Health

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.

Summary

Mrs C, an advocacy worker, submitted a complaint on behalf of her client (Ms A) regarding the care and treatment received by Ms A's late brother (Mr A) from his medical practice. Ms A complained about the time taken for the practice to diagnose her brother's cancer and about a failure to involve her in his care and listen to her concerns about his deteriorating condition. Mr A had a history of mental and physical health problems and had been diagnosed with renal cancer several months after being discharged from hospital, where he had been an in-patient for over 15 years. After being diagnosed with cancer, Mr A died the following month.

We took independent medical advice from a GP. The adviser did not consider that there were any unreasonable delays in investigating Mr A's symptoms and referring him to a hospital specialist. They noted that the practice took reasonable steps to try to have hospital investigations happen sooner and remained alert to the potential need for hospital admission. The adviser observed that Mr A had capacity and was entitled to decline investigation, as he did on occasion. However, they considered that the relevant investigations were carried out and that additional assessments, at the times these were declined, would not have changed Mr A's diagnosis or treatment plan. They also considered that, from the available evidence, Mr A's care appeared to have been appropriately discussed with Ms A and her concerns taken into account. We accepted the advice received and did not uphold the complaints.

Summary

Mrs C, an advocacy worker, submitted a complaint on behalf of Ms A regarding the care and treatment received by her late brother (Mr A). Mr A had a history of mental and physical health problems and was an in-patient in the Royal Edinburgh Hospital for more than 15 years. He was discharged into supported accommodation. Daily support was provided by a voluntary sector organisation and his psychiatric care was overseen by the board's community rehabilitation team (CRT). Mr A's physical health deteriorated following discharge and he was diagnosed with renal cancer around five months later. Mr A died the following month. Ms A complained about the time taken to diagnose her brother's cancer and about a failure to involve her in his care and listen to her concerns about his deteriorating condition.

We obtained independent advice from a mental health professional. They noted that the primary responsibility for monitoring Mr A's health following his discharge lay with his GP practice. However, they noted that the CRT had a role in liaising with the GP practice and monitoring Mr A's engagement with them. The adviser considered that the discharge plan lacked clarity surrounding these roles and responsibilities and lacked focus on Mr A's physical health, despite his history of physical health problems and known difficulties engaging with healthcare providers. The plan did not set out a schedule for visits from Mr A's key worker and the adviser observed that there were long gaps between visits, despite Mr A's carers contacting the CRT to raise concerns about his wellbeing.

The adviser also considered that the discharge plan should have set out strategies for involving Ms A in her brother's care and observed that the key worker did not contact Ms A directly until five months after discharge. In light of the advice received, we concluded that the CRT could have been more proactive in overseeing Mr A's care following discharge and in engaging with his family. Arrangements for doing so should have been set out in the discharge plan and we considered that closer monitoring of Mr A's physical health and evident deterioration might have resulted in medical assessments being requested earlier. We therefore upheld the complaints. We could not say that closer monitoring would have led to an earlier diagnosis or altered the outcome for Mr A but we noted that it could have allayed some of the family's distress. We obtained additional independent advice from a GP who noted that, when Mr A was referred for investigation of his deteriorating condition, he was thoroughly assessed and managed appropriately.

Recommendations

We recommended that the board:

• ask relevant staff to reflect on the failings highlighted in this investigation and advise us of identified actions to improve future discharge planning, with a specific focus on monitoring physical health and engaging with family/carers; and
• apologise to Ms A and her family for the identified failure to monitor Mr A more closely following his discharge from hospital.

Summary

Mr C and his father (Mr A) complained about the care and treatment provided to Mr A in relation to an operation to fit a pacemaker. They were unhappy about treatment Mr A received at the Royal Infirmary of Edinburgh when the pacemaker was fitted and said that there was inadequate information about possible complications of the surgery and incorrect treatment during the surgery. They also complained about the response and aftercare following surgery when Mr A reported his levels of pain and concerns. They said that as a result of the failures, Mr A's quality of life had been adversely affected and that he had to undergo another operation to repair the incorrectly positioned pacemaker.

