Health

Summary

Ms C complained about the care and treatment she received from University Hospital Crosshouse for what she believed was suspected appendicitis. She said she made frequent visits to the A&E department at the hospital and was also admitted to the hospital, but her condition was not reasonably assessed and treated. She said her condition then deteriorated and spread to her bowel and she had to have part of her large and small bowel removed. Ms C also complained that her complaint about her treatment was not reasonably responded to by the board.

We took independent advice from two advisers, one a consultant in emergency medicine and the other a consultant colorectal surgeon (who specialises in conditions relating to or affecting the colon and rectum). The emergency medicine adviser said that the treatment Ms C received in the A&E department at the hospital was reasonable.

The colorectal surgical adviser said they did not think that there was an unreasonable failure by the board to diagnose Ms C's appendicitis sooner, as the initial clinical signs would not have been very obvious for acute appendicitis. They also said there was a delayed diagnosis of acute appendicitis, but explained that the diagnosis of this is sometimes challenging even to an experienced surgeon and it would have been difficult to know and impossible to determine at what precise moment Ms C actually had acute appendicitis. We therefore did not uphold Ms C's complaint that her condition was not reasonably assessed and treated, but we did make a recommendation based on the advice we received about how the board should have shared the learning points from Ms C's complaints.

In terms of the complaints handling, Ms C indicated in her complaint to the board that she was concerned about the care and treatment she received from the board and her GP. The board did not appear to take any action to assist in progressing Ms C's complaint about her GP, either by contacting Ms C's GP practice or by advising Ms C to do so herself. We, therefore, considered that her complaint was not reasonably responded to by the board and we upheld this part of Ms C's complaint. We also found that at the time of Ms C's complaint, the board did not have a full written complaints procedure in place. They said that they were in the process of compiling a toolkit that would address this, so we made a recommendation about this too.

Recommendations

We recommended that the board:

• take steps to ensure that in future they keep documentary evidence of the remedial action taken as a result of patients' complaints;
• feed back our decision on their handling of Ms C's complaint to the staff involved;
• provide us with a copy of their comprehensive complaints tool kit and evidence that this has now been launched; and
• provide Ms C with a written apology for failing to respond reasonably to her complaint about her GP.

Summary

Mr C complained about the care and treatment that his late wife (Mrs A) had received at University Hospital Crosshouse across a number of admissions. Mr C was concerned that staff were overly focussed on Mrs A's existing conditions and did not pay enough attention to new symptoms that were unconnected to these. Mrs A passed away after she became very unwell with a bleeding duodenal ulcer (an ulcer in part of the bowel, just after the stomach) following a number of admissions to the hospital across four months.

After taking independent advice on this case from a consultant geriatrician, we upheld Mr C's complaint. We found that while many aspects of Mrs A's care had been good, there was a failure to carry out appropriate investigations to determine the cause of her anaemia after this was revealed by blood tests during one of her admissions. We received advice that this meant a potential opportunity to diagnose the ulcer earlier was missed and that this could have led to specific treatment to reduce the risk of this bleeding. We made a number of recommendations to address the issues we identified.

Recommendations

We recommended that the board:

• issue Mr C with a written apology for the failure to take further action to establish the cause of Mrs A's anaemia following a specific admission;
• ensure that this case is included for discussion at the appraisals of the relevant clinicians; and
• discuss this case at an appropriate clinical governance forum.

Summary

Mrs C complained about care and treatment provided to her late father at University Hospital Crosshouse, and about the board's handling of her complaint. During our investigation the board sent a letter to Mrs C that acknowledged and apologised for their failings, and set out an action plan to remedy the failings. We discussed the letter with Mrs C and, as she was satisfied that the board had resolved her complaints, we agreed to close the file on her complaint. In closing the file, we wrote to the board to express our concerns about the time they took to deal with Mrs C's complaint. While we did not make a formal recommendation, we asked them to provide us with evidence relating to their action plan, which they did.

Summary

Ms C complained about the treatment her father (Mr A) received from the practice over a five month period in 2013. Mr A had been diagnosed with bladder cancer in 2012 and attended the practice on a number of occasions complaining of back pain. Ms C did not feel that his condition was taken seriously or that adequate treatment was provided by the practice.

We sought independent medical advice on this case. Whilst we generally found that the practice provided good treatment in line with national guidance during the period in question, we found that the GPs could have been more proactive in arranging specialist investigations when Mr A's pain failed to reduce. Our investigation also highlighted significant concerns about the management of Mr A's pain some months later on the day he died. We were critical of the practice for failing to react to the urgency of the situation when family members contacted them, and for failing to have important palliative care drugs available to alleviate Mr A's pain.

