Health

Summary

Mr C complained to the board about the care and treatment he received from a prison health centre for on-going back pain. He was unhappy that the doctor had not done enough to manage his pain or deal with the cause of it. The pain relief medication and physiotherapy were not helping, and he wanted another back operation.

We took independent advice from a GP adviser. We found that the doctor had followed Scottish guidance on the management of back pain, and prescribing painkillers and physiotherapy was appropriate given his symptoms. When Mr C reported that his pain was not improving with these measures, the doctor then referred him for surgical review. We concluded that the care and treatment was reasonable.

Summary

Miss C took her young son to A&E at Crosshouse Hospital as he was suffering from breathing problems and chest pain. A doctor arranged for a chest x-ray. He said there was no infection and discharged Miss C's son. Nearly a month later, Miss C's GP contacted her about a letter from the hospital stating that her son's x-ray had been misread. It said that he had pneumonia and required antibiotics. Miss C complained to the board about the delay in being told the x-ray had been misread. She said that her son's health had suffered as a result of this.

The board wrote to Miss C and apologised for the delay in notifying the GP of the x-ray report. While the x-ray had been interpreted initially by a doctor in A&E, this interpretation was incorrect. This was only found when the x-ray was formally reported on some 25 days later. A letter was then sent to the GP with the accurate report. The board offered an unreserved apology for the delay in reporting the x-ray, which was due to a combination of staff vacancies and demand on the service at that time. The board have since obtained additional support in an effort to reduce waiting times for imaging reports. The board said that the doctor who incorrectly interpreted the x-ray would be spoken to about their actions. They also said that the case would be discussed at clinical governance and audit meetings in order that lessons could be learned.

We took independent advice from a medical adviser who is a specialist in emergency medicine. The adviser confirmed that the time taken to formally report the x-ray was unacceptable even if there were staffing issues. We upheld the complaint. As the board had already apologised for the delay and had taken action to prevent a repeat occurrence, no recommendations were made.

Summary

Miss C complained that the board failed to provide appropriate medical treatment when she attended Crosshouse Hospital with a knee injury. At the hospital, she had been reviewed by the on-call doctor for orthopaedics (the medical specialism for conditions involving the musculoskeletal system). The doctor arranged for her to attend a knee clinic three days later. We took independent advice from a medical adviser, who is a consultant orthopaedic surgeon. We found that it had been appropriate to refer Miss C to the knee clinic and that this appointment had been arranged promptly. Consequently, we did not uphold this aspect of Miss C's complaint.

Then, six days after attending the hospital, Miss C had an operation on her knee. Afterwards, she continued to have pain and stiffness in her knee. She was referred to a physiotherapist, and for tests to check if she had a blood clot in a vein. She then saw the orthopaedic surgeon who had carried out the operation. The surgeon was concerned that Miss C might have complex regional pain syndrome (CRPS - an uncommon form of chronic pain, usually affecting a limb and typically developing after an injury, surgery, stroke or heart attack; the pain is out of proportion to the severity of the initial injury). The surgeon prescribed medication and referred Miss C for more physiotherapy. When this failed to improve things, the surgeon decided that Miss C had CRPS and referred her to a pain clinic and for hydrotherapy (the use of water in pain relief and the treatment of disease). However, Miss C decided to attend a private hospital and subsequently had further surgery. She complained to us about the treatment she received from the board in the months after her initial operation.

Based on the advice we received, we found that Miss C's operation was carried out satisfactorily and that her follow-up appointments were timely, appropriate and reasonably managed. We also found that the board had carried out adequate investigations regarding the pain and stiffness in Miss C's knee. Therefore, we did not uphold this aspect of her complaint.

Summary

Mr C complained about the medical care he had received while in prison. This related to the medication he was receiving for an old wound, and he also said that the board failed to provide appropriate follow-up treatment after an operation he had. Mr C also complained that the board failed to provide him with appropriate treatment for his depression, anxiety, post-traumatic stress and for his lack of sleep.

During our investigation, we took independent advice from a medical adviser, who is a GP. The complaint was investigated and showed that the treatment given to Mr C was reasonable and appropriate. The advice we received was that the management of his pain from the old wound was of a reasonable standard, entailed using appropriate evidence-based treatments, and that there was a regular review of his medical condition. In addition, the advice we received was that Mr C received reasonable follow-up care after his operation, and that he was receiving reasonable treatment and assessment of his mental health problems. Finally, we found no evidence that the board failed to provide appropriate treatment for his sleep difficulties.

