Health

Summary

Mrs C complained about the care and treatment provided following an injury to her shoulder. Mrs C complained that A & E staff at Raigmore Hospital failed to promptly diagnose that she had multiple fractures to her arm. Mrs C also raised concerns that on her subsequent attendance at the fracture clinic, staff failed to carry out a CT scan (a scan which uses x-rays and a computer to create detailed images of the inside of the body) as a matter of urgency. Mrs C complained that the board failed to ensure that she received surgery for her shoulder within a reasonable timescale. Mrs C linked these concerns with subsequent complications in her shoulder, which led to further surgery. Mrs C complained that the board failed to provide reasonable care and treatment at the further operation she received approximately nine months after her shoulder injury. Mrs C also raised concerns about whether the board appropriately investigated her complaints.

The board said A & E had assessed and managed Mrs C appropriately. The board also considered Mrs C received a CT scan within a reasonable timeframe. The board said emergency admissions impacted on the timescale for Mrs C's surgery; however, they said she ultimately received treatment within an appropriate timescale. The board said the timescales did not impact on Mrs C's recovery. The board did not comment on Mrs C's concerns about the care and treatment provided at the second operation.

After receiving independent advice from an orthopaedic surgeon, we did not uphold Mrs C's complaints about her care and treatment. We found the A & E diagnosis had been reasonable as documented in the medical records. We found the timescales for receiving the CT scan and the surgery were reasonable. We found that it was not likely that these timescales caused Mrs C's slow recovery. We also found that the care and treatment provided at the second operation was reasonable.

We upheld Mrs C's complaint about the board's handling of her concerns. We found that, given the nature of the concerns raised, the board should have investigated further. We recommended that the board apologise to Mrs C, and remind staff of the requirements of the Scottish Government's 'Can I help you?' guidance.

Recommendations

We recommended that the board:

• apologise for the failings identified by this investigation; and
• remind relevant staff of the complaints handling requirements under the 'Can I help you?' guidance.

Summary

Mr C has suffered from spondylolisthesis (where a bone in the spine slips out of position, either forwards or backwards) for a number of years. After his lower back pain became worse his GP referred him for physiotherapy. Mr C attended an appointment with a physiotherapist and was told to self-manage his condition by undertaking core stability exercises and maintaining posture awareness. Mr C had previously found massage therapy to be beneficial to him and he was unhappy that this treatment was not offered to him despite his requests. Mr C had previously obtained massage therapy privately but no longer had the resources to do so.

Mr C wrote to the board to complain that the exercises recommended by the physiotherapist were not helping his condition. Mr C stated that he had obtained private treatment (for massage therapy) on occasion, and that he believed that this treatment should be offered by the NHS. The board investigated Mr C's complaint and concluded that whilst massage therapy can help lower back pain for short periods of time, the exercise programme recommended to Mr C was the most appropriate for managing his condition.

After taking independent medical advice from a musculoskeletal out-patient physiotherapist, we did not uphold Mr C's complaint. The adviser concluded that it was reasonable of the board to refuse Mr C massage therapy as there was limited evidence to support the effectiveness of the treatment in managing chronic lower back pain. The adviser also thought that the exercise programme treatment that was recommended to Mr C was reasonable. In view of this, there was no evidence that the board had unreasonably refused to offer Mr C massage therapy and we did not uphold the complaint.

Summary

Mrs C complained about care she received from the medical practice when she attended with an injury to her toe. Mrs C has diabetes which makes foot complications more common and harder to treat. Mrs C had been prescribed an antibiotic to treat the infection but she had returned to the practice around a month later as she was still in pain, at which point she was referred to hospital. She had to have emergency surgery, resulting in the amputation of her big toe. Mrs C said that she had attended the practice three times before being referred to hospital and that the amputation could have been avoided if the practice had provided appropriate care and treatment when she had first attended.

The practice said that they had conducted an audit and could not find any evidence that she had attended on the first occasion. We took independent advice from a GP adviser. The adviser considered the records available and found the treatment Mrs C was given was appropriate, and that Mrs C's GP could not have foreseen that Mrs C's condition deteriorated or recurred between the point at which she was prescribed antibiotics and being referred to hospital. We also found no evidence of the initial appointment that Mrs C referred to. We did not uphold Mrs C's complaint.

