Health

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.

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.