Health

Summary

Mr and Mrs C complained about the care their daughter (Miss A) received at Stobhill Hospital for treatment of anorexia nervosa. They were concerned about the care plan that was in place and that the board had acted inappropriately when attempting to remove Mrs C as Miss A's named person under the Mental Health (Care and Treatment) (Scotland) Act 2003. A person being treated under the 2003 Act can choose someone to help protect their interests.

We took independent advice from one of our advisers who is a consultant psychiatrist, and found that the care and treatment was reasonable overall. We considered that staff had appropriately managed situations which could potentially have had a negative effect on Miss A's treatment. We concluded that there was evidence to support that the board were acting in accordance with national guidance and in Miss A's best interests to assist her recovery when attempting to remove Mrs C as named person.

Summary

Ms C complained about the treatment which an out-of-hours GP provided to her late sister (Ms A). Ms A had acute myeloid leukaemia (cancer of the white blood cells that accumulate in the bone marrow) and was receiving chemotherapy. Ms A attended the out-of-hours GP with pain in her back passage. She was diagnosed with haemorrhoids (swollen blood vessels in or around the anus and rectum) and sent home. Ms A continued to be in pain and contacted the out-of-hours service the following day and she was admitted to hospital where she was diagnosed with having necrotising fasciitis (a severe skin infection). As a result, a large area of her buttock was removed and a stoma bag was fitted. Ms C felt that Ms A should have been admitted to hospital on the first occasion.

We took independent advice from an adviser in general practice and concluded that the GP who initially saw Ms A carried out an appropriate examination and that the diagnosis of haemorrhoids was reasonable. Ms A's GP had made a reasonable diagnosis based on the presenting symptoms and in view of Ms A's previous medical history. Ms A's condition had deteriorated quickly in between attending the GP and being admitted to hospital. We did not uphold Ms C's complaint.

Summary

Miss C complained to us about the care and treatment she received when she attended A&E at the Royal Alexandra Hospital. Miss C had previously been diagnosed with a suspected inguinal hernia (an opening in the wall of the lower abdomen near the groin) and had been referred for an out-patient ultrasound scan and an appointment to see a general surgeon to discuss the treatment options. Whilst awaiting this appointment, Miss C attended A&E with increasing pain from the area. She was examined by doctors who did not identify any palpable (able to be touched or felt) lump and found that she was clinically well. She was discharged with painkillers. Miss C subsequently went on holiday, but had to cut her holiday short due to worsening symptoms. She was admitted to hospital when she returned from holiday. It was subsequently identified that she had a groin abscess, which had to be drained. Miss C considered that the doctors in A&E had not carried out a reasonable assessment and had failed to identify the abscess.

We took independent advice from a consultant in emergency medicine. We found that it was not likely that the abscess was present when Miss C had attended A&E. The assessment carried out by doctors in A&E had been reasonable. It had also been reasonable for staff not to carry out blood tests or an ultrasound scan and to discharge Miss C with pain relief and to await the ultrasound scan. Although we did not uphold the complaint, we did identify some areas for improvement and we made a recommendation to the board in relation to this.

Recommendations

We recommended that the board:

• remind the staff involved in Miss C's care that they should monitor and record the pain experienced by a patient and also the effectiveness of treatments given to relieve the pain; full documentation of assessments and second opinions should be made to provide contemporaneous notes for each attendance; and they should record what advice is given to patients when they are discharged, particularly in relation to follow-up arrangements, what to do if things get worse and also advice about travel, driving or work.

Summary

Mrs C complained about the clinical treatment and nursing care that her late mother (Mrs A) received at the Glasgow Royal Infirmary. Mrs A was admitted after becoming unwell at home and it was suspected that she was suffering from gallstones blocking the bile duct. Mrs A had a number of existing conditions and had been prescribed clopidogrel (a drug that reduces blood clotting) for one of these conditions.

As Mrs A was on clopidogrel, which increases the risk of serious bleeding during invasive tests, it was decided that a scan would be carried out to investigate. This confirmed that she had a blockage in the bile duct and it was agreed that an endoscope (a thin flexible tube) procedure would be arranged to investigate further and clear the blockage. Mrs A's clopidogrel had been stopped the previous day due to other test results and so arrangements were made for the endoscope procedure to take place in six days' time. Mrs A's condition deteriorated a few days later and she developed sepsis (blood poisoning) before the procedure could be carried out. She was transferred to the high dependency unit but passed away.