Summary

Ms C, a voluntary agency worker, complained on behalf of Mr A that the dental care and treatment he had received had been inadequate. We took dental advice which stated that the care and treatment had been appropriate. It noted Mr A had not attended regular dental reviews, which had contributed to the damage to his teeth.

We found that the dentist had acted reasonably and that the care they had provided was appropriate, and we therefore did not uphold this complaint.

Summary

Ms C, a voluntary agency worker, complained on behalf of Mr A that the dental treatment he had received was inadequate. Ms C said Mr A believed the treatment he had received had contributed to tooth decay in his mouth. Mr A asked for compensation for the treatment he said he received.

We took independent dental advice, which stated that Mr A had not received the appropriate dental treatment. The advice noted that Mr A had been fitted with a bridge which had only been partially attached, as it had been supported by only one tooth, rather than two, as would normally be the case. The advice said the bridge was, therefore, always likely to fail. The advice noted, however, that Mr A had not maintained the appropriate level of oral hygiene or attended review appointments which were essential for preventing tooth decay following the fitting of bridge work. The advice stated that on balance, Mr A's dental treatment had been unreasonable, since a bridge should only have been fitted if it could be fully attached.

We found that Mr A's treatment was unreasonable, and he should, therefore, have the cost of his dental treatment refunded.

Recommendations

We recommended that the dentist:

• refund Mr A the cost of the dental treatment;
• provide evidence that the dentist has reflected on the failures in Mr A's care identified in the investigation; and
• apologise for the failings identified in this report.

Summary

Ms C, who works for a voluntary agency, complained on behalf of Mr A that the care and treatment he received was inadequate and that his subsequent complaint had been poorly handled. Mr A had suffered repeated problems with dental bridgework failing. Ms C said he had been seen by a number of different dentists, causing problems with continuity of care. Mr A also believed that a tooth had been prepared for a crown inappropriately and that he had had an unnecessary extraction, and that he had unreasonably been refused bridgework treatment.

We took independent dental advice, which stated that Mr A had received a comprehensive examination. It was not practical to fit a bridge because of decay in the teeth it would have to be attached to. It would also not have been appropriate to attempt any other restorative work until Mr A's gum disease issues were dealt with. The advice noted that Mr A had been insistent that a bridge be fitted, but the dentist had correctly refused on the basis that this would be inappropriate and would worsen the condition of his teeth.

We found that Mr A's care and treatment was reasonable in the circumstances. His complaint had been thoroughly investigated and a response provided within a reasonable timescale.

Summary

Mr C complained about the mental health care and treatment of his late wife (Mrs C) in the weeks prior to her suicide. Mrs C had a history of mental illness, and was referred urgently to psychiatry by her GP due to returning symptoms. Mrs C was assessed and a plan was made to treat her at home with support from the Intensive Home Treatment Team (IHTT). After four weeks, the IHTT referred Mrs C to her local team (Rehabilitation and Enablement Services Mental Health Team (RES MHT)) for further care. However, due to problems with the referral process there was a delay in transferring care and a ten day gap between appointments. Mrs C completed suicide the day after her first RES MHT appointment.

The board conducted a Significant Clinical Incident investigation into Mrs C's death. While the review team concluded the care was appropriate, they identified problems with the transfer process, and a lack of documentation about the role Mrs C's family had in her care planning. In response to Mr C's complaint, the board acknowledged failings in involving Mrs C's family in her care planning and in the referral process. The board apologised to Mr C and provided information on a number of actions underway to improve the RES MHT service.

After taking independent mental health and psychiatry advice, we upheld Mr C's complaint. We agreed with the board's findings that there was a lack of involvement of Mrs C's family in her care planning, and failings in the referral process. We also found that, while a comprehensive risk assessment was carried out, the management plan did not include a summary formulation of risk (as required by the local policy). While we considered the board had already taken appropriate action to address the issues found in relation to the RES MHT, we asked that they provide details of action taken in relation to the IHTT.

Recommendations

We recommended that the board:

• remind staff of the requirement to implement a summary formulation of risk (as well as a risk management plan) under the Clinical Risk Screening and Management Policy; and
• demonstrate that action has been taken to improve documentation of carer involvement (and patient consent to this) by IHTT staff in care planning and risk management.

