Health

Summary

Mr C's daughter (Ms A) was admitted to Ninewells Hospital three times with severe abdominal pain and swelling accompanied by nausea. Investigations and tests were negative. Mr C complained that Ms A was discharged from hospital unreasonably, and that doctors failed to reach a diagnosis, which led to a great deal of anxiety for Ms A and her family. As a result, Mr C said that Ms A’s health deteriorated.

We took independent advice from a medical adviser who is a specialist in gastroenterology (medicine of the digestive system and its disorders). We found that the board properly investigated Ms A's symptoms, and that the decision to discharge her on each occasion was reasonable because no abnormalities were found. The adviser said that a diagnosis had been reached by doctors. However, we found that this was not clearly relayed to Ms A so we understood Mr C's position that doctors had failed to reach a diagnosis. We therefore made a recommendation to put this right.

Recommendations

We recommended that the board:

• bring the adviser’s comments about functional disorders to the attention of relevant staff; and
• offer to meet with Ms A to fully explain the reasons for the referral to a chronic pain team.

Summary

Ms C, an advice worker, complained on behalf of Miss A, who had had surgery to her jaw at Ninewells Hospital. Following this surgery, Miss A had been diagnosed with a serious injury to her neck, which had required a second operation to correct. Ms C suggested that the first operation had been inappropriate and that Miss A's injury had taken too long to diagnose.

We received independent advice from a consultant maxillofacial (mouth, jaws, face and neck) surgeon and a consultant orthopaedic (concerning the musculoskeletal system) surgeon. The advice said that the injury was extremely rare and that it was not clear when the injury had occurred, although it was highly probable that it occurred during the operation. There were no signs before the surgery that Miss A was at risk of suffering this type of injury and the operation was the appropriate one for her condition. The advice said that the time taken to diagnose the injury was reasonable in the circumstances.

We found that Miss A had suffered a very rare complication. Although this was highly unfortunate and understandably traumatic, it did not mean that the treatment she had received was unreasonable.

Summary

Mrs C and her husband were participants in an egg-sharing programme (as donor) in the Assisted Conception Unit at Ninewells Hospital. As part of the programme, after fertility treatment, Mrs C retained some of her eggs and some were donated to a recipient. Mrs C complained that the care and treatment given to her was unreasonable, and that staff were primarily concerned with the recipient. She said that communication with the staff was also unacceptable, and that she was given information despite saying that she did not want it. She believed she had been looked down upon.

We obtained independent advice from a consultant obstetrician and gynaecologist (a doctor specialising in pregnancy, childbirth and the female genital tract) who was a reproductive medicine specialist. We found that all of Mrs C's treatment had been conducted in terms of the Human Fertilisation and Embryology Act code of practice. While there had been a slight delay in providing part of the treatment, this had been because the recipient's and Mrs C's menstrual cycles had to be synchronised. The delay was unavoidable. Similarly, the code of practice had been followed with regard to communication with Mrs C, but it seemed that she had not fully understood. We noted that the board had since made changes to prevent a similar occurrence. Mrs C's complaint was not upheld.

Recommendations

We recommended that the board:

• apologise for the delay in responding to the formal complaint.

Summary

Mrs C complained to us on behalf of Mrs A, in relation to an incident of potential contamination due to the use of unclean equipment. Mrs A attended Dundee Dental Hospital for treatment, and during the course of her treatment a microscope was put close to her mouth. She could see dirty marks on the microscope which looked like dried blood. After her treatment she raised concerns with staff. One nurse immediately wiped the microscope. Mrs A said that she was told it would be sent for analysis. Later that day staff contacted Mrs A to provide further information and advice.

Following Mrs A’s complaint to the board, they took further steps to investigate the situation, and identified failures in the board’s cleaning protocols, which were rectified.

We took independent advice from one of our nursing advisers, which indicated that, while it was not appropriate for dirty equipment to be in use, the board had identified gaps in their protocols and had made appropriate changes. She also considered that the information and advice provided to Mrs A and her husband were reasonable. The adviser was also satisfied that appropriate action was taken in cleaning the equipment, and did not express concerns that the wipe used to clean it had not been analysed.

We concluded that Mrs A was understandably upset by what had happened. However, we found that it had been appropriate to clean the equipment as soon as possible, and not taking a sample for analysis was in line with national policy. We also considered that the information and advice Mrs A was given were appropriate. We found that the board’s response to the complaints made and the action taken were reasonable.

Summary

Mr C complained about the way in which his pain relief medication was handled by the prison health centre. Mr C has osteoporosis (a condition causing weakness of the bones) and had been prescribed tramadol (a strong opioid painkiller). He was unhappy that there was little discussion or information about why it was being stopped. He was also unhappy that the board failed to provide relevant information in their response to his complaint.

We took independent advice from a medical adviser who is a GP. We found that, when reviewing Mr C's medication, the health centre acted in line with Scottish national guidelines on the management of chronic pain and on prescribing. Tramadol was not the only type of painkiller that could be used to treat Mr C's pain, and there is a lack of evidence for the long-term use of opioids for chronic pain. We considered it reasonable that the health centre tried alternative painkillers on the basis that further review took place.

