Health

Summary

Mr C's father (Mr A) was diagnosed with stomach cancer and died five months later. Mr C complained that the medical practice should have investigated his father's symptoms sooner as an earlier scan may have allowed some level of preventative treatment. We took independent advice from a medical adviser who is a GP. We found that until he was under the care of hospital specialists, Mr A had not reported or exhibited symptoms of more serious underlying disease which would have suggested urgent referral in accordance with national guidelines for the investigation of cancer. The adviser therefore considered that there was no evidence from Mr A's medical records that the practice failed to identify or act on any concerning symptoms, so we did not uphold Mr C's complaint.

Summary

Mrs C contacted the practice about appointments for her sons. She was unhappy with the way in which the practice handled her contact. She felt that the practice manager had breached confidentiality by referring to a previous conversation she had had with a GP at the practice about one son when she was calling about her other son. She also felt that the practice had not acted correctly in relation to allegations that she was abusive and that she was told to go elsewhere. She was also unhappy that they had noted on her medical records that she was more interested in her sons' rights than taking them to review appointments.

Following consideration of Mrs C's complaint to the practice and to us, the practice's response to her complaints as well as the information the practice provided to us following our enquiry (which included records of the conversations Mrs C had had with the practice), we did not uphold Mrs C's complaints. We felt it was reasonable for the practice manager to refer to previous conversations between Mrs C and the practice in so far as it related to her own actions and behaviour, rather than the specific medical conditions of her sons. The notes of the conversations did not indicate that Mrs C was abusive, rather that she was upset and excessively angry. Given the circumstances, we considered that the practice's handling of Mrs C's contact, which was to put a note on her record that any future issues are fed back to the practice manager, was a reasonable way to proactively manage internally any potential issues with future contact. There was no record in the practice's notes of the conversation that Mrs C was told to go elsewhere and the practice and Mrs C had differing recollections of what was said. It was not possible, therefore, for us to determine exactly what was said. Although we understood that Mrs C was unhappy about what was written in the record about not taking her sons to review appointments, we considered that the practice's explanation that this was an accurate reflection of the discussion and beneficial to have recorded for any future contact, was reasonable.

Summary

Mr C complained about the length of time he had to wait for surgery for prostate cancer and said that the board did not provide treatment in line with the national waiting time targets. We took independent advice from a medical adviser. We found that the GP referral for Mr C was acted on promptly by the board's urology service and the time taken to reach a diagnosis of prostate cancer was reasonable taking into account the complexity of Mr C's case. However, after the decision was reached to proceed with surgical treatment for Mr C's cancer there was a lack of co-ordination in gathering all the information and beginning treatment which meant the waiting time target was not met. Although we found that the delay was unlikely to have affected the long-term outcome, the delay and lack of information provided would have added to the uncertainty and anxiety for Mr C at what would have been a very difficult time for him. We concluded that the overall care he received was not of an acceptable standard and led to an avoidable delay.

Recommendations

We recommended that the board:

• apologise to Mr C for the failings identified; and
• review the circumstances regarding Mr C's case to ensure that, in future cases, care is appropriately co-ordinated with adequate information given to the patient and taking into account appropriate waiting time targets.

Summary

Mr C complained on behalf of his partner (Miss A) about the delay in her parathyroid surgery (surgery to remove glands next to the thyroid which secrete a hormone that regulates calcium levels in a person's body), and the board's communication with them about this. Mr C said the consultant physician at the endocrine clinic at the Royal Infirmary of Edinburgh who first dealt with Miss A's case told them the surgery would take place within approximately ten weeks of their initial appointment. Mr C said he attended appointments with Miss A (who is profoundly deaf) about her care and communicated with the board on her behalf about the delay in her surgery.

We obtained independent medical advice on the complaint from a consultant in general medicine. The adviser said there was an avoidable delay in the consultant physician at the endocrine clinic arranging Miss A's referral to the consultant surgeon who was to perform her operation. The adviser also said that once the referral was made, there was an avoidable delay in Miss A's surgical review with the consultant surgeon taking place and these delays resulted in an avoidable delay in Miss A's surgery. Mr C and the consultant physician gave differing accounts of what was said about when the surgery would take place. In the absence of supporting evidence from any independent witnesses, it was not possible for us to conclude what was said at the consultation.

The adviser said the board had a responsibility for keeping records of communications with patients and, on balance, they considered that the board should have been able to provide a clear record of the communication with Mr C on Miss A's case. As they could not, the adviser said the communication by the board was unreasonable.

