Health

Summary

Mr C had a history of bowel problems. He had surgery at Balfour Hospital to rectify a twisted bowel and hernia. Mr C was concerned that his bowel was perforated during the operation, which meant it leaked and was slow to heal, affecting his ability to work. Five months later he had further surgery to repair the damage, after which the healing process was quick. Mr C complained that the board did not provide adequate reasoning for the delay in carrying out the second surgical procedure.

We took independent medical advice on this case from a consultant colorectal surgeon. Whilst we recognised the significant impact that Mr C's post-operative problems had had on his life, we found that he had experienced a recognised complication of this type of surgery. He had developed a fistula (a tube-shaped hollow between organs) possibly caused by one of his stitches opening. We were satisfied that a period of time had to be left between the two surgeries to allow the fistula to repair itself and prevent further damage. The second operation was, therefore, not delayed and we found no evidence of failings by the medical team.

Summary

Mrs C complained about the care and treatment of her late mother (Mrs A) when she was admitted to the Royal Infirmary of Edinburgh with a urinary tract infection. Mrs A was also treated for a bacterial infection (staphylococcus aureus) and Mrs C raised concerns that medical staff did not adequately investigate the cause of this infection and relied upon the administration of strong antibiotics, which she considered wiped out her mother's immune system. Mrs A was subsequently diagnosed with a further bacterial infection (clostridium difficle) and, although plans were being made for her discharge from hospital, she suffered a gastrointestinal bleed and died two weeks later. We obtained independent advice from a consultant physician, who advised that most aspects of Mrs A's medical care were reasonable, including the investigation of her infections, the decision to treat with antibiotics and the management of her symptoms. The adviser did not consider that Mrs A's death could have been avoided. However, the adviser did query the initial choice of antibiotic and was also critical of the fluid management. In light of this, we upheld this aspect of the complaint.

Mrs C also complained about the standard of nursing care, including concerns about lack of available staff to provide assistance when required, dementia awareness and continuity of care. We obtained independent nursing advice. The adviser identified significant gaps in the recorded care of Mrs A, and a lack of care planning to meet Mrs A's changing needs. The nursing adviser did not consider it clear that staff understood how Mrs A's dementia affected her or took this into account in her care. We upheld this aspect of the complaint.

Mrs C raised further concerns about the hygiene and infection control measures in place on the ward. The available medical records did not provide sufficient evidence of the specific allegations of poor hygienic practice but we noted that the board had accepted and apologised for poor hygiene standards in Mrs A's care. We also upheld this aspect of the complaint.

Mrs C complained that the record-keeping in relation to her mother's care was inadequate. We received advice that the record-keeping fell below a reasonable standard and so we upheld this aspect of the complaint. We also upheld Mrs C's complaint that communication was inadequate, on the basis of a lack of evidence to show that nursing staff communicated reasonably with the family. In some instances we considered that the board had already taken appropriate action to address the identified failings and, in others, we made some recommendations.

Recommendations

We recommended that the board:

• confirm that the use of appropriate antibiotics will be highlighted to junior doctors as part of their induction process;
• confirm that the findings of our investigation will be reflected upon by the relevant consultant(s) as part of their annual appraisal;
• remind ward staff about the importance of completing fluid intake / output charts;
• apologise to Mrs C's family for the poor record-keeping in relation to Mrs A's care; and
• demonstrate to us that record-keeping on the ward is now of a reasonable standard.

Summary

Mr C complained to us about the treatment which he received from a GP at the medical practice. He said that he had been unwell for a period of years and that it was suspected he had Irritable Bowel Syndrome. He reported to the GP that he had further bowel problems and that he wanted to be referred to hospital. Mr C said that the GP refused to refer him to hospital. He continued to be in pain for a further week, and attended hospital himself where he was diagnosed with septicaemia and a cancerous tumour.

The practice maintained that due to the symptoms reported by Mr C there was no indication that an immediate hospital admission was required. The practice were aware that Mr C had already been referred for a colonoscopy and the GP took steps to give the referral more priority.

We took independent advice from an adviser who is a GP. We found that Mr C's GP was aware of his clinical history, took note of his presenting symptoms and made out an appropriate prescription. There was no indication that Mr C reported acute abdominal pain which warranted emergency hospital admission that day, and it was appropriate to speed up the priority of the colonoscopy referral. We did not uphold Mr C's complaint.

Summary

Mrs C complained that staff at the minor injuries clinic (MIC) at the Western General Hospital failed to identify that her ankle was broken. She also complained that as part of the board's investigation, the staff member involved gave false information about the advice given to Mrs C when she attended the MIC. Mrs C stated she was advised she could travel while the board stated she was advised travel was not ideal.

