Health

Summary

Ms C raised a number of concerns about the care and treatment her father (Mr A) received at Biggart Hospital. Mr A had been transferred from another hospital for rehabilitation after he suffered a fracture to his right upper arm after a fall.

We took independent advice on the case from a medical adviser and a nursing adviser.

The medical adviser considered that while communication between ward staff and the fracture clinic fell below a reasonable level, the board had acknowledged this and apologised. The medical adviser said the length of Mr A's stay at the hospital was reasonable, based on the injury he had suffered and his particular circumstances. The medical adviser considered the initial assessment of Mr A's chest fell below a reasonable standard because, although in their complaints response the board stated that this was to treat a chest infection, Mr A's medical records did not record why he was prescribed antibiotics and how this treatment would be reviewed.

The medical adviser and the nursing adviser both considered that further investigation and assessment should have been made when swelling to Mr A's leg was identified by nursing staff.

The advisers also said that Mr A had not been provided with a reasonable amount of physiotherapy treatment and there was a lack of provision of physiotherapy for Mr A on weekends and bank holidays. They also considered the amount of occupational therapy provided to Mr A was below a reasonable level. Although the board had apologised to Ms C that the level of support fell short of her expectations, the medical adviser was critical of the board's failure to acknowledge that a lack of staff time and workload commitments had impacted on the service Mr A received.

Recommendations

We recommended that the board:

• feed back the findings about Mr A's swollen leg to the staff involved, for reflection and learning, including reminding nurse practitioners to highlight abnormal clinical findings to medical staff;
• feed back the failures in relation to record-keeping to the staff involved, for reflection and learning;
• provide evidence of the review of physiotherapy staffing levels and provision of their services;
• consider and report on steps taken to address the failings in provision of occupational therapy identified by this investigation; and
• issue a general written apology to Ms C, acknowledging the failings identified in this investigation.

Summary

Mr C complained about a misdiagnosis of cancer. He said staff at Ninewells Hospital told him about three years ago that he had six to nine months to live, but then told him about a year ago that he did not have cancer. Mr C was concerned about the misdiagnosis, and that the board did not follow up to determine the correct diagnosis for his symptoms. Mr C also raised concerns about the board's handling of his complaint, as they had still not responded to him four months after he complained.

We asked the board when they would respond to his complaint, and they said they aimed to do so within three weeks. Mr C did not receive a response within this timeframe, and we began considering his complaint. However, the board then sent Mr C the final response from their investigation. We asked Mr C if he was satisfied with this response, or if he wished us to keep investigating. Mr C said he did not want us to keep investigating, and we closed our file on the complaint.

Summary

Mr C complained because he said the board failed to respond appropriately to his complaint about scheduled appointments with the pain clinic. In particular, Mr C said the board had responded to his complaint saying that there was nothing documented about planned appointments with the pain clinic. However, before receiving the board's response, Mr C said a nurse gave him a written note. The note showed that his medical record had been checked and noted that he was due to attend pain clinic appointments.

We made enquiries with the board but before finalising our investigation, Mr C was freed from prison. We tried contacting Mr C to confirm his new contact details but he did not respond to us. Therefore, we closed his complaint without reaching a finding.

Summary

Mr and Mrs C complained on behalf of their son (Mr A) about care he received on two visits to A&E at Gilbert Bain Hospital. Mr A attended the hospital and was diagnosed with a viral infection. He returned two days later and was again diagnosed with a continuing viral infection. A further three days later, Mr A became very unwell and was admitted to hospital. He was later transferred to a hospital in another board area and diagnosed with osteomyelitis (a bone infection caused by bacteria).

Mr and Mrs C complained that Mr A had not been reasonably assessed and treated. We took independent advice from an adviser in emergency medicine. They said that Mr A was given a thorough and appropriate examination on both occasions. The adviser said the symptoms were consistent with a viral infection and there were no symptoms which indicated further tests should have been carried out. The adviser also noted that osteomyelitis is a very rare condition and one not often seen in children Mr A's age.

Considering the advice we received, we did not uphold this complaint.

Summary

Mr C complained about the care his mother (Mrs A) received from the Scottish Ambulance Service (the ambulance service). Mrs A had a history of vertigo and migraine but she had been recently advised that she had symptoms of having suffered a transient ischaemic attack (TIA, often referred to as a mini-stroke, where blood supply to the brain is interrupted). Mrs A's GP had advised her to stop taking her migraine medication.

