Health

Summary

Mrs C's husband was an adult with incapacity and she was his power of attorney. He was diagnosed with an abscess on his right kidney and had to be transferred by air ambulance to a hospital in another board area. Mrs C accompanied her husband in the air ambulance and arranged to stay in accommodation near to the hospital. She sought to claim back the accommodation expenses from the board but her claim was refused. Mrs C complained that the board acted unreasonably by failing to refund her accommodation expenses.

Following our investigation, we established that the board had followed their patient travel policy when reaching a decision on her claim. Section 10.2 of the policy was clear that travelling in the air ambulance did not make an individual an escort for the purpose of the policy and that they would be responsible for their own accommodation and return expenses. Therefore, we did not uphold Mrs C's complaint.

Summary

Mrs C learned that she had a gene mutation which increased the risk of breast and ovarian cancer. She decided to have surgery to remove both breasts to reduce the risk of developing breast cancer, and reconstruction surgery. Her surgery was cancelled on the morning she was due to be admitted. The board said that the cancellation was due to their failure to ensure the correct implants were available for the surgery to progress, and apologised. When she complained to us, Mrs C was concerned that she has not been given an alternative date for surgery.

Whilst we were considering Mrs C's complaint she was given a date for surgery. Following Mrs C's surgery she decided not to proceed with her complaint because the quality of care she received from the board had been so good.

Summary

Mrs C complained about an ambulance crew who attended her following a fall in her garden. After the fall, Mrs C knew she had damaged her back; she was in severe pain and could not move her legs. The crew attended without carry equipment and pulled her up into a garden chair and gave her gas and air. The crew appeared to be unsure about whether or not to take Mrs C to hospital but eventually did so (after an hour) and she was diagnosed as having fractured three vertebrae.

We took independent advice from an A&E consultant and found that, given Mrs C's reported symptoms, the location and severity of her pain, it was highly suggestive that Mrs C had suffered a lumbar (lower back) spinal fracture. As a result, she required a hospital assessment for an x-ray or CT scan (a scan that uses x-rays and a computer to create detailed images of the inside of the body) as required. It was not appropriate for the crew to have attempted an assessment of Mrs C on scene or to have tried to sit her on a chair, and her spine should have been immobilised. We upheld the complaint and noted that the service had already arranged for the Area Service Manager to review the case and allow the crew to reflect on their actions.

Recommendations

We recommended that Scottish Ambulance Service:

• apologise to Mrs C for the failings identified.

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.