Health

Summary

Mr C was admitted to Hairmyres Hospital with symptoms suggestive of vasculitis (inflammation of a blood vessel or vessels). He was prescribed steroids and discharged. He was seen again at a clinic, at which point it was understood that he would be reviewed by a respiratory team three weeks later. A plan was put in place to reduce his steroid dose over this three-week period.

An appointment was also made for a follow-up appointment with his consultant two months later, by which time it was assumed he would have been seen by the respiratory team. However, when he attended he had still not been seen by them, and had remained on steroids. Mr C was re-referred urgently, and an appointment was made. Following this appointment it was advised that the steroids would be cut down, with a view to stopping them altogether.

Mr C subsequently contracted avascular necrosis (AVN - death of bone tissue due to a lack of blood supply) in both hips, which meant he required a total replacement of his right hip. He believed this was caused by his prolonged steroid use.

We took independent advice from a medical adviser who told us that Mr C's steroids were prescribed appropriately and were used for a relatively short period. There was no evidence to suggest that the steroids would have contributed to his AVN and we were satisfied that his dosage was gradually reduced appropriately. Therefore, we did not uphold Mr C's complaint.

Summary

Miss C's father (Mr A) attended the medical practice on two occasions over a four week period with chest and abdominal problems and breathlessness. He also had a phone consultation with the practice about his condition. Whilst waiting for x-ray results, Mr A died suddenly. His post mortem gave his cause of death as cardiac enlargement (an enlarged heart which may not pump blood effectively, resulting in congestive heart failure).

Miss C complained that the practice failed to provide appropriate care and treatment to her father. She raised a number of concerns including that a nurse practitioner and a GP at the practice failed to carry out appropriate assessments and examinations of her father and provide appropriate treatment.

We obtained independent medical advice on Miss C's complaint from a nursing adviser and a GP adviser. The nursing adviser explained that the nurse practitioner's assessment and examinations of Mr A were reasonable and Mr A was provided with appropriate treatment. The GP adviser said that the GP's assessment, care and management of Mr A were reasonable and in accordance with relevant guidelines. The GP adviser said the details recorded in the consultation together with the examination of Mr A were not significantly suggestive of a heart condition as the primary underlying cause of Mr A's condition. They explained that chest infection was a reasonable diagnosis for the GP to have made based on the symptoms and signs presented to them. Therefore, we did not conclude that the practice failed to provide appropriate care and treatment to Mr A.

Summary

Mrs C complained about the care her daughter (Miss A) received at Wishaw General Hospital's A&E department after she injured her knee. Mrs C said that it took several visits to the hospital before a magnetic resonance imaging scan (MRI - a scan which can show injuries to cartilage, ligaments and tendons) was carried out which identified a significant injury to Miss A's knee-cap. Mrs C was also dissatisfied with the orthopaedic department's communication with her in relation to Miss A's surgery.

We took independent advice from a consultant in emergency medicine and a consultant radiologist. We found that the x-ray performed at Miss A's initial presentation to the A&E department was interpreted satisfactorily. In addition, we took into consideration that knee injuries in general can be difficult to initially assess due to pain and swelling, so it was therefore appropriate that staff arranged a follow-up appointment. We did not find that there was any undue delay in carrying out the MRI scan which was arranged when Miss A's injury did not settle.

We concluded that the orthopaedic department should have explained more clearly to Mrs C what the operation entailed. This was acknowledged by the board but not reflected in their response to the complaint which we were critical of. Furthermore, they should have kept Mrs C pro-actively informed about the factors that affected the operation not going ahead on a particular day.

Recommendations

We recommended that the board:

• apologise for failing to respond to Mrs C's concerns about communication issues surrounding the operation and share these findings with relevant staff.

Summary

Mr C, who works for an advocacy agency, complained on behalf of Mr A about the care and treatment provided to him by his psychiatrist. Mr A's community care package initially included him receiving night visits from care staff but these were discontinued due to his non-compliant behaviour. He was subsequently detained in hospital for a period. Mr C complained that Mr A's psychiatrist had not provided him with sufficient support in the community and that this had led to his hospital detention. In particular, he complained that the psychiatrist did not take adequate steps to try to have Mr A's overnight support reinstated. He also complained about the care Mr A received while in hospital and raised concerns that there was not an appropriate care plan in place throughout his admission.

We took independent advice from a psychiatrist who considered that the actions taken by Mr A's psychiatrist were reasonable in the circumstances. The adviser noted that there was disagreement among the wider team regarding how best to manage Mr A's care and that, even if the psychiatrist had done more, there was no guarantee that this would have helped prevent Mr A's hospitalisation. We therefore could not conclude that the psychiatrist unreasonably contributed to Mr A's hospital admission. We were also advised that that there was an adequate care plan in place during Mr A's hospital admission, although it was noted that this was not always successful in engaging him. We did not uphold either aspect of the complaint.

Summary

Ms C, who works for an advice agency, complained on behalf of Ms A about treatment she had received from the medical practice. Ms A has chronic psoriasis (a long-term, recurring skin disease, which causes sore or itchy patches of skin) on her hands and feet. She sought treatment for this at her practice but continued to suffer symptoms. Following a visit from a district nurse, Ms A was referred to a podiatrist (a clinician who diagnoses and treats abnormalities in the lower limbs). Ms C complained about the delay in Ms A being referred to a podiatrist.