Summary

Mr C said that his GP had referred him to hospital for a rheumatology appointment but that the rheumatology consultant had rejected the referral as he did not think it would have been of benefit to Mr C. Mr C said he had then been told by a pain management consultant that there was nerve root damage. Mr C had complained to the board. The board's response to Mr C's complaint explained that the initial referral was actioned quickly but there was no indication from the referral letter that Mr C's problems were due to inflammation (which would have triggered a referral to rheumatology). The rheumatology consultant had contacted Mr C's GP at the time and the GP had not advised him that Mr C's condition had changed. Mr C complained to us that the board had failed to adequately respond to his formal complaint.

We took independent advice from one of our advisers who told us that the nerve root damage described was not evidence of inflammation and as such the actions of the rheumatology consultant were appropriate. It was also noted that on receipt of the rheumatology consultant's letter, the GP had recorded that he also did not feel that a rheumatology assessment was appropriate. We found that the board's response to the formal complaint was appropriate and so we did not uphold the complaint.

Summary

Mrs C complained about the care and treatment her husband (Mr C) received at University Hospital Ayr following his admission with acute abdominal pain. In particular, she was aggrieved that a CT scan (computerised tomography - a scan that uses x-rays and a computer to create detailed images of the inside of the body) had not been carried out when he was first admitted to hospital. She complained that the delay in carrying out investigations and treatment had caused Mr C unnecessary suffering for three days.

During our investigation, we took independent advice from a consultant general surgeon. We found that the treatment given to Mr C was reasonable and appropriate. The advice we received was that there had been no delay in diagnosing and starting appropriate treatment, and there was no indication that a CT scan should have been carried out earlier than day three of Mr C's admission. Our adviser was satisfied that the CT scan and subsequent surgery which both took place on day three of Mr C's admission to hospital were carried out within a reasonable timeframe.

Summary

Mrs C complained that her late husband (Mr C)'s GP practice did not properly investigate his underlying heart condition, which was diagnosed at a post-mortem examination. The practice were apologetic about Mr and Mrs C's experience but did not find any failings in the care given to Mr C.

We took independent advice from a medical adviser who is a GP. The adviser said that Mr C's symptoms were not consistent with possible angina (chest pain caused by an inadequate blood supply to the heart) or a heart attack. Therefore, we considered that the assessments, treatment and referrals to specialists were reasonable and appropriate. We did not uphold the complaint.

Summary

Mrs C complained that Crosshouse Hospital did not take appropriate action on the signs and symptoms her late husband (Mr C) presented with at the A&E department on two occasions and at the out-patient ear nose and throat clinic. Mr C died a year later from heart disease.

We took independent advice from two medical advisers, one of whom is a consultant in emergency medicine, and the other a consultant in ear nose and throat conditions. The advice we received was that Mr C's symptoms were not characteristic of an underlying cardiac condition and that the care was reasonable in terms of the examinations, tests and treatment provided, so we did not uphold the complaint.

Summary

Mr C complained the board had wrongly diagnosed his son (child A) with attention deficit hyperactivity disorder (ADHD - a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness) and was concerned about the medication that had been prescribed.

Mr C was also unhappy that he had not been consulted before child A was assessed and diagnosed. He complained that crucial information provided by him had been disregarded by the board’s Child and Adolescent Mental Health Service. Mr C was also concerned that entries concerning him and his family in child A’s medical records, which he disputed, may have impacted upon the diagnosis of ADHD.

We appreciated Mr C’s intention throughout had been to achieve the best outcome for child A. We took independent advice from an adviser who is a consultant psychiatrist in child and adolescent mental health. The adviser said that the assessment of child A appeared to have been comprehensive and balanced, taking account of the information available at the time, and was in line with the relevant national guidance. The adviser considered that the diagnosis of ADHD and the medication prescribed to child A were also appropriate. The adviser could find no evidence that the disputed entries in child A’s medical records about Mr C and his family had influenced the diagnosis. We accepted that advice.

Taking account of all the evidence, we did not find the board had inappropriately diagnosed child A with ADHD and so we did not uphold Mr C’s complaint.

Summary

Mrs C complained that the practice had not contacted her to tell her about the need for blood tests to be repeated. The practice responded to her complaint advising that they held a recording of a phone conversation in which she was told about the need for blood tests to be repeated. They offered Mrs C the chance to hear the recording. Mrs C brought her complaints to us. We received a transcript of the call from the practice, which supported their view. We decided we would not pursue the matter further in those circumstances.