When Mrs A collapsed, her husband (Mr A) called for an ambulance. The crew arrived, assessed Mrs A's condition and decided against hospital admission. The crew believed Mrs A had suffered a migraine and advised her to take her medication, despite being informed her GP had told her to stop taking it. Six days after this Mrs A suffered a stroke. She died two days later.

Mr C complained about the ambulance service's decision not to transport Mrs A to hospital. We took independent advice from a medical adviser who is a GP. They said that there was enough evidence to give suspicion that Mrs A had suffered a further TIA and conclude that she required hospital assessment. The adviser also commented on the crew's advice to Mrs A to take her migraine medication. The adviser said this was unreasonable and outside the scope of their expertise. The adviser said that non-prescribers should not advise patients to take medication without medical advice, particularly medication recently stopped by the patient's own GP. We upheld the complaint and made recommendations.

We also identified problems with the way Mr C's complaint was handled. We were not given evidence that the recommendations made by the ambulance service during their own investigation had been carried out. We also noted that when Mr C raised new questions with the contact listed on the ambulance service's final response letter, that person declined to correspond on the complaint further. We did not believe this to be reasonable.

Recommendations

We recommended that the ambulance service:

• apologise to Mr C and his family for the failings identified in this letter;
• provide us with the outcome of their own recommendations;
• review the role of named contacts at the end of complaints letters; and
• remind non-prescribers of their role in advising patients on medication.

Summary

Mr C complained about an ambulance crew that attended his wife (Mrs C). After Mrs C was taken to hospital, she was diagnosed with a ruptured abdominal aortic aneurysm (a weak point in a blood vessel), which was a life-threatening condition. Mr C said the crew did not diagnose his wife's condition or provide treatment for it, and did not regard the situation as an emergency. In addition, Mr C was unhappy with the ambulance service's response to his complaint.

We took independent advice from an adviser who is a consultant in emergency medicine. Although we would not expect the crew to make a definitive diagnosis of an abdominal aneurysm, we found that they should be able to recognise when a patient is seriously unwell. In this case, the crew assumed that Mrs C's symptoms were due to sciatica (back and leg pain caused by irritation or compression of the sciatic nerve) or muscular back pain, and they failed to recognise that she had a life-threatening condition. We upheld this part of Mr C's complaint. Once the crew decided to take Mrs C to hospital they gave her morphine. In this respect, they provided treatment to Mrs C and so we did not uphold this part of Mr C's complaint.

The crew did not use blue lights when taking Mrs C to hospital, which was reasonable as it was the early hours of the morning. However, doing this was another indication that the crew did not recognise Mrs C was seriously unwell, as was their discussion about leaving Mrs C at home for review by her local doctor. We upheld Mr C's complaint that the crew failed to regard the situation as an emergency. In addition, we had concerns about the accuracy of the ambulance service's response to Mr C, and we upheld this aspect of his complaint.

Recommendations

We recommended that the ambulance service:

• apologise to Mr C for the failings identified by our investigation;
• ensure that staff are aware of the signs and symptoms of leaking abdominal aortic aneurysms, including atypical presentations;
• ensure that staff are aware that normal vital signs do not exclude serious and life-threatening medical and surgical conditions;
• ensure that, when making a decision not to transport patients to hospital, their staff document detailed history and examination findings which confirm the diagnosis of a minor illness. Documentation in these circumstances should demonstrate that significant clinical findings, both positive and negative, have been interpreted within the context of the clinical history and inform the clinical outcome;
• ensure that, when making a decision not to transport a patient to hospital, their staff reference which alternative pathway route is being followed; and
• ensure that staff investigating complaints use appropriate reference material, such as clinical textbooks, when considering matters of clinical judgement.

Summary

Mr C complained about the care and treatment of his wife (Mrs C). Mr C was particularly concerned that the clinical notes showed Mrs C had symptoms of a stroke late on the evening of her admission to the Balfour Hospital (and doctors were told about this), but her stroke was not diagnosed until the doctor reviewed her early the next morning. Mr C was concerned that the delay meant that Mrs C was not able to receive thrombolysis treatment (a kind of treatment that can only be used within 4.5 hours after the onset of a stroke), and this may have impacted on her subsequent condition.