We took independent advice from a GP adviser. The adviser said that the practice had made appropriate investigations into Ms A's condition and recommended reasonable treatments. As the psoriasis affected Ms A's hands as well as her feet, they did not believe a referral to a podiatrist was appropriate at that time. For this reason, we did not uphold the complaint.

Summary

Miss C was examined by her current GP and had a contraceptive coil removed. However, at that time, Miss C had thought that all coils had already been removed; therefore, she thought her previous GP had failed to remove a coil.

We looked at the file on Miss C's complaint, at her medical records from her current and previous GPs, and we took independent advice from a GP adviser. We noted the adviser's comments that patients should be aware if they have a coil in place and if it needs to be removed, and that it is a patient's responsibility to tell their GP if they wish to have an existing coil removed. We found that the care provided by Miss C's previous GP in relation to fitting and removing coils was reasonable in the circumstances at the time. Therefore, we did not uphold Miss C's complaint.

Summary

Mr C, who works for an advice agency, complained to the medical practice on behalf of his client (Mr A) who suffered from lower back and leg pain. Mr A said that there had been a delay by the practice in referring him for a MRI scan (magnetic resonance imaging - a scan used to diagnose health conditions that affect organs, tissue and bone) and it did not appear that they had followed the correct referral process and that had contributed to the delay. It was only after an appointment with a private physiotherapist that a MRI scan was arranged.

We took independent advice from a GP adviser and concluded that the practice had made appropriate referrals for specialist opinions from physiotherapy and orthopaedics and that initially there were no indications that, from a clinical perspective, a MRI scan was appropriate. By the time Mr A had seen the private physiotherapist, the clinical situation had deteriorated and at that time it was then appropriate to make a referral for an MRI scan. We did not uphold the complaint.

Summary

Mrs C, who works for an advice agency, complained on behalf of the family of Mr A. She said they believed Mr A's nasogastric tube had been incorrectly inserted, which had caused a collapsed lung by puncturing the inside of his lung. They said that, following this, he had deteriorated and this had contributed to his death. Mr A's family believed that Mr A had been being prepared for discharge at the time of the insertion.

The board said that they did not believe it was possible that the nasogastric tube had led to Mr A's death. The tube had been inserted by an experienced nurse, and checked by x-ray. When it was found to be in the wrong place, it had been immediately removed. The board said that there had been no discharge plan in place for Mr A.

We received independent medical and nursing advice. The medical advice stated it was not medically possible for a nasogastric tube to puncture a lung. Mr A had suffered from serious lung disease and it was more likely that this had caused his collapsed lung. The nursing advice said the insertion of a nasogastric tube was routine, but that even if inserted correctly, it could subsequently move within a patient. It was appropriate for the board to have confirmed the position by x-ray and this was an example of good practice.

We found there was no evidence that Mr A had not received an appropriate level of care and treatment and did not uphold the complaint.

Summary

Ms C complained that the board failed to provide her with reasonable treatment for her thyroid problem. Ms C listed several issues regarding her care. She said that the consultant ear, nose and throat surgeon at the Southern General Hospital who dealt with her case underestimated the seriousness of the original scan and histology findings (report on the microscopic appearance of tissue). She complained that the surgeon unreasonably subjected her to repeat investigations and new referrals. She also complained that the surgeon ignored the final histology report which Ms C said confirmed she had cancer. Additionally, Ms C complained that the board did not respond reasonably to her complaint about her treatment.

We obtained independent advice on the complaint from a consultant surgeon specialising in ear, nose and throat, head and neck, and the thyroid gland. The adviser said that, given the length of time Ms C had had the nodule on her thyroid, the previous investigation of the nodule, and the fact there was no record of it having changed since it was first noted, the likelihood of malignancy (cancer) would have been low. The adviser explained that it was entirely reasonable for the consultant to undertake investigations before removing the nodule to check that there were no other medical issues which could cause problems with the anaesthetic and surgery.

The adviser did not consider that the consultant ignored the final histology report, just that they had not seen it. Ms C had moved house and was receiving treatment from another board by the time the consultant saw the report. However, the adviser said there was an unnecessary delay in the consultant noting and acting on the final histology report. This appeared to be caused by the process in the department for checking the results, and the board have indicated that action has been taken to improve this.

On balance, we considered that the board did not fail to provide Ms C with reasonable treatment. However, we also considered that the board did not respond reasonably to Ms C's complaint as there were inaccuracies in their response.

Recommendations

We recommended that the board:

• feed back our decision on Ms C's complaint about the treatment provided by the board to the staff involved; and
• provide Ms C with a written apology for the failings identified in both complaints.

Summary

Ms C complained that following an operation for pancreatic cancer she was discharged home from Aberdeen Royal Infirmary without being given medication (which was specifically for digestive problems involving the pancreas). As a result, Ms C's condition deteriorated and she developed symptoms of severe pain, sickness and diarrhoea. She had to be readmitted to hospital and the medication was re-started, and her symptoms began to improve.

We took independent advice from a medical adviser who noted that it was a discretionary decision for the consultant to make prior to Ms C's discharge from hospital and that this was a reasonable decision for them to take. Some clinicians would prescribe this specific medication on discharge whilst others would not. The fact that the medication was not prescribed was not, in itself, an indication of a failure in service.

We found that the decision to discharge Ms C without medication was appropriate in the circumstances but that it was unfortunate that her condition deteriorated and that she required a further admission to hospital. With hindsight, if Ms C had been given this medication, it may have prevented her deterioration but the consultant had to consider the available information at the time of discharge. We did not uphold the complaint but noted that the matter should have been discussed with Ms C prior to discharge.