Health

Summary

Mrs C raised a number of issues about the care and treatment her late husband (Mr C) received during admissions to Ninewells Hospital and Royal Victoria Hospital.

During our investigation, we took independent advice from a consultant geriatrician and a nursing adviser. We found no evidence that the clinical and nursing care was unreasonable. In particular, the consultant geriatrician noted that Mr C had been suffering from several conditions and had required significant medication to try and control his symptoms, and we found that there had been a number of discussions with Mrs C about her husband's condition. The consultant geriatrician was satisfied that the medication given to Mr C was always appropriately considered, prescribed and administered. While some of the medication caused side effects, the consultant geriatrician was satisfied that the board tried to avoid this medication as much as possible and that the side effects were unavoidable.

The nursing adviser was satisfied that Mr C had been regularly assessed and care was planned for his mobility problems. We were satisfied that the care planning and assessment charts and nursing notes confirmed that Mr C's needs were fully assessed and managed. We did not uphold Mrs C's complaints.

Summary

Mr C complained about the care and treatment provided by a physiotherapist during his recovery from surgery performed on his hand. Mr C complained that the physiotherapist provided inadequate exercise advice at an appointment, in particular by encouraging him to perform intensive exercise on the hand, which led his wound to open. Mr C considered this advice led to ongoing pain in his hand and its reduced function.

The board said there was no evidence that advice had been given to perform intensive exercise. The board said advice was provided to perform gentle exercise, which was appropriate, and there was no link between the physiotherapy care and treatment provided and the subsequent problems Mr C experienced in his hand.

After receiving independent advice from a consultant physiotherapist, we did not uphold Mr C's complaint. We found there was no evidence that the board provided inappropriate advice, rather the records indicated the physiotherapy advice was reasonable given Mr C's circumstances.

Summary

Mr C complained to us that the medical practice failed to provide him with appropriate clinical treatment when he turned up for a consultation and was in need of medical attention. He was also told that he had been removed from the practice list of patients and he complained that they did not provide an explanation for this.

The practice explained that when Mr C attended the practice there was no indication that he required medical treatment and that he did not mention this to the staff who saw him. They also explained that the reasons he had been removed from the practice patient list were that he had previously intimated he was leaving the country and they had received a medication enquiry from another medical practice outwith Scotland. Further, they explained that contact was made to Mr C's registered address and staff were informed he was no longer resident there, and that he had failed to attend a pre-arranged consultation.

We took independent advice from an adviser in general practice medicine and concluded that if there was no indication that a patient required immediate medical attention then there was no requirement for a GP to see a patient immediately. In addition, as the practice had confirmed that Mr C was no longer at the address stated then it would be reasonable for them to remove him from the practice patient list. The clinical records substantiated the explanations provide by the practice. We did not uphold the complaints.

Summary

Mr C complained that his prison's medical health centre unreasonably stopped his medication. However, before we could reach a decision on his complaint, he was released from prison and gave us no forwarding address. We therefore closed his complaint without making a decision.

Summary

Mr C's father (Mr A) was diagnosed with stomach cancer and died five months later. Mr C complained that the medical practice should have investigated his father's symptoms sooner as an earlier scan may have allowed some level of preventative treatment. We took independent advice from a medical adviser who is a GP. We found that until he was under the care of hospital specialists, Mr A had not reported or exhibited symptoms of more serious underlying disease which would have suggested urgent referral in accordance with national guidelines for the investigation of cancer. The adviser therefore considered that there was no evidence from Mr A's medical records that the practice failed to identify or act on any concerning symptoms, so we did not uphold Mr C's complaint.

Summary

Mrs C contacted the practice about appointments for her sons. She was unhappy with the way in which the practice handled her contact. She felt that the practice manager had breached confidentiality by referring to a previous conversation she had had with a GP at the practice about one son when she was calling about her other son. She also felt that the practice had not acted correctly in relation to allegations that she was abusive and that she was told to go elsewhere. She was also unhappy that they had noted on her medical records that she was more interested in her sons' rights than taking them to review appointments.

Following consideration of Mrs C's complaint to the practice and to us, the practice's response to her complaints as well as the information the practice provided to us following our enquiry (which included records of the conversations Mrs C had had with the practice), we did not uphold Mrs C's complaints. We felt it was reasonable for the practice manager to refer to previous conversations between Mrs C and the practice in so far as it related to her own actions and behaviour, rather than the specific medical conditions of her sons. The notes of the conversations did not indicate that Mrs C was abusive, rather that she was upset and excessively angry. Given the circumstances, we considered that the practice's handling of Mrs C's contact, which was to put a note on her record that any future issues are fed back to the practice manager, was a reasonable way to proactively manage internally any potential issues with future contact. There was no record in the practice's notes of the conversation that Mrs C was told to go elsewhere and the practice and Mrs C had differing recollections of what was said. It was not possible, therefore, for us to determine exactly what was said. Although we understood that Mrs C was unhappy about what was written in the record about not taking her sons to review appointments, we considered that the practice's explanation that this was an accurate reflection of the discussion and beneficial to have recorded for any future contact, was reasonable.