Recommendations

We recommended that the board:

• feed back our decisions on both complaints to the staff involved;
• take steps to ensure that, in future, staff record emails and phone calls made by patients or their representatives in the patients' electronic records; and
• provide Mr C and Miss A with a written apology for the failings identified in both complaints.

Summary

Mrs C sustained nerve damage following dental treatment she received in 2014. She also complained that the dentist failed to respond to the Edinburgh Dental Institute (EDI)'s request for further information after she was referred there for further review.

We sought independent advice from a general dental practitioner. We considered that the symptoms Mrs C experienced in October 2014 were consistent with accidental injection of sodium hypochlorite (a solution used to clean out the root canal) through the end of the root of her tooth. This is a rare but recognised complication of the treatment and is not in itself evidence of unreasonable care. We also considered that prior to 2015, it was a risk which would not normally have been discussed with patients before treatment. We did, however, identify the likelihood that the dentist had not used a rubber dam (a device used to isolate the root canal and protect a patient's airway) and concluded that this was unreasonable practice even though it would not have prevented the nerve damage caused. We upheld this part of Mrs C's complaint. We found no evidence to demonstrate that the dentist had not responded to any requests for information from the EDI and we did not uphold this part of Mrs C's complaint.

Recommendations

We recommended that the dentist:

• apologise to Mrs C for the failure to use a rubber dam; and
• takes steps to ensure the use of a rubber dam.

Summary

Mr C complained to us about the care and treatment his son (Mr A) received when he was admitted to the Royal Edinburgh Hospital under a short-term detention certificate under the Mental Health Act. Mr A has severe autism, learning disabilities and epilepsy. We took independent advice on Mr C's complaint from a mental health adviser and a consultant physician.

With regard to Mr A's physical health, we found that the action taken in relation to Mr A's bowel problems was reasonable. The medication given to him was also appropriate. However, staff had failed to medically review Mr A on the day he was admitted to hospital and there was no evidence that a structured nursing needs assessment was carried out in the days following his admission. In addition, there was a significant delay in obtaining a full psychology and occupational therapy assessment for him. In view of these failings, we upheld this aspect of Mr C's complaint.

Mr C also complained that staff in the hospital had failed to provide his son with appropriate care needs. We found that the records in relation to whether Mr A's family had been asked to leave when he was admitted and whether the family had initially been asked not to visit were inadequate. We also considered that more could have been done to explore potential options for safely personalising Mr A's room. In addition, a structured nursing assessment had not been carried out on one of the wards Mr A was in and there was no personal hygiene/grooming care plan for that ward. There was also a delay in referring Mr A to advocacy services. In view of all of these failings, we also upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the board:

• issue a written apology to Mr C for the failings identified; and
• provide detailed evidence that steps have been taken to prevent the failings identified from occurring in other cases.

Summary

Mr C brought this complaint to us on behalf of his late wife (Mrs C), following a rapid deterioration in her health. He raised concerns that GPs should have identified her deteriorating condition over the course of three consultations she had with them prior to her admission to hospital. She was admitted to hospital suffering from shock within 24 hours of her last GP visit. The hospital doctors were unable to save her, as she did not respond to the treatment she was given, and she died a week after admission.

We took independent advice from a GP adviser. The adviser reviewed the consultations that Mrs C had with GPs, and was satisfied that the assessments had been reasonable and the treatments were appropriate. She noted that the main issue discussed had been back pain. There had been no mention of diarrhoea, though Mr C said that his wife had been suffering from this for several weeks. He reported that he mentioned it to the GP at the final consultation. However, it was not noted in the medical records, and the adviser was satisfied that the GPs had made reasonable decisions based on the information they were given. The adviser also noted that the GPs may have made different decisions if they had been told of Mrs C's persistent diarrhoea.

We noted the sequence of events that led to Mrs C's death, but concluded that GPs could not have predicted this, based on the information she gave them. We were satisfied that the GPs had assessed and treated Mrs C reasonably for the back problems she presented with, and noted that they were also reasonable not to ask about diarrhoea when she had not raised this as an issue. We were satisfied that the practice provided Mrs C with appropriate clinical treatment in view of the symptoms which she presented with.

Summary

Mr C complained about his late father (Mr A)'s care and treatment in Wishaw General Hospital in the period before his death in June 2015.

