Health

Summary

Mrs C was referred to the Royal Infirmary of Edinburgh for a coronary angiogram and percutaneous coronary intervention (a procedure to examine the coronary arteries, and if narrowing or blockages are found, to stretch these to enable blood to flow properly). Following the procedure, Mrs C had a bleed from her femoral artery (a large artery in the thigh), and it was necessary to carry out emergency surgery to stop this.

Mrs C was concerned there was a lack of due care during the procedure, and said she had been traumatised by the procedure and suffered from flashbacks and memory loss. The board wrote to Mrs C to explain what had happened, and offered to meet with her, but she declined. The board said the bleed Mrs C experienced was a recognised complication of the procedure.

After taking independent medical advice, we did not uphold Mrs C's complaint. We found that staff carried out the procedure reasonably, and the bleed Mrs C suffered was a recognised complication of the procedure, with staff taking reasonable and appropriate action in response to this. However, the adviser noted that staff did not complete the board's pro formas for the procedure, and we were critical of this, so we made a recommendation to the board.

We also noted that the consent documentation showed Mrs C was not keen to read the information about the procedure, and there was no record that this information was given to her verbally or the key risks of the procedure discussed. While we acknowledged that Mrs C also had responsibility to ensure she understood the risks of the procedure before agreeing to it, we found that staff should have offered Mrs C the relevant information verbally (and documented this) before continuing with the procedure, so we also made a recommendation about this.

Recommendations

We recommended that the board:

• take steps to ensure the NHS Lothian pro formas for Diagnostic Cardiac Catheterisation and percutaneous coronary intervention are completed; and
• feed back our findings regarding informed consent to the staff involved.

Summary

Mrs C complained to us that the medical practice had failed to provide appropriate care and treatment to her late husband (Mr C) who died following an overdose. Mrs C said that her family had reported their concerns about Mr C's behaviour and that he should have been referred to the mental health services but the practice did not listen to their concerns.

The practice maintained that, on examination, there was no indication that Mr C suffered from mental health issues or that there was the possibility of a suicide risk.

We took independent advice from a GP. We concluded that as Mr C was showing signs of paranoid ideation (having beliefs that you are being harassed or persecuted, or beliefs involving general suspiciousness about others' motives or intent), verbal aggression, and transient confusion this would warrant a mental health assessment in the first instance with the possibility of referral for a specialist opinion. We also found that the practice should have taken action in view of the concerns voiced by the family. Although there was no evidence that the inactions of the practice directly led to Mr C taking an overdose, we upheld the complaint in light of the failings identified.

Recommendations

We recommended that the practice:

• apologise to Mrs C for the failings identified in this report;
• make contact with the Health Board Clinical Support Group for guidance on training regarding patients with mental health problems; and
• ensure that the GP discusses this case as part of their annual appraisal.

Summary

Mrs C complained of continual abdominal pain and she had a scan. The scan showed a rotation in her gut and, as it was unclear whether or not this was the cause of her pain, it was agreed that she should have a diagnostic laparoscopy (a surgical procedure to access the inside of the stomach and pelvis through a small hole in the skin). This confirmed the mal-rotation but nothing to establish the pain Mrs C was experiencing.

However, Mrs C remained in severe pain after her operation and because of this and the diagnostic uncertainty, the procedure was carried out again but, once more, no new abnormalities were identified. It was concluded that further surgery would be unlikely to help Mrs C but because of her continuing pain she was admitted to a critical care bed for observation. Mrs C later complained that she had not been provided with appropriate medical treatment.

We obtained independent advice from a consultant general surgeon. We found that in view of Mrs C's chronic abdominal pain, all the investigations and procedures carried out were reasonable and that she had been provided with appropriate medical treatment. For this reason, the complaint was not upheld. However, our investigation also showed that there was no record of the reasoning for a second laparoscopy, discussions with Mrs C, or a copy of her consent. There was no evidence that Mrs C had been given an appropriate explanation for what had happened to her. As a consequence, we made recommendations to the board.

Recommendations

We recommended that the board:

• apologise for the shortcomings identified;
• emphasise to the clinical staff concerned the necessity of following good practice by appropriately recording consent and completing records clearly, accurately and legibly; and
• remind clinical staff of the importance of good communication.

Summary

Mrs C complained after her mother (Mrs A) suffered a fall in Hairmyres Hospital. Mrs A suffered from dementia and was unsteady on her feet. Mrs C said the board had not done enough to prevent her mother's fall.

We took independent advice from a nursing adviser. The adviser found that the board had carried out appropriate assessments and were monitoring Mrs A's mobility. The adviser explained that staff had to balance trying to encourage Mrs A to be independent (with a view to getting her home) with the need to ensure her safety. The adviser was satisfied that the board had done all they reasonably could to mitigate the risk of Mrs A having a fall, recognising that they cannot eliminate the possibility altogether. For this reason, we did not uphold the complaint.

Summary

Mr C was admitted to Hairmyres Hospital with symptoms suggestive of vasculitis (inflammation of a blood vessel or vessels). He was prescribed steroids and discharged. He was seen again at a clinic, at which point it was understood that he would be reviewed by a respiratory team three weeks later. A plan was put in place to reduce his steroid dose over this three-week period.

An appointment was also made for a follow-up appointment with his consultant two months later, by which time it was assumed he would have been seen by the respiratory team. However, when he attended he had still not been seen by them, and had remained on steroids. Mr C was re-referred urgently, and an appointment was made. Following this appointment it was advised that the steroids would be cut down, with a view to stopping them altogether.