Summary

Mrs C complained to us that her daughter (Miss A) had been detained unreasonably under an emergency detention certificate (a 72-hour emergency section) after displaying symptoms of a mental disorder. We are normally unable to consider complaints about detention under the Mental Health Act, as there is a right of appeal to a mental health tribunal. However, there is no right of appeal against an emergency detention certificate and we were able to consider this aspect of Mrs C's complaint. We took independent advice on Mrs C's complaint from a psychiatric adviser. We found that Miss A had met the criteria for detention and it was reasonable that she was detained under an emergency detention certificate. We did not uphold this aspect of Mrs C's complaint.

Mrs C also complained that nursing staff at Parkhead Hospital had restrained Miss A unreasonably around the time she was detained. We found that the restraint used by staff had been reasonable and was consistent with normal practice at that time.

Miss A had been discharged and the emergency detention certificate had been revoked when she saw a consultant on the day after she had been detained. Mrs C complained that appropriate medical staff were unavailable until the day after Miss A was detained. She said that if an appropriate doctor had been available at the time Miss A was admitted, she would not have had to be detained in hospital overnight. We found that is that it is common, accepted practice that there was no consultant on the ward when Miss A had been admitted to hospital out-of-hours. We also found that it was reasonable that Miss A's detention was reviewed and revoked within 24 hours. We did not uphold this aspect of Mrs C's complaint. That said, we found that the board had failed to issue an adequate response to Miss A's complaint to them and we made a recommendation in relation to this.

Recommendations

We recommended that the board:

• issue a written apology to Miss A for the failure to respond to the matters raised in her complaint.

Summary

Ms C, an advice agency worker, complained on behalf of the family of Mrs A. Two GPs at the practice had visited Mrs A's home on request and diagnosed that she had a urinary tract infection, for which they prescribed medication. After the GPs left, the family tried to move Mrs A upstairs to her bedroom, but in the process she suffered a leg injury. An ambulance was called and she was admitted to hospital for that injury.

The family complained that Mrs A was not very mobile and that the GPs should have admitted her to hospital, rather than simply leave them on their own to manage an elderly, immobile patient in a home with steep stairs.

We took independent advice on this case from a GP. Our investigation established that the GPs had acted in line with guidance on hospitalisation in the SIGN guideline, 'The Management of Urinary Tract Infection in Adults'. (SIGN is the Scottish Intercollegiate Guidelines Network, which is an organisation that develops clinical guidelines for the NHS in Scotland.) In other words, they had appropriately identified that, in her case, Mrs A should be treated at home but that hospitalisation might become appropriate. The GPs had also appropriately arranged urgent referral to a multi-disciplinary team, who would be able to help Mrs A with self-care and mobilisation.

The GPs considered that they had advised the family that Mrs A might need to remain downstairs initially. In the absence of independent evidence, the facts around this could not be established either way. The lead GP felt on reflection that he could have checked more whether the family had understood his advice and information, and said he would check this more in future cases.

Summary

Mr C was referred to Glasgow Dental Hospital by his dentist in January 2015. He attended the appointment in March but told the hospital he did not wish to see the same clinician again. Mr C also requested a second opinion following the outcome of this appointment. Mr C's case was passed to hospital management for a new appointment to be made.

In the meantime, Mr C changed dental practitioner. In July 2015, he was referred back to Glasgow Dental Hospital by his new dentist. However, the hospital replied to say they were unable to offer Mr C an appointment because of a previous history of aggressive behaviour and non-attendance. They suggested that future treatment be carried out by Mr C's dental practice.

In December 2015, Mr C complained to the board about not being provided with a second opinion after his March appointment. The board apologised for not carrying out a second opinion, but maintained that they were unable to offer an appointment. Mr C then complained to us.

We took independent advice from a dentist. They said it appeared that a second opinion had not been offered as a result of administrative oversight. They said that this was unacceptable, but noted that the board had acknowledged this and looked into their procedures to prevent such a situation recurring. We asked the board to advise us of the action they have taken.

The adviser also said that the board were entitled to discharge Mr C back to the care of his dentist because of the non-specialist nature of Mr C's treatment, episodes of aggressive behaviour towards clinical staff and multiple non-attendance at appointments. We accepted this advice, although on balance we upheld the complaint because a fuller explanation should have been provided and because of the failure to organise a second opinion.

Recommendations

We recommended that the board:

• advise us of the action taken to prevent a situation occurring whereby a request for a second opinion is not actioned.