After taking independent advice from an adviser who is a consultant surgeon, we did not uphold Mrs C's complaint about clinical treatment. The adviser considered that appropriate investigations had been carried out and that while having the endoscope procedure earlier might have avoided sepsis developing, it was reasonable practice to have waited until the clopidogrel had been stopped for a period of seven days before undertaking the procedure. The adviser also considered that the drug had been stopped at a reasonable point in Mrs A's admission.

After taking independent advice from a nursing adviser, we did not uphold Mrs C's complaint about nursing as no failings in care were identified.

Summary

Mrs C complained on behalf of her late husband (Mr A) about care he received from his GP practice. Mr A attended the practice having been diagnosed with oedema (where fluid collects in the legs and abdomen). He had been prescribed medication to combat the oedema. Mr A was referred to his GP to investigate the cause of the oedema and the GP took blood tests, which were normal. The GP also noted that, apart from the oedema, there were no signs of heart failure. As Mr A was obese, and therefore at greater risk of heart problems, the GP referred him for an echocardiogram (a heart scan that uses sound waves to create images) to investigate any potential heart problems. Mr A passed away before he was seen for a heart scan. The cause of death was an enlarged heart.

We took independent advice from a medical adviser. The adviser was satisfied that the practice had made appropriate investigations into Mr A's symptoms and made an appropriate referral. For this reason, we did not uphold the complaint.

Summary

Ms C, who works for an advice agency, complained on behalf of Mrs A. Mrs A said that her husband (Mr A) had been provided with inadequate care during an admission to Glasgow Royal Infirmary. Mrs A believed that Mr A had not been provided with appropriate antibiotics and that there were delays in providing him with medication. Mr A had undergone surgery, but had subsequently deteriorated. He had suffered a heart attack at the start of visiting hours and Mrs A had to wait in a day room. Mr A had subsequently died before Mrs A was able to see him.

We took independent medical advice on Mr A's care and treatment. The adviser said Mr A had suffered from a serious heart attack, as well as kidney problems. Although there were instances when he did not receive medication promptly, these did not impact on his prognosis, or the outcome of his treatment. Mr A had suffered two major heart attacks in succession on the day he died. All reasonable resuscitation techniques had been tried, and it was reasonable that Mrs A was not allowed in to see Mr A whilst resuscitation was being attempted.

We found that Mr A had received reasonable clinical care and treatment and the delays in administering medicine had been investigated and addressed appropriately by the board. We therefore did not uphold the complaint.

Summary

Mrs C's mother (Mrs A) was admitted to the Glasgow Royal Infirmary with a chest infection. After initial improvement and transfer to another ward her condition deteriorated. She suffered a cardiac arrest and died while awaiting admittance to the intensive care unit. Mrs C raised a number of concerns about her mother's care and treatment. These included that the board's medical and nursing staff failed to review, monitor and treat her mother appropriately and that the board did not make reasonable efforts to communicate her mother's condition to her family.

We obtained independent advice on the complaint from a consultant physician and a nurse. The consultant adviser explained that Mrs A was reviewed by medical staff on several occasions each day, including specialist haematology input. They said Mrs A's treatment included antibiotics which were reviewed and altered according to her evolving clinical problems and results from the laboratory. The consultant adviser said all of this was reasonable.

The nursing adviser said that observations on Mrs A were carried out frequently and in accordance with the board's policy. They said that when Mrs A's condition deteriorated, the appropriate action was taken with the nursing staff reporting this to a senior clinician.

From Mrs A's arrival on the hospital ward to the point when her health deteriorated, the advisers were not critical of the level of communication with the family. However, the advisers considered that after Mrs C and her family were called to attend hospital following the deterioration in Mrs A's health, the board did not make reasonable efforts to communicate with Mrs C and her family about Mrs A's condition. We upheld this aspect of Mrs C's complaint and made a recommendation to the board.

Recommendations

We recommended that the board:

• provide us with evidence of the steps that have been taken to ensure that in future proactive communication takes place with a patient's family when a patient deteriorates.

Summary

Mr C raised a number of complaints about the care and treatment provided to his father (Mr A) before and during his admission to the Royal Alexandra Hospital. Mr A was diagnosed with an unusual form of tuberculosis causing a skin condition. Mr C said that while his father was in the hospital he suffered from peripheral neuropathy (damage to or disease affecting nerves causing weakness in the limbs) and had become immobile.

Mr C was concerned that the medication prescribed to treat his father's tuberculosis, isoniazid, was not properly monitored and had caused Mr A's peripheral neuropathy. Mr C said there had been a failure to discuss with Mr A and his family the potential side effects of this treatment and to tell them that Mr A had also been diagnosed with diabetes. Mr C also considered that Mr A had not been provided with appropriate physiotherapy treatment to address his immobility.