Mr A had been diagnosed with terminal cancer in 2014 and in late May 2015 he was taken into hospital to have an oesophageal stent (a mesh tube in his throat) inserted. However, the procedure did not take place and only an endoscopy (a procedure where a tube-like instrument is put into the body to look inside) was performed. In June 2015, Mr A was admitted again and during his admission he suffered a number of falls. Mr C complained that Mr A was not provided with appropriate clinical or nursing care.

We took independent advice from a consultant geriatrician and from a nurse. We found that when Mr A was first admitted in May 2015, there were problems with the documentation available to the surgical team. It was brief and did not show that his condition had been considered in detail. Furthermore, we found that although a number of clinicians had been involved in his case, none of them had been involved with Mr A in any detailed or personal way and communication had been poor. On his second admission, our investigation showed that although it had been detailed in his notes, one-to-one care had not been provided to Mr A. Had it been, a third fall may have been avoided. For these reasons, we upheld Mr C's complaint.

Recommendations

We recommended that the board:

• make a formal apology for the failures identified;
• ensure that the clinicians involved in the case are aware of the adviser's comments and that they discuss them at their next formal appraisal;
• make a formal apology for the failure to provide one-to-one care observation; and
• review their processes for providing one-to-one care.

Summary

Mrs C complained about the care given to her late husband (Mr C) while he was a patient in Wishaw General Hospital. Mr C had Parkinson's Disease and dementia and had been admitted to hospital for a period of assessment. Mrs C said that between his admission to hospital and his discharge to a care home (a period of several months), she was not properly consulted on his treatment plans, nor was she appropriately involved in multi-disciplinary meetings to discuss his care. She said that this was even although she had welfare power of attorney which allowed her to look after Mr C's interests (to consent to his treatment) as he no longer had capacity to do this.

While Mrs C had raised her concerns with the board, they had indicated to her that Mr C had been cared for appropriately but they apologised if she felt his nursing care had been poor.

We took independent advice from a senior mental health professional and we found that Mr C's care plan had been inadequate. There had been a particular omission with regard to his personal care. There was no evidence that in the absence of Mr C's participation and agreement that Mrs C as power of attorney had been involved. Similarly, Mrs C was not as involved as she should have been in decisions about her husband's care and treatment and her involvement in multi-disciplinary meetings was inconsistent and sporadic. For these reasons we upheld her complaint about this.

Although Mrs C had also complained that Mr C's medication regime was changed inappropriately, we found no evidence of this.

Recommendations

We recommended that the board:

• make a formal apology to recognise their failures with regard to care planning;
• ensure that all care plan templates are completed in full in relation to keyworker/patient/carer involvement and that they are appropriately signed and dated, and demonstrate to us that this has been done;
• make a formal apology to Mrs C for the fact that she was not involved in multi-disciplinary meetings as was appropriate; and
• ensure that staff involved in Mr C's care are reminded of the importance of ensuring that carers with power of attorney are fully and appropriately included in decision-making.

Summary

Mr and Mrs C made a complaint on behalf of their son (Mr A) who had been diagnosed with epilepsy some years ago. Mr A had been seizure free for a number of years but in July 2014 began to experience seizures again. He was admitted to Monklands Hospital on three occasions in November and December 2014 and Mr and Mrs C complained that he was not cared for or treated reasonably. They also said that communication with him was poor.

We took independent advice from consultants in emergency medicine and in neurology and we found that at each of Mr A's admissions, emergency clinicians treated him reasonably and appropriately. He was examined and assessed and appropriate tests were undertaken. He was released from hospital with advice to contact his GP and for psychiatric follow-up. The third time Mr A went to A&E, he was admitted for observation. He was exhibiting bizarre behaviour and suffering from depressive symptoms. However, it was established that although there was clearly documented evidence to confirm that Mr A was emotionally ill, it was accepted that he was suffering epileptic seizures and no definitive tests were requested to refute or deny this. Instead doctors concentrated on altering his medication. For this reason, Mr and Mrs C's complaints about Mr A's care and treatment were upheld. However, we did not find any evidence to suggest that communication with him had been poor.

Recommendations

We recommended that the board:

• make Mr A a formal apology to recognise our findings about care and treatment;
• ensure that members of the neurology team involved in Mr A's care are familiar with the appropriate national guidance; and
• ensure that neurology staff involved in Mr A's case consider it at their next formal appraisal.