Recommendations

We recommended that the practice:

• apologise to Ms C's family for the failings identified;
• discuss the adviser's concerns with the relevant staff members at their annual appraisals; and
• take steps to ensure that they have an adequate supply of ‘just in case’ drugs available to their palliative care patients.

Summary

Mr C complained that the board failed to take reasonable steps to diagnose and treat his elbow pain after he raised concern at Ayrshire Central Hospital in August 2013. He was unhappy with the time taken to carry out nerve conduction tests at the end of December 2013, which indicated that he had cubital tunnel syndrome (nerve compression). He was not given the results until six weeks later and was then referred for specialist surgical review. Mr C felt that, had his diagnosis been reached sooner and surgery carried out promptly, additional nerve damage would not have occurred.

We took independent advice from two advisers: a physiotherapist and an orthopaedic consultant (a specialist in conditions involving the musculoskeletal system). We noted that the board apologised to Mr C for a delay in Mr C receiving his results and they took reasonable action to carry out a review and make improvements in this respect. However, we identified that when Mr C first presented with his elbow pain, the physiotherapist did not take into account the possibility of nerve compression. In addition, whilst a different physiotherapist noted motor deficit two weeks later, they did not arrange immediate referral to a specialist in accordance with the board's musculoskeletal guidance. Instead, they raised concern in an email to an orthopaedic doctor but did not mention all the relevant symptoms. We also found records indicating that there had been earlier discussion about referring Mr C for nerve conduction tests at the beginning of September 2013 but this was not organised until four weeks later. Whilst we concluded that staff acted unreasonably in not referring Mr C for specialist review from the outset and arranging the tests sooner, there was insufficient evidence to demonstrate that he sustained additional nerve damage.

Recommendations

We recommended that the board:

• apologise to Mr C for the failings identified;
• share the findings with the physiotherapy and orthopaedic staff involved in Mr C's care; and
• consider reviewing their musculoskeletal guidance to ensure that appropriate information is provided on cubital tunnel syndrome as a specific condition.

Summary

Mrs C complained about the gastroenterology care she received from the board. Mrs C was attending an out-patient clinic at University Hospital Ayr and had previously undergone surgery to remove her gallbladder. She continued to experience various problems with her digestion along with skin problems, particularly on her hands. Mrs C complained that there had been too many consultants involved in her care and that there had been a lack of continuity in her care. Mrs C also complained that the board had not coordinated her care appropriately and that they unreasonably failed to reach a diagnosis of her condition.

During our investigation, we took independent advice from a consultant gastroenterologist. We found that the board had acknowledged there were a number of gastroenterologists involved in Mrs C's care due to retirement and sick leave and they had apologised for this. However, the advice we received was that for patients with chronic conditions like Mrs C, the use of short term locum consultants should be avoided. We found that this had affected the continuity of Mrs C's care and resulted in a potentially avoidable referral to another NHS board. We upheld Mrs C's complaints regarding the number of consultants involved and the lack of continuity in her gastroenterology care.

The adviser considered that there was evidence of good coordination of Mrs C's care with referrals to other specialties being followed up promptly by a single consultant and consequently we did not uphold that element of her complaint. We also did not uphold Mrs C's complaint about a lack of definitive diagnosis. The advice we received was that the board had carried out numerous investigations to try to determine the cause of Mrs C's continuing symptoms and that reasonable steps were taken in attempts to reach a definitive diagnosis. The adviser highlighted two blood tests that could be carried out for completeness but overall, the board's action on diagnosis was considered to be reasonable.

Recommendations

We recommended that the board:

• ensure that all relevant staff are made aware of the adviser's comments on locum consultations for patients with chronic conditions; and
• ensure that Mrs C's consultant is made aware of the adviser's comments on additional blood tests that could be carried out for completeness.

Summary

Mr C complained about the care and treatment of his late wife (Mrs C) during several admissions to Western Isles Hospital, following a fall. Mr C said they were initially told there were no breaks or fractures, but he found out over a week later that in fact Mrs C had several rib fractures. He then found out several weeks after this that Mrs C also had a fractured vertebra. Mr C complained about the delay in diagnosing the fractures, and raised concerns about the overall medical and nursing care. He also said staff told him he would be refunded for his expenses when he accompanied Mrs C to a hospital on the mainland, but the board later refused to reimburse him.

The board explained that Mrs C was very ill, with a severe chest infection and a number of medical conditions. They said the rib fractures appeared to be old, and would not have changed her treatment. They also said Mr C was not eligible to be reimbursed for his expenses under their travel policy (and they had updated their information leaflet to make this clearer). The board agreed that some aspects of Mrs C's care could have been better, in particular management of her diabetes, and they took actions to improve this.