We took independent advice from a consultant in respiratory medicine and a consultant in medicine for the elderly.

The respiratory medicine adviser said the incidence of peripheral neuropathy causing weakness in the limbs is a very rare side effect of isoniazid and that Mr A was not in the category of patient who would be considered to be at greater risk of developing this condition. Also, Mr A had been prescribed pyridoxine, a standard treatment to protect the nerves. The adviser said the doses of medication Mr A received were appropriate and properly monitored and they would not normally mention peripheral neuropathy as a possible side effect of taking isoniazid to a patient such as Mr A. Overall, the adviser did not identify any failings in Mr A's care and treatment.

The evidence showed that medical staff had spoken with Mr A's family to discuss his condition on several occasions and that Mr A's daughter had been advised on at least one occasion that Mr A had diabetes.

The adviser in medicine for the elderly also said that Mr A was seen regularly by physiotherapy staff, and that there had been a very good multi-disciplinary approach to the management of his rehabilitation, and considerable effort had been made to improve the level of his mobility. Unfortunately, the severity of Mr A's state of health meant that physiotherapy could not achieve a better recovery for him.

While we did not uphold Mr C's complaints, we identified issues concerning communication and record-keeping, and we made a recommendation to address this.

Recommendations

We recommended that the board:

• remind relevant staff of the importance of ensuring that when there is discussion about a patient's condition and treatment, the patient and their family clearly understand what is being said and the discussion is clearly recorded in the patient’s medical records.

Summary

Mr C complained on behalf of his wife (Mrs A) about the board's management of his wife's labour at the Southern General Hospital. He also complained that the board's communication with him and his wife during her admission was unreasonable. His concerns included that the midwife's initial assessment of his wife was incompetent and the obstetrics and gynaecology registrar who became involved in his wife's care unreasonably failed to assess his wife. He said the board unreasonably refused to provide antibiotics for his wife for an existing infection, resulting in his baby having to have antibiotics via cannula (a tube inserted into the body for the delivery of fluid). Mr C was also concerned that when he and his wife first attended the hospital it was unreasonably suggested that they could go home.

We obtained independent medical advice on the complaint from a midwife and a consultant obstetrician and gynaecologist. The midwifery adviser said that the midwife's clinical assessments of Mrs A were competently carried out to best practice standards. The obstetrics and gynaecology adviser said they could see no reason for the obstetrics and gynaecology registrar to repeat the midwife's initial assessment and/or initiate a different management plan for Mrs A.

The midwifery adviser said it was unusual for women to labour so rapidly and because of this there was not an opportunity for the midwife to provide the antibiotics to Mrs A and the treatment was given directly to their baby. The adviser said this was a difficult situation where the clinicians were recommending a treatment plan which Mr C did not agree with and as a result Mrs A did not get the support she required when her labour progressed so rapidly. The obstetrics and gynaecology adviser explained that the antibiotics would need to have been given to Mrs A at least four hours prior to delivery and the postnatal administration of antibiotics by cannula to their newborn daughter was unavoidable.

The midwifery adviser said that as Mrs A was in very early labour when she first attended hospital, following initial assessment, it was reasonable for the midwife to offer that Mr C and his wife either remain at the hospital to see if labour established or go home. We did not uphold Mr C's complaints.

Summary

Mr C complained that his former GP practice unfairly refused a repeat prescription and removed him from their practice list after he complained about the matter.

We took independent advice from a GP adviser and found evidence to show that the repeat prescription had been lost or mislaid by the practice and this had not been explained by the reception staff to the GP who had been asked to reissue it. It was only at Mr C's persistence that he managed to receive his medication a few days later after attending the practice on several occasions. We also considered that the practice had not investigated and responded appropriately to this aspect of Mr C's complaint.

We identified that the practice had not followed General Medical Services (GMS) contractual guidance, nor their own policy, when they removed Mr C from the practice list without issuing a warning. We concluded that the practice failed to address Mr C's concerns in a professional manner and that they resorted to unreasonably removing him from the practice list causing him unnecessary distress and inconvenience.

Recommendations

We recommended that the practice:

• review their process for recording missing prescriptions and ensure that information is shared with the appropriate GP who has been asked to re-issue a prescription;
• share these findings with the staff involved and remind them of the importance of providing full and accurate responses to complaints;
• apologise to Mr C for the failings identified with his prescription;
• apologise for failing to issue Mr C with a warning prior to removing him from their practice list in accordance with GMS contractual guidance; and
• ensure all relevant staff are fully aware of the GMS contractual guidance and their own policy before removing a patient from the practice list.