Mr C subsequently contracted avascular necrosis (AVN - death of bone tissue due to a lack of blood supply) in both hips, which meant he required a total replacement of his right hip. He believed this was caused by his prolonged steroid use.

We took independent advice from a medical adviser who told us that Mr C's steroids were prescribed appropriately and were used for a relatively short period. There was no evidence to suggest that the steroids would have contributed to his AVN and we were satisfied that his dosage was gradually reduced appropriately. Therefore, we did not uphold Mr C's complaint.

Summary

Miss C's father (Mr A) attended the medical practice on two occasions over a four week period with chest and abdominal problems and breathlessness. He also had a phone consultation with the practice about his condition. Whilst waiting for x-ray results, Mr A died suddenly. His post mortem gave his cause of death as cardiac enlargement (an enlarged heart which may not pump blood effectively, resulting in congestive heart failure).

Miss C complained that the practice failed to provide appropriate care and treatment to her father. She raised a number of concerns including that a nurse practitioner and a GP at the practice failed to carry out appropriate assessments and examinations of her father and provide appropriate treatment.

We obtained independent medical advice on Miss C's complaint from a nursing adviser and a GP adviser. The nursing adviser explained that the nurse practitioner's assessment and examinations of Mr A were reasonable and Mr A was provided with appropriate treatment. The GP adviser said that the GP's assessment, care and management of Mr A were reasonable and in accordance with relevant guidelines. The GP adviser said the details recorded in the consultation together with the examination of Mr A were not significantly suggestive of a heart condition as the primary underlying cause of Mr A's condition. They explained that chest infection was a reasonable diagnosis for the GP to have made based on the symptoms and signs presented to them. Therefore, we did not conclude that the practice failed to provide appropriate care and treatment to Mr A.

Summary

Mrs C complained about the care her daughter (Miss A) received at Wishaw General Hospital's A&E department after she injured her knee. Mrs C said that it took several visits to the hospital before a magnetic resonance imaging scan (MRI - a scan which can show injuries to cartilage, ligaments and tendons) was carried out which identified a significant injury to Miss A's knee-cap. Mrs C was also dissatisfied with the orthopaedic department's communication with her in relation to Miss A's surgery.

We took independent advice from a consultant in emergency medicine and a consultant radiologist. We found that the x-ray performed at Miss A's initial presentation to the A&E department was interpreted satisfactorily. In addition, we took into consideration that knee injuries in general can be difficult to initially assess due to pain and swelling, so it was therefore appropriate that staff arranged a follow-up appointment. We did not find that there was any undue delay in carrying out the MRI scan which was arranged when Miss A's injury did not settle.

We concluded that the orthopaedic department should have explained more clearly to Mrs C what the operation entailed. This was acknowledged by the board but not reflected in their response to the complaint which we were critical of. Furthermore, they should have kept Mrs C pro-actively informed about the factors that affected the operation not going ahead on a particular day.

Recommendations

We recommended that the board:

• apologise for failing to respond to Mrs C's concerns about communication issues surrounding the operation and share these findings with relevant staff.

Summary

Mr C, who works for an advocacy agency, complained on behalf of Mr A about the care and treatment provided to him by his psychiatrist. Mr A's community care package initially included him receiving night visits from care staff but these were discontinued due to his non-compliant behaviour. He was subsequently detained in hospital for a period. Mr C complained that Mr A's psychiatrist had not provided him with sufficient support in the community and that this had led to his hospital detention. In particular, he complained that the psychiatrist did not take adequate steps to try to have Mr A's overnight support reinstated. He also complained about the care Mr A received while in hospital and raised concerns that there was not an appropriate care plan in place throughout his admission.

We took independent advice from a psychiatrist who considered that the actions taken by Mr A's psychiatrist were reasonable in the circumstances. The adviser noted that there was disagreement among the wider team regarding how best to manage Mr A's care and that, even if the psychiatrist had done more, there was no guarantee that this would have helped prevent Mr A's hospitalisation. We therefore could not conclude that the psychiatrist unreasonably contributed to Mr A's hospital admission. We were also advised that that there was an adequate care plan in place during Mr A's hospital admission, although it was noted that this was not always successful in engaging him. We did not uphold either aspect of the complaint.

Summary

Ms C, who works for an advice agency, complained on behalf of Ms A about treatment she had received from the medical practice. Ms A has chronic psoriasis (a long-term, recurring skin disease, which causes sore or itchy patches of skin) on her hands and feet. She sought treatment for this at her practice but continued to suffer symptoms. Following a visit from a district nurse, Ms A was referred to a podiatrist (a clinician who diagnoses and treats abnormalities in the lower limbs). Ms C complained about the delay in Ms A being referred to a podiatrist.

We took independent advice from a GP adviser. The adviser said that the practice had made appropriate investigations into Ms A's condition and recommended reasonable treatments. As the psoriasis affected Ms A's hands as well as her feet, they did not believe a referral to a podiatrist was appropriate at that time. For this reason, we did not uphold the complaint.

Summary

Miss C was examined by her current GP and had a contraceptive coil removed. However, at that time, Miss C had thought that all coils had already been removed; therefore, she thought her previous GP had failed to remove a coil.

We looked at the file on Miss C's complaint, at her medical records from her current and previous GPs, and we took independent advice from a GP adviser. We noted the adviser's comments that patients should be aware if they have a coil in place and if it needs to be removed, and that it is a patient's responsibility to tell their GP if they wish to have an existing coil removed. We found that the care provided by Miss C's previous GP in relation to fitting and removing coils was reasonable in the circumstances at the time. Therefore, we did not uphold Miss C's complaint.