Health

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.

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.