The board explained that thrombolysis treatment was not suitable for Mrs C, because it was not clear at the time that Mrs C's condition was due to an acute stroke and in any case the 4.5 hour window for treatment had already passed by the time of admission. The board also explained that doctors are cautious in offering thrombolysis to patients with diabetes (which Mrs C had) because there is a higher risk of complications, and because low blood sugars can sometimes 'mimic' the effect of a stroke.

After taking independent medical advice, we upheld Mr C's complaints. We agreed that thrombolysis would not have been suitable for Mrs C, because there was no clear time of onset for her stroke and by the time her symptoms were clear it was over 4.5 hours from when she was last known to be well. However, we found that staff should have considered the possibility of a stroke when Mrs C was admitted, and this should have been diagnosed that evening when the symptoms became clearer. This would have enabled staff to explain the decision about thrombolysis to Mr and Mrs C at the time, and put in place appropriate monitoring and assessment of her deterioration overnight, as well as better managing her diabetes the next day.

Recommendations

We recommended that the board:

• issue a written apology to Mr C for the delay in diagnosing Mrs C's stroke; and
• ensure that staff involved reflect on Mrs C's care and discuss our findings, with reference to the specific points raised by the adviser.

Summary

Mr C's mother (Ms A) had ingrowing toenails. Following a house call from her GP, she was referred to the board's podiatry service for treatment. Mr C said Ms A was in pain and called the podiatry service. He was told the waiting time could be up to 12 weeks. He was not prepared to wait that long so he paid for the treatment to be done privately. When Mr C complained to the board about the length of time Ms A would have had to wait, the board explained that the GP referral had contained no indication that Ms A was in pain. Had it done so, she would have been seen sooner.

We sought independent advice from a hospital adviser. The adviser considered that, in the absence of any indication of urgency in the GP referral, it was reasonable that the podiatry service deemed the referral to be routine rather than urgent. We accepted the adviser's view and did not uphold the complaint.

Summary

Ms C was booked in at the Western General Hospital for a colonoscopy (examination of the bowel with a camera on a flexible tube). She phoned the board in advance to let them know that, as she required sedation for this procedure, she would need an overnight stay in hospital. However, when she attended, she was told that no beds were available and that she would either need to reschedule or have the procedure using gas and air. Ms C has a history of suffering serious pain during these procedures and her records noted that she would require sedation. As a result of her symptoms, the time since her last colonoscopy and her family history of bowel cancer, Ms C felt that she could not reschedule and agreed to go ahead with the procedure. She found the procedure very painful. Although she was asked a number of times during the procedure whether she would like them to stop, she agreed to it proceeding. She felt that the board had placed her in an impossible situation. She brought her complaint to us.

We considered the evidence available and noted that she had followed the board's guidance for those requiring sedation for colonoscopies. However, we also noted that there are times where procedures have to be cancelled due to a lack of beds. Ms C was advised, when she booked her overnight stay, that this could not be guaranteed and she was given the option of rescheduling. We acknowledged the distress this situation had caused her, but we found that the board's actions were reasonable under the circumstances. Therefore, we did not uphold her complaint.

Summary

Mr C complained that the prison health centre unreasonably failed to prescribe him with appropriate pain medication. We reviewed his clinical records and we took independent advice from a GP adviser. The information available confirmed that Mr C was caught concealing his medication and because of that, the decision was taken to stop his pain medication. However, he was prescribed an alternative and referred to the pain clinic. The adviser said the decision to stop his pain medication was reasonable given that Mr C was caught concealing his medication. The adviser also confirmed that, in their view, Mr C had been prescribed an appropriate alternative medication for his pain.

Mr C also complained that there was an unreasonable delay in the health centre removing an item from his ear. In their response to his complaint, the board said they checked Mr C's records and they could not see anything about him raising concerns about something being stuck in his ear. Following our review of Mr C's record, it appeared that the board's response was incorrect. We noted that a nurse had recorded in Mr C's clinical record that he had approached her about having something stuck in his ear. The nurse also recorded that she successfully removed the item the same day as Mr C reported it to her by flushing his ear. In light of this information, we did not uphold Mr C's complaint, but we did make a recommendation relating to the way the board responded to his complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for failing to respond appropriately to his complaint.