We took independent advice from a medical adviser. We found that there was no evidence that sufficient information was given to Mr A about the procedure and possible complications or that staff took account of his additional needs (given his anxiety and loss of hearing). We also found that while there were problems with the pacemaker that had to be rectified, this does not mean that it was incorrectly implanted in the first place. Having said that, we were critical that staff failed to address Mr A's anxiety or ensure he was adequately sedated which may have contributed to an increased likelihood of lung puncture during the procedure. Moreover, while we found that clinical staff dealt with Mr A's concerns technically following the operation, staff failed to address his anxiety which may have exacerbated his symptoms. We therefore upheld the complaint and made a number of recommendations.

Recommendations

We recommended that the board:

• review their procedures around consent and ensure that the process accommodates patients with additional needs;
• bring the failures related to consent and additional needs to the attention of relevant staff;
• bring the failures related to managing anxiety during the surgical procedure to the attention of relevant staff;
• ensure relevant staff consider referral to rehabilitation in similar circumstances; and
• apologise to Mr A for the failures this investigation identified.

Summary

Mr C complained on behalf of his daughter (Ms C) about the treatment that her mother (Mrs A) received at the Royal Infirmary of Edinburgh. Mrs A was admitted to A&E suffering with back pain, vomiting and palpitations. It was considered that she may have had a kidney infection with systematic septic response (a potentially life-threatening condition triggered by an infection). Mrs A was treated with antibiotics and fluids before being admitted to the acute medical unit where she was assessed. It was then decided to withhold the antibiotics until the source of the infection had been identified. Mrs A was admitted to a ward the following morning and test results showed that she was suffering from a urinary tract infection which was then treated. Mrs A's condition deteriorated and she had to be admitted to intensive care. As Mrs A's liver was failing, a transplant was organised. However, she remained very ill following this and later developed a perforation in her bowel. Mrs A died in hospital as a result of her illness.

Mr C asked us to investigate his concerns about Mrs A's treatment, particularly the prescription of antibiotics during the initial stages. Mr C was also concerned about record-keeping and communication with the family during Mrs A's time in hospital. After taking independent advice on this case from a consultant in general medicine, we upheld Mr C's complaint about medical treatment. We found that there had been a delay in the initial administration of antibiotics in the A&E department. Our adviser said that it would have been reasonable to continue to treat Mrs A with antibiotics while awaiting test results to determine the source of the infection. Our adviser found that the board had not followed their sepsis protocol as, in addition to the issues around administration of antibiotics, blood cultures were not taken until two days after Mrs A's admission to the hospital. We found that other aspects of Mrs A's treatment were reasonable. We did not uphold the second part of Mr C's complaint as we found no evidence that the communication with family members was unreasonable.

Recommendations

We recommended that the board:

• apologise to Mr C and Ms C for the failures identified in the initial management of Mrs A's condition;
• ensure that this case is included for discussion at the next appraisals of the doctors who made the antibiotic prescription decisions; and
• ensure that staff at the acute medical unit are reminded of the need to maintain accurate contemporary records.

Summary

Ms C complained on behalf of her son (Mr A) about the treatment he had received from his dentist. Mr A had x-rays taken of his teeth and an area of decay was identified in a tooth. The dentist considered that this required a filling and carried out the treatment at a later appointment. Mr A experienced some pain following the filling and returned to have this assessed on two occasions. He then continued his treatment at a different dental practice. Ms C complained to the dentist about the size and shape of the filling. She also questioned why no attempt had been made to protect the nerve before proceeding with the filling, and commented on attempts to treat Mr A's pain with the use of toothpaste for sensitive teeth.

In the response from the practice, the dentist advised that the tooth had been lined before it was filled and that at no time had the nerve been exposed. The dentist considered the size and shape of the filling to be reasonable and in proportion to the decay. As a goodwill gesture, a refund was offered for the cost of the NHS treatment Mr A had received.

After taking independent advice on this case from a dental adviser, we did not uphold Ms C's complaint. We found that the treatment that had been provided to Mr A represented reasonable practice. Our adviser agreed that the filling was of a reasonable size and shape. They also considered that steps had been taken to protect the nerve and that while toothpaste for sensitive teeth may have had minimal effect, it would not have worsened the situation.

Summary

Miss C said that although she had been attending her GP since January 2013, he failed to take her concerns and symptoms seriously. She said that it was not until she attended the surgery with her partner in August 2014 that she was referred to a hospital consultant. She was then diagnosed with a brain tumour.