We concluded that reasonable attempts were made by the health centre, and in the board's complaint response, to explain why the medication was being reduced and then stopped.

Summary

Mr C has had contact with mental health services in the board area since 1997, and his complaint concerned the care and treatment he received from 2004 until 2014. Mr C said it was clear he had suffered from post-traumatic stress disorder throughout his contact with mental health services during this period, but that the board failed to diagnose him with this or provide appropriate treatment, such as trauma-focussed cognitive behavioural therapy (CBT). Mr C complained this meant that he was unable to return to work and effectively 'lost' ten years of his life.

We took independent advice from one of our medical advisers who specialises in psychiatry. We found that the action taken by each mental health practitioner following contact was reasonable, and there had been no indication that trauma-focussed CBT should have been preferred to the treatment given.

Summary

Mrs C complained to us on behalf of her late mother (Mrs A) about the care and treatment she received in the Royal Victoria Hospital during the last three months of her life. Mrs A had fallen while in hospital. Over subsequent weeks her mobility deteriorated and she complained about pain in her hip. Mrs A was referred for a psychiatric review and then a pain assessment that highlighted concerns about her condition. She was referred for an x-ray, which identified a fractured hip. Mrs C complained that this should have been identified earlier, and that staff did not do enough to adequately manage Mrs A’s pain. She said that if the hip pain had been appropriately investigated, Mrs A would have had better pain control in the final weeks of her life.

We sought independent advice from a nursing adviser and an adviser in elderly medicine. The nursing adviser highlighted significant concerns about the assessment and monitoring of Mrs A’s pain. They were also critical that nurses made negative remarks about Mrs A’s behaviour, without noting that the behaviour was a result of her pain.

The adviser in elderly medicine found that doctors had appropriately assessed Mrs A after her falls. They noted that Mrs A had complex care needs, and her pain had a number of sources. However, they were critical that when Mrs A started to complain of pain in her hip about a month after her last fall, this was not further investigated. They said that if the fracture had been identified then, Mrs A could have received better pain management in the weeks before she died.

We were critical that the nursing staff did not do enough to appropriately assess Mrs A’s pain as her condition deteriorated. This made it more difficult for doctors to assess her. However, medical staff also failed to identify significant signs of a potential hip fracture for several weeks, and this left Mrs A with poor pain management for longer than necessary.

Recommendations

We recommended that the board:

• undertake an independent nursing review of pain monitoring and assessment by nursing staff in the relevant wards;
• highlight the findings of this investigation with the staff involved, particularly in relation to the impact of an earlier x-ray and subsequent complaints handling; and
• apologise to Mrs C for the failures in Mrs A's care and treatment identified in our investigation, and for her time and effort in pursuing this complaint.

Summary

Mr C complained that the board provided him with unreasonable dental care and treatment. He also said that they delayed in dealing with his dental problems that developed as a result.

We took independent advice from a dental surgeon. We found that, although one of Mr C's teeth had to be removed shortly after it had been treated, an initial examination and x-ray before treatment had confirmed that it was deeply decayed. Mr C wanted to retain his tooth and so the decay had been removed and his tooth had been filled. The tooth did not settle and Mr C then asked for it to be removed. Mr C subsequently asked the board to provide him with an implant or a bridge, but these options were not available to him, mainly because his teeth were severely compromised by gum disease. We did not uphold his complaint.

Summary

Ms C complained on behalf of her father (Mr A) about a delay in transferring him home from hospital. Ms C complained that the ambulance service had not taken reasonable steps to ensure they could transfer Mr A home.

The transfer was booked by staff on the hospital ward. They advised the ambulance service that, if there were any steps at Mr A's home, they believed Mr A would be able to move from a stretcher to a wheelchair. When the crew arrived, they found that Mr A would not be able to do this and they cancelled the transfer.

We found this was a reasonable decision to have made, ensuring the safety of both the patient and the crew. Therefore, we did not uphold the complaint.

Summary

Mr C complained about the care and treatment of his late wife (Mrs C) during an ambulance visit and, in particular, the decision not to take Mrs C to hospital. Mrs C had been recently admitted to hospital. Two days after discharge, Mr C became concerned about Mrs C’s symptoms and called 999. An ambulance crew attended and gave Mrs C oxygen treatment and advice about fluid intake. However, the paramedic decided not to take Mrs C to hospital immediately.

Mr C said the decision to leave Mrs C at home was made because the paramedic could not get through to the duty doctor for permission to bring her to hospital. He said Mrs C’s hospital admission later that day was arranged by a community nurse who visited shortly afterwards and raised concerns about Mrs C’s condition with the duty doctor. The ambulance service disagreed with this account. They said the paramedic spoke to the duty doctor and agreed that it would be appropriate to leave Mrs C at home to allow time for Mrs C’s recent insulin injection, and the advice about fluid intake, to take effect. The ambulance service said the paramedic arranged for an unscheduled care nurse to visit in four hours to check whether Mrs C had improved, and this was what prompted Mrs C’s admission later that day.

After taking independent advice from a paramedic adviser, we did not uphold Mr C’s complaint. There was evidence that the paramedic did call the duty doctor to discuss Mrs C’s condition and to arrange review. The adviser considered that, in these circumstances, the decision to leave Mrs C at home was reasonable.