We took independent advice from a consultant in emergency medicine. While we found that Mrs C's ankle fracture had been missed when she attended the MIC, the advice we received was that the fracture had not been obvious and it was understandable that it had been missed. However, we were concerned that when the radiologist's report identified the fracture, the board did not contact Mrs C in line with their procedures. We were also concerned that the board failed to explain the reason for the failure in their system in this case. We therefore upheld this part of the complaint and made several recommendations to address the failings we found.

We found no objective evidence to prove or disprove what advice about travel had been given to Mrs C when she attended the MIC. We did not uphold this part of the complaint.

Recommendations

We recommended that the board:

• provide further information on the system in place for reviewing MIC x-ray reports, correlating them to the interpretation and diagnosis by the practitioner and the system for acting on any missed injuries;
• provide further information on how any missed injuries are recorded and audited;
• bring the adviser's comments on the advice to give patients with soft tissue injuries to the attention of the relevant physiotherapy practitioner; and
• ensure that the physiotherapy practitioner involved in this case is reminded of the requirement to make accurate records of advice given to patients and specifically document any advice given with regards to fitness to travel.

Summary

Mrs C complained to us that she had repeatedly asked the medical practice whether they had access to a report on the colonoscopy procedure (examination of the bowel with a camera on a flexible tube) which she underwent in hospital. The practice said that they would have to wait until the hospital advised them of the result. Mrs C contacted the hospital and was told that the practice could have obtained the report electronically. Mrs C complained to the practice and they said that while the result of the report was available electronically it would be for the hospital clinician who requested the report to advise the patient and the practice of the result.

We took independent advice from a GP adviser and concluded that while the result was available electronically it was outwith the role of a GP to report the result to the patient. It was the responsibility of the clinician who arranged the test to report the result. A GP would not be able to interpret the result of the test or know what the patient's management plan was. We also found that the practice had made contact with the hospital who explained that there was a backlog in the reporting of the results and that their involvement actually meant that the result was reported earlier than it would otherwise have been. We did not uphold the complaint.

Summary

Mr C complained about the delay in treatment for his wife (Mrs C) when she was diagnosed with oesophageal cancer. Chemotherapy was commenced around 12 weeks after diagnosis in an effort to shrink the tumour and make it operable. Unfortunately, Mrs C did not tolerate this well and it was discontinued, with her cancer having progressed. Mr C complained that the delay in commencing treatment allowed the cancer to spread to Mrs C's lymph nodes, meaning surgery was not possible. The board acknowledged that Mrs C's wait for treatment was outwith the national waiting target of 62 days from referral with a suspicion of cancer to the start of treatment. However, they assured Mr C that all the investigations carried out to determine the extent of the cancer were appropriate.

We obtained independent medical advice from a consultant general surgeon, specialising in upper gastro-intestinal surgery. They informed us that Mrs C's tumour was very extensive at the point of diagnosis and had already spread to her lymph nodes. They considered that appropriate tests were then carried out to determine if there were any curative treatment options, advising that the national target can be difficult to achieve when additional tests are required. However, they noted that part of the delay Mrs C experienced was caused by the absence of a particular clinician who was able to carry out one of the tests. They suggested that the board should look at staff training issues and review their management of waiting times between tests. Notwithstanding this, they did not consider that the delay Mrs C experienced had any impact on the curability of her cancer.

We found no evidence that the board failed to recognise the severity of Mrs C's cancer and we did not uphold this aspect of Mr C's complaint. However, we considered that the extent of the cancer was not made clear enough to Mr C by the board, particularly when responding to his complaint. This could have alleviated his concern that the cancer had spread to an inoperable stage during the wait for treatment. In relation to this wait, while we noted the complexities of the diagnostic pathway, we considered that some of the delay was avoidable. We, therefore, upheld this aspect of the complaint.

Recommendations

We recommended that the board:

• apologise to Mr and Mrs C for failing to explain more clearly the extensive nature of the cancer from the time it was first diagnosed;
• ask relevant staff to reflect on the findings of this investigation in order to improve communication in similar future circumstances;
• apologise to Mr and Mrs C for the delay in starting Mrs C's treatment; and
• review their oesophago-gastric cancer pathway, including staff training issues and the management of waiting times between tests/discussions, with a view to reducing future incidences of avoidable delay.

Summary

Mr C complained that he sustained damage around his knee after surgery at the Royal Infirmary of Edinburgh. He also raised a concern that, after reporting pain and clicking in his knee some years later, a neurophysiologist (a medical professional specialised in the function of the nervous system) at the Western General Hospital should have referred him for nerve conduction tests (studies to check for abnormalities in the nerves). Mr C also complained that an orthopaedic surgeon at St John's Hospital did not refer him in a timely manner to physiotherapy and to the orthopaedic surgeon who had carried out his original surgery. Mr C was dissatisfied with the lack of communication in relation to his care and with the board's handling of his complaint.