After taking independent medical and nursing advice, we upheld two of Mr C's complaints. We were not critical that staff did not identify Mrs C's fractures on the original x-rays, but we were concerned that there was a delay in the reporting of scans, which meant that staff were unaware of Mrs C's fractures for some time. We also found that staff failed to investigate a new symptom of pain when Mrs C returned to hospital a few days after her fall. Finally, we found there was evidence that nursing staff thought Mr C was eligible for reimbursement under the travel policy (so it was likely they gave him inaccurate information about this).

Recommendations

We recommended that the board:

• feedback our findings to the staff involved for reflection and learning;
• review their process for reporting on x-rays to ensure reports are completed within a reasonable timeframe;
• ensure relevant staff discuss the radiology adviser's comments on the scan at a discrepancy meeting;
• apologise to Mr C for the failings our investigation identified; and
• remind staff that the travel policy does not apply in relation to patients transferred by ambulance, or patients transferred between treatment centres.

Summary

A GP was called to Mrs A's home when she was experiencing breathing difficulties. The GP examined Mrs A and prescribed medication. Two days later Mrs A was admitted to hospital with respiratory failure. Mrs A subsequently complained to the practice about the care and treatment she received at the home visit. The practice explained the reasons why the GP had made his decisions and indicated that they considered that these had been reasonable. Mrs A remained dissatisfied and Mrs C, who works for an advice agency, complained to us on behalf of Mrs A. Specifically, Mrs A wanted to see if there was a preventable delay in her care.

We took independent advice from a GP adviser. The adviser reviewed the medical records for the home visit and considered that the symptoms and signs recorded were consistent with the diagnosis made, which was an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). The adviser told us that the GP had identified this appropriately and treated Mrs A in line with the National Institute for Health and Care Excellence (NICE) guidance relevant to COPD in Scotland.

Overall, the adviser was satisfied that the practice's care and treatment of Mrs A was reasonable. We agreed with this advice, and did not uphold the complaint.

Summary

Mr C complained about the care and treatment of his mother (Mrs A), who was admitted to Perth Royal Infirmary following some falls, and then transferred to Murray Royal Hospital for assessment. Mrs A remained in Murray Royal Hospital for about three months, although she was transferred back to Perth Royal Infirmary on several occasions.

During Mrs A's time at Murray Royal Hospital, Mr C made allegations of abuse by nursing staff, and he complained that the board did not investigate this properly. Mr C also raised concerns about Mrs A's nursing and medical care at Murray Royal Hospital. These included concerns about her falls and physical safety, the numerous transfers between hospitals, the delay in replacing Mrs A's dentures, Mrs A's medications, and the decisions to detain Mrs A under the Mental Health Act and to use covert medication. Mr C also said the board failed to reimburse him for items lost during Mrs A's admission.

The board apologised to Mr C for the time taken to replace Mrs A's dentures and for the lost items. They arranged several reviews of Mrs A's care in response to Mr C's complaint, but found her care was satisfactory.

After taking independent advice from a mental health adviser and an adviser who is a consultant in general medicine, we upheld two of Mr C's complaints. We found there had been some failings in nursing care, including inadequate care planning (particularly in relation to falls risk) and inadequate nutrition monitoring. We also found the board failed to agree a clear communication plan with Mr C. However, we found that Mrs A's medical care was reasonable, and the decisions to detain Mrs A and use covert medication were made appropriately and in line with relevant guidance. We also found that, although the board had not yet reimbursed Mr C for all the missing items, they had handled his claim reasonably.

Recommendations

We recommended that the board:

• apologise to Mr C for the overall failings our investigation found;
• feed back the findings of our investigation regarding falls prevention, care planning and nutrition monitoring to the staff involved for reflection and learning;
• take steps to ensure individualised care planning is used to proactively identify and address patients' comprehensive care needs;
• review the use of communication plans for relatives and carers at Murray Royal Hospital; and
• review staff training needs in relation to falls prevention planning and responding to a fall (particularly where there is a suspected fracture).

Summary

Mrs C's husband (Mr C) was admitted to Perth Royal Infirmary and treated for pneumonia. His condition did not improve whilst in hospital and he died seven days after being admitted.

Mrs C raised a number of specific complaints about the medical and nursing treatment her husband received at the hospital. In particular, she felt that his medication was not managed appropriately and that she was left to take care of many of his basic personal care needs.

We took independent advice from two advisers, one a consultant geriatrician and the other a nurse. Whilst we were critical of the board for failing to ensure Mr C's teeth were cleaned regularly and for initially denying Mrs C access to the ward outside of normal visiting times, we were generally satisfied that the medical and nursing care was of a good standard.