Summary

Mr C complained about the length of time he had to wait for surgery for prostate cancer and said that the board did not provide treatment in line with the national waiting time targets. We took independent advice from a medical adviser. We found that the GP referral for Mr C was acted on promptly by the board's urology service and the time taken to reach a diagnosis of prostate cancer was reasonable taking into account the complexity of Mr C's case. However, after the decision was reached to proceed with surgical treatment for Mr C's cancer there was a lack of co-ordination in gathering all the information and beginning treatment which meant the waiting time target was not met. Although we found that the delay was unlikely to have affected the long-term outcome, the delay and lack of information provided would have added to the uncertainty and anxiety for Mr C at what would have been a very difficult time for him. We concluded that the overall care he received was not of an acceptable standard and led to an avoidable delay.

Recommendations

We recommended that the board:

• apologise to Mr C for the failings identified; and
• review the circumstances regarding Mr C's case to ensure that, in future cases, care is appropriately co-ordinated with adequate information given to the patient and taking into account appropriate waiting time targets.

Summary

Mr C complained on behalf of his partner (Miss A) about the delay in her parathyroid surgery (surgery to remove glands next to the thyroid which secrete a hormone that regulates calcium levels in a person's body), and the board's communication with them about this. Mr C said the consultant physician at the endocrine clinic at the Royal Infirmary of Edinburgh who first dealt with Miss A's case told them the surgery would take place within approximately ten weeks of their initial appointment. Mr C said he attended appointments with Miss A (who is profoundly deaf) about her care and communicated with the board on her behalf about the delay in her surgery.

We obtained independent medical advice on the complaint from a consultant in general medicine. The adviser said there was an avoidable delay in the consultant physician at the endocrine clinic arranging Miss A's referral to the consultant surgeon who was to perform her operation. The adviser also said that once the referral was made, there was an avoidable delay in Miss A's surgical review with the consultant surgeon taking place and these delays resulted in an avoidable delay in Miss A's surgery. Mr C and the consultant physician gave differing accounts of what was said about when the surgery would take place. In the absence of supporting evidence from any independent witnesses, it was not possible for us to conclude what was said at the consultation.

The adviser said the board had a responsibility for keeping records of communications with patients and, on balance, they considered that the board should have been able to provide a clear record of the communication with Mr C on Miss A's case. As they could not, the adviser said the communication by the board was unreasonable.

Recommendations

We recommended that the board:

• feed back our decisions on both complaints to the staff involved;
• take steps to ensure that, in future, staff record emails and phone calls made by patients or their representatives in the patients' electronic records; and
• provide Mr C and Miss A with a written apology for the failings identified in both complaints.

Summary

Mrs C sustained nerve damage following dental treatment she received in 2014. She also complained that the dentist failed to respond to the Edinburgh Dental Institute (EDI)'s request for further information after she was referred there for further review.

We sought independent advice from a general dental practitioner. We considered that the symptoms Mrs C experienced in October 2014 were consistent with accidental injection of sodium hypochlorite (a solution used to clean out the root canal) through the end of the root of her tooth. This is a rare but recognised complication of the treatment and is not in itself evidence of unreasonable care. We also considered that prior to 2015, it was a risk which would not normally have been discussed with patients before treatment. We did, however, identify the likelihood that the dentist had not used a rubber dam (a device used to isolate the root canal and protect a patient's airway) and concluded that this was unreasonable practice even though it would not have prevented the nerve damage caused. We upheld this part of Mrs C's complaint. We found no evidence to demonstrate that the dentist had not responded to any requests for information from the EDI and we did not uphold this part of Mrs C's complaint.

Recommendations

We recommended that the dentist:

• apologise to Mrs C for the failure to use a rubber dam; and
• takes steps to ensure the use of a rubber dam.

Summary

Mr C complained to us about the care and treatment his son (Mr A) received when he was admitted to the Royal Edinburgh Hospital under a short-term detention certificate under the Mental Health Act. Mr A has severe autism, learning disabilities and epilepsy. We took independent advice on Mr C's complaint from a mental health adviser and a consultant physician.

With regard to Mr A's physical health, we found that the action taken in relation to Mr A's bowel problems was reasonable. The medication given to him was also appropriate. However, staff had failed to medically review Mr A on the day he was admitted to hospital and there was no evidence that a structured nursing needs assessment was carried out in the days following his admission. In addition, there was a significant delay in obtaining a full psychology and occupational therapy assessment for him. In view of these failings, we upheld this aspect of Mr C's complaint.

Mr C also complained that staff in the hospital had failed to provide his son with appropriate care needs. We found that the records in relation to whether Mr A's family had been asked to leave when he was admitted and whether the family had initially been asked not to visit were inadequate. We also considered that more could have been done to explore potential options for safely personalising Mr A's room. In addition, a structured nursing assessment had not been carried out on one of the wards Mr A was in and there was no personal hygiene/grooming care plan for that ward. There was also a delay in referring Mr A to advocacy services. In view of all of these failings, we also upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the board:

• issue a written apology to Mr C for the failings identified; and
• provide detailed evidence that steps have been taken to prevent the failings identified from occurring in other cases.