We took independent advice from two consultant medical advisers, one specialised in orthopaedic surgery and the other in neurophysiology. We found no evidence that Mr C's surgery at the Royal Infirmary of Edinburgh was unreasonable although the consent procedure fell below a reasonable standard. We agreed that nerve conduction tests would not have provided anything further in the management of Mr C's care some years after the surgery and that this was evident when such tests were carried out and no abnormality was found. We did not consider that the orthopaedic surgeon had delayed unreasonably in referring Mr C to physiotherapy or to the surgeon who had carried out the knee surgery. Whilst we concluded that communication with Mr C about his care appeared reasonable overall, we upheld Mr C's complaint that the board failed to adhere to his request for electronic communication during their investigation of his complaint, and we made recommendations to the board.

Recommendations

We recommended that the board:

• ensure that their current consent forms prompt the clinician to record that the advantages and risks of surgery have been discussed with the patient;
• apologise to Mr C for failing to adhere to his request for electronic communication;
• review the wording of their electronic information consent form to ensure that it is not contradictory; and
• take steps to ensure that patients' requests for electronic communication are properly logged and acted upon.

Summary

Ms C complained that since at least April 2012, her partner (Mr A) had been receiving care for his mental health problems but that it had been inadequate and insufficiently 'holistic'. She said that her views on his illness had either not been sought or had been discounted. She also said that as Mr A's partner, she would have expected to have been more involved and supported.

We took independent advice from a mental health professional and we found that the level of support provided to Mr A, particularly during periods of crisis, was appropriately reactive to Mr A's needs and presenting symptoms. Further, we found that Ms C often accompanied Mr A to his appointments and there was clear evidence that her views were listened to and recorded. While Ms C's difficulties in supporting Mr A were noted, it was also established that she had been supported in a manner and to a degree that was reasonable in the circumstances.

Summary

Mr C was diagnosed with a cataract in his eye and an epiretinal membrane (a thin sheet of tissue over the centre of the eye that can restrict vision). He was referred to The Princess Alexandra Eye Pavilion for surgery to remove the cataract with a separate procedure to follow to remove the epiretinal membrane. On the day of the surgery, Mr C's consultant ophthalmologist was absent due to illness. Mr C was offered the chance to delay the surgery until he returned or to proceed with another surgeon. He opted to proceed.

Mr C experienced complications of surgery that resulted in his retina becoming detached. He found out after the surgery that the surgeon was still a trainee and felt this should have been made clear to him before he consented to the procedure. He also complained that it took several consultations over a number of weeks to diagnose his detached retina.

We obtained independent medical advice on this complaint. We concluded that, whilst Mr C's retinal detachment was not present during the first few post-operative examinations, at one appointment it was noted that the ophthalmologist could not get a clear view of his retina. We accepted the advice that, had an ultrasound been carried out at this point, the detachment may have been identified. This could have led to diagnosis a week sooner than Mr C experienced. We also found that, whilst Mr C's consent for surgery had been properly obtained, it would have been good practice for the board to tell him that a trainee surgeon was going to carry out the procedure.

Recommendations

We recommended that the board:

• apologise to Mr C for failing to arrange an ultrasound;
• share this decision with the staff involved in Mr C's care;
• apologise to Mr C for failing to tell him that the surgeon was a trainee; and
• share the adviser's comments on good practice with the ophthalmologists.

Summary

Ms C was concerned about the way she said she had been treated for colorectal and cardiac problems. Ms C believed that her concerns about her health had not been dealt with reasonably or taken seriously. We obtained independent advice from a consultant colorectal surgeon (the colorectal adviser) and a consultant cardiologist (the cardiology adviser).

We did not find any evidence that the board unreasonably delayed in progressing a referral made by Ms C's GP for rectal bleeding. The advice we received from the colorectal adviser was that all appropriate and necessary tests and scans were carried out at the Western General Hospital. Ms C was diagnosed with internal haemorrhoids, which was considered the most likely cause of her rectal bleeding. We found that the treatment she received for this was reasonable. We also found that the decision to advise against haemorrhoid surgery was a correct assessment and represented good clinical judgement and was in line with surgical guidelines. Taking into account the advice we received, we considered the treatment Ms C received for her colorectal problems was reasonable.

In respect of the concerns raised by Ms C about her cardiology treatment at the Royal Infirmary of Edinburgh, the cardiology adviser said that all reasonable and proportionate investigations had been carried out and had repeatedly shown normal findings. We found that it was appropriate and reasonable of the cardiology department to have concluded that Ms C's symptoms were not of cardiac origin. Overall, the cardiology adviser had identified no failings with regard to the care and treatment provided to Ms C by the cardiology department. We accepted that advice.