The complaint was investigated and we took independent advice from a medical adviser who is a GP. We found that early in 2013, Miss C's optician had written to her GP asking him to arrange for her to see an ophthalmologist (a doctor who specialises in diseases and injuries in and around the eye). He did so and Miss C attended the ophthalmology clinic. She remained in ophthalmology care until her discharge four months later. After that, Miss C saw her GP twice, both times for shoulder complaints. It was not until she attended her GP in August 2014 complaining of previously unrecorded symptoms that the possibility of a brain tumour was suspected and then diagnosed following her referral to hospital. We found no evidence of delay or a failure to treat appropriately.

Taking all of this into account, whilst recognising the challenges Miss C has had to face, we did not uphold the complaint.

Summary

Mrs C complained about the care and treatment received by her late husband (Mr C) while he was a patient at Raigmore Hospital. Mr C underwent surgery to treat colon cancer but he continued to experience health problems and had a number of readmissions over the course of the following months. Around five months after surgery, investigations showed a recurrence of Mr C's cancer. He was admitted to a hospice for palliative care and died two months later. Mrs C raised concerns about the steps taken to investigate her husband's ongoing symptoms and pain following the surgery. She also complained about a lack of planned follow-up action, including the omission of a referral to oncology.

We obtained independent advice from a consultant colorectal and general surgeon, who considered that the investigations undertaken during Mr C's admissions were reasonable and consistent with applicable guidance. The adviser noted that it was unfortunate that the investigations did not detect the recurrence of Mr C's cancer earlier but did not consider that this was due to a failing on the part of the board. We accepted this advice and did not uphold this complaint.

In relation to the decision not to refer Mr C to oncology following his surgery, the board indicated that the multi-disciplinary team had not felt that he would be fit enough to undergo chemotherapy. They noted that this was discussed with Mr C at the time but this discussion was not recorded in the clinical records. They acknowledged that it might have been useful for Mr C and his family to have met an oncologist to discuss the risks and benefits of chemotherapy and they apologised that this was not arranged. While accepting that Mr C was unlikely to have been fit enough for chemotherapy within the relevant time period, the adviser agreed that the opportunity to speak to an oncologist should have been considered. The adviser was critical of the board's failure to record their discussion with Mr C and noted that this was not consistent with the General Medical Council (GMC)'s guidelines on record-keeping. In the circumstances, we upheld this complaint.

Recommendations

We recommended that the board:

• reflect on the record-keeping failure highlighted in this case and take steps to ensure staff adhere to the relevant GMC guidelines in this area.

Summary

Mrs C, who is an advocacy worker, complained on behalf of her client (Mrs B). Mrs B said that her mother (Mrs A) was left without proper care and support from her local medical practice. She said that they failed to recognise the seriousness of Mrs A's condition and she died as a consequence.

We took independent advice from a medical adviser who is a GP. We found that Mrs A had very complex medical problems. She had severe artery disease and had already had a leg amputated above the knee. She also had severe heart disease. Mrs A was being cared for in the community. When the practice were alerted to the fact that she had a small necrotic area (a patch of dead tissue) on her leg stump which had been there for three to four weeks, a GP assessed Mrs A at home and decided that she be reviewed urgently. A day later, the practice were advised that the affected area was deteriorating. Contact was attempted with both Mrs A and the warden of her accommodation but this proved impossible as neither answered the phone. A home visit was then arranged for the next day. Meanwhile, Mrs A was taken into hospital where she died a few days later. We did not uphold the complaint as we were satisfied that the practice had taken all reasonable action in the circumstances.

Summary

Mrs C complained on behalf of her mother (Mrs A). Mrs A had been diagnosed late with Hodgkin lymphoma (a type of cancer of the lymphatic system, a network of vessels and glands throughout the body). Mrs C believed that the practice had failed to spot clear symptoms of the disease over an extended period.

We took independent advice from a medical adviser who is a GP. The adviser reviewed Mrs A's medical records in detail. They noted that some of the tests Mrs C believed should have been performed could only be requested by a specialist following review in hospital. The adviser stated that Mrs A had not presented with typical symptoms of Hodgkin lymphoma and her existing medical conditions had made her diagnosis more complex. Mrs A had not met the criteria for referral under Scottish cancer referral guidelines and had been referred urgently for investigation by the practice on several occasions.

We found that the practice had provided a reasonable standard of care and treatment to Mrs A. We found there was no evidence that symptoms of Hodgkin lymphoma had been overlooked, or that referrals should have been made sooner.