Health

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.

Summary

Ms C complained about the care and treatment of her late great aunt (Miss A) in Aberdeen Royal Infirmary. Miss A had cancer which was noted to be progressing and a palliative care approach was taken. She died a few weeks later. Ms C raised particular concerns surrounding the decision to stop providing her great aunt with intravenous fluids (fluids delivered directly into the vein). She considered that this led to Miss A becoming dehydrated and potentially hastened her death. We took independent advice from a consultant physician. They advised that the decision to discontinue the provision of intravenous fluids was reasonable, as it was no longer clearly beneficial and had become uncomfortable for Miss A. They considered that this decision was appropriately discussed with Miss A and her family. We did not uphold this complaint. However, the adviser identified an issue, not raised as part of the complaint, surrounding the communication of a decision that Miss A would not be resuscitated in the event of cardiac or respiratory arrest. Healthcare Improvement Scotland had since inspected the hospital and identified a similar issue. They made a recommendation and we asked to board to provide confirmation that this has been implemented.

Ms C also complained about the nursing care provided to Miss A. We took independent advice from a nurse. They advised that appropriate nursing care was provided, with evidence of regular comfort checks and assistance with personal care. We, therefore, did not uphold the complaint. However, while appropriate care appeared to have been delivered, this was not formally planned in a detailed end of life care plan. We recommended that the board consider doing so in future.

Ms C complained that the board's response to her complaint was delayed and did not answer the specific questions she asked. We identified that the board did not adhere to the terms of their complaints procedure in responding to the complaint and, in particular, that they failed to address all of Ms C's specific concerns. We upheld this complaint.

Recommendations

We recommended that the board:

• inform us of the steps they have taken to implement the relevant Healthcare Improvement Scotland recommendation following their inspection of Aberdeen Royal Infirmary in August 2015;
• consider the use of an end of life care plan as outlined in the Scottish Government's guidance on 'Caring for people in the last days and hours of life';
• apologise to Ms C and her mother for failing to appropriately respond to their complaint; and
• ask complaints handling staff to reflect on the findings of this investigation and ensure future adherence to their complaints procedures, with particular focus on timescales, comprehensiveness and language.

Summary

Mrs C complained to us that after having had surgery on her wrist she attended the medical practice to have four stitches removed by the practice nurse. The practice nurse removed the stitches but Mrs C continued to have problems with the wound site and developed infections. She was referred back to the clinic where the surgery was performed and it was discovered that one of the stitches had not been removed and was the cause of the infections. Mrs C believed that the practice had failed to appropriately remove all of the stitches following the surgery.

We took independent advice from an adviser in general practice medicine and a nursing adviser. The clinical adviser said that the practice had provided Mrs C with appropriate treatment when she reported concerns following the surgery. The doctors prescribed antibiotic medication and made an appropriate referral for an orthopaedic opinion. The nursing adviser explained that a recognised complication when removing stitches is that a small piece can remain under the skin but would, over time, make its way to the surface. This could cause infection but would not necessarily indicate that a failing in care had occurred. In light of the advice we received, we did not uphold Mrs C's complaint.

Summary

Mrs C complained about the care and treatment provided to her late mother (Mrs A). Mrs C raised concerns that hospital staff at Dr Gray's Hospital unreasonably arranged to transfer Mrs A to Turner Memorial Hospital. Prior to the transfer, Mrs C had been treated in Dr Gray's Hospital for her existing chronic obstructive pulmonary disease (a disease of the lungs in which the airways become narrowed). Mrs C said Mrs A had suffered diarrhoea on the day of the transfer and looked unwell.

The board said Mrs A's transfer had been reasonable. They said there was no evidence of diarrhoea prior to transfer, and Mrs A had been appropriately transferred.

After receiving independent advice from a geriatrician, we upheld Mrs C's complaints. We found that staff had unreasonably transferred Mrs A. In particular, we considered that Mrs A's condition was unstable, and her transfer was not subject to an appropriate level of consideration. We also considered that the board did not comply with the 'Can I help you?' guidance in answering Mrs C's complaint. We made a number of recommendations to address these concerns.

Recommendations

We recommended that the board:

• apologise to the family for the failings identified;
• confirm that the staff responsible will discuss this issue as part of their annual appraisal;
• remind staff of the importance of adequate record-keeping; and
• remind relevant staff of the complaints handling requirements under the 'Can I help you?' guidance.

Summary

Mrs C complained that the Royal Aberdeen Children's Hospital provided her son (Mr A) with inadequate care and treatment. In particular, Mrs C felt that there was not a proper care plan in place and that specific treatment should have been provided. Mrs C also raised concerns that a specialist nurse did not understand Mr A's health problems and acted inappropriately in making a referral to the Reporter to the Children's Hearing (an authority set up to safeguard children).

