board failed to provide reasonable care and treatment following his report of concerns about his testicular health. He also complained that the handling of his complaint about these concerns fell below a reasonable standard.

We took independent advice from a GP adviser. They noted that the actions taken by the doctors who saw Mr C had been in keeping with the appropriate guidelines relating to problems with the testicles. Mr C had been appropriately referred for review by a specialist, although his case did not meet the threshold for an urgent referral. We found that although Mr C had experienced a delay in receiving assessment by a specialist at hospital, this was not the fault of the GP who referred him. When Mr C complained about the delay, the GP contacted the appropriate hospital department and requested an update on Mr C's appointment. We therefore did not uphold Mr C's complaint about the care and treatment provided to him.

In terms of the handling of Mr C's complaints, we found that although the board had exceeded their 20-day target for responding, they kept Mr C informed of the progress of their investigation. We found that the handling of Mr C's complaints was reasonable. We therefore did not uphold this aspect of Mr C's complaint.

Summary

Mrs C, who works for an advocacy and support agency, complained on behalf of her client (Mr A) that he was unreasonably discharged from an ophthalmology clinic at Wishaw General Hospital. Mr A believed he should be reviewed regularly with an ophthalmologist, rather than being seen by his local optometrist.

We took independent ophthalmological advice and found that due to Mr A's late stage glaucoma (a condition where the optic nerve is damaged that can cause blindness) and other underlying health issues it was reasonable for the board to state that there was no further surgical intervention that could be taken. We found that Mr A's optician would be able to review and manage his eyes and that it was not necessary for Mr A to continue to be reviewed at the ophthalmology clinic. Therefore, we did not uphold this complaint.

Summary

Mrs C complained about the care and treatment provided by the board in relation to her varicose veins. She also complained about the board's communication with her.

Mrs C attended an appointment at Wishaw General Hospital with a vascular surgeon to discuss a procedure to treat her varicose veins. She understood she was to undergo a procedure called vein stripping (where the vein is pulled out from under the skin with minimal incision). However, the procedures, performed at Hairmyres Hospital, were radiofrequency ablations (where the vein is heated with radiofrequency energy causing the vein to contract and then close) and stab avulsions (where several tiny incisions are made in the skin through which the varicose vein is removed). Mrs C complained that she should have undergone the vein stripping procedure. Mrs C also raised concerns about the post-operative advice and care provided by the board, in particular concerning dressing and travel.

After receiving independent advice from a vascular surgeon,we upheld Mrs C's complaints concerning communication and post-operative advice. We found that a number of the board's staff gave Mrs C confusing and incorrect information. However, we did not uphold Mrs C's complaint that she should have received the vein stripping procedure. Rather, we found that the procedure performed was the appropriate one for a patient in her circumstances.

Recommendations

We recommended that the board:

• ensure that supporting staff in the vascular surgery department are aware when procedures are updated or changed; and
• ensure that there is a standardised approach to post-operative advice and care for patients following varicose vein surgery.

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.