We took independent advice on this case from a medical adviser and a nursing adviser. We found evidence that the care provided by the hospital was appropriate. In particular, there was good interdepartmental communication between relevant specialities within the hospital and Mr A was reviewed regularly. A second specialist opinion was also appropriately requested from another hospital in England and followed up by the Royal Aberdeen Children's Hospital. Whilst we did not uphold the complaint, we found that the board had not provided Mrs C with a full response to her complaint. Therefore, we made a recommendation to address this.

We also considered that the specialist nurse acted in accordance with professional guidance in making the referral to the Reporter to the Children's Hearing given there was multi-agency concern about Mr A's health and wellbeing.

Recommendations

We recommended that the board:

• share with those staff dealing with complaints the importance of ensuring that full and comprehensive written responses are provided to complaints.

Summary

Mr C complained about the care and treatment his late wife (Mrs A) received at Aberdeen Royal Infirmary. Mr C accepted an apology and explanations from the board for a number of his concerns, but Mr C was not satisfied with the board's response to his concern relating to his wife's DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) status. Mr C was not satisfied that the hospital staff in the gastroenterology department had followed the DNACPR policy and disputed the accuracy of a record which stated that a doctor had discussed the decision with him and his wife. We took independent advice from a consultant physician who was critical of the failure to complete a DNACPR form and the low level of detail in the medical notes surrounding the decision. We upheld this part of Mr C's complaint.

Mr C also complained that the board had taken a number of months to provide him with a written response to his complaint and had exceeded their target response time. Mr C was also concerned that the board had not sufficiently investigated his complaint and he was not satisfied with the response that the board had given him. We acknowledged that, in investigating Mr C's complaint, the board had met with him on two occasions and that this had contributed to the delay in providing a response. However, we remained critical about the individual delays that contributed to the time it took the board to respond, and found that the board had failed to keep Mr C updated on the progress of their investigation into his complaint. We also upheld this part of Mr C's complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for failing to adhere to the DNACPR policy;
• provide evidence that staff in the gastroenterology department have been reminded of the importance of completing DNACPR forms where appropriate;
• provide evidence of any audit or quality improvement work which has monitored the completion of DNACPR forms in the gastroenterology department since staff were reminded to complete the forms;
• apologise for the failure to keep Mr C updated on the progress of their investigation into his complaint and failure to respond to his emails; and
• advise staff responsible for investigating complaints to update complainants in line with 'Can I Help You?' guidance.

Summary

Mr C complained about the dental care and treatment he received at the dental practice. Mr C attended the practice frequently over the course of a year, both for routine and emergency appointments. Mr C complained that at an appointment a dentist conducted an excessive investigation, causing two of his crowns to fall out during the following months. Mr C also raised broader concerns that failures in his care led his dental health to decline to a point where he required significant restorative work and multiple extractions.

The board considered there was no evidence that an excessive investigation had caused the collapse of Mr C's crowns, which they linked with existing decay. More generally, the board said Mr C's care and treatment was appropriate.

After receiving independent advice from a dental practitioner, we did not uphold Mr C's complaint. We found there was no evidence that an excessive investigation occurred. We found the care and treatment Mr C received was reasonable.

Summary

About six weeks after the birth of her child, Mrs C attended her GP practice with bleeding and abdominal pain. She was treated with antibiotics. She was reviewed several times over the next few months, and a urine test and vaginal swab were carried out, with further antibiotics prescribed. Mrs C was then referred to gynaecology as a private patient, and subsequent investigations showed there were retained products of conception (pieces of placenta) left after the birth. Mrs C complained about the delay in referring her, and said she was only referred after telling the GPs she had private medical insurance.

The practice explained that the cause of Mrs C's bleeding had been unclear. Mrs C had had a CT scan (a scan which uses x-rays and a computer to create detailed images of the inside of the body) after the birth which had returned a normal result (suggesting there were no retained products of conception). In relation to the delay, the practice noted that on one occasion the GP asked Mrs C to come back in one to two weeks, but Mrs C did not return until six weeks later. Mrs C said this was the first available appointment, but the practice said there were a number of earlier appointments available with the same or different GPs. The practice gave us a copy of their audit records, which showed the appointment was booked only a few days before the date of the appointment.

After taking independent medical advice from a GP, we upheld Mrs C's complaint. The adviser said that the GPs should have arranged an ultrasound in view of Mrs C's symptoms of unexplained bleeding for six weeks after birth, and they should have referred Mrs C to gynaecology earlier. However, we agreed that part of the delay was caused by Mrs C returning in six weeks, rather than two (which may have been due to a misunderstanding or miscommunication).

Recommendations

We recommended that the GPs concerned:

• apologise to Mrs C for the failings our investigation found;
• familiarise themselves with postpartum complications and consider identifying this as a learning aim; and
• reflect on our findings as